Jérémie Vandevoorde

Dynamique de l'idéation et des comportements préparatoires dans le passage à l'acte suicidaire: vers une méthodologie qualitative standardisée

Suicidal risk factors are nowadays well known. We often detect many of these risk factors in clinical situations, but their interaction and their writing in the suicidal sequence are still largely unrecognized. Building on narratives from suicidal patients, the authors propose a method for investigating the upstream components of suicide in an attempt to understand how the risk factors and the state of the person interact and converge on the suicidal action better. The interview is divided into the following four sections. (1)The patient is invited to mentally go back to the hours immediately preceding the suicide attempts and reconstruct the sequence of thoughts, feelings and doings of the day. Here, we explore the dynamic progression of his cognitions, emotions, actions and state of consciousness. We also note the social affective context of the suicidal act. (2) Proceeding backwards into the memory, the patient is invited to retrieve all foreshadowing elements, situating them on two axes: behavioural planning, that is, effective or contemplated actions in relation to suicide (stocking drugs, seeking information about substance toxicity, weapon training, etc.). (3) The second axis focuses on the phenomenology of the suicidal ideation, that is, intensity, frequency, proximity/availability of suicidal ideation, etc. These are assessed by means of an analogical rule. Finally, the current attempt is situated in the context of the suicidal history of the patient: previous attempts, severity, operative mode, etc. Our clinical experience using this semi-structured interview has shown that the method gives an insight into the unique combination of factors leading to the suicidal act in a given person and permits to understand and foresee relapses better. A new model of suicide is emerging from our data, suggesting the importance of the preparatory phase, which combines a progressive non-conscious learning of the gestures to accomplish, rumination of suicidal ideations and alteration of consciousness and the sense of self. The method is illustrated through an example. The necessity to further test this interview method is called for.

Évaluation de l’activité suicidaire aux urgences psychiatriques : un entretien d’exploration (SE-EC) et sa grille de report (ASA)

The epidemiological literature shows that the population going through general or psychiatric emergencies indicates a high suicide risk. Suicide is classified as an avoidable mortality by the WHO. Therefore, suicidal potential must be assessed at different stages of hospitalization: when the patient comes to the emergency, during hospitalization, after hospitalization in the context of prevention and regularly monitoring. The authors present a simple approach to the investigation of suicidal activity through a semi-structured clinical interview and propose a fast and convenient grid report, experienced at psychiatric emergencies. A real and concrete case illustrates the method whereas are reminded the suicide warning signs and indices of increase about risk of acting out at the hospital.

Mise au pointPsychiatrieÉvaluation de l’activité suicidaire aux urgences psychiatriques : un entretien d’exploration (SE-EC) et sa grille de report (ASA)The suicide assessment in the psychiatric emergencies: A semi-structured interview

The epidemiological literature shows that the population going through general or psychiatric emergencies indicates a high suicide risk. Suicide is classified as an avoidable mortality by the WHO. Therefore, suicidal potential must be assessed at different stages of hospitalization: when the patient comes to the emergency, during hospitalization, after hospitalization in the context of prevention and regularly monitoring. The authors present a simple approach to the investigation of suicidal activity through a semi-structured clinical interview and propose a fast and convenient grid report, experienced at psychiatric emergencies. A real and concrete case illustrates the method whereas are reminded the suicide warning signs and indices of increase about risk of acting out at the hospital.