Depressed and Suicidal Patients in the Emergency Department: An Evidence-Based Approach (Behavioral Health CME)

Depressed and Suicidal Patients in the Emergency Department: An Evidence-Based Approach (Behavioral Health CME) is organized by EB Medicine.

Date of Original Release: May 1, 2019. 
Date of most recent review: April 10, 2019.
Termination date: May 1, 2022.
CME Expiration Date: May 31, 2022.

Target Audience: This enduring material is designed for emergency medicine physicians, physician assistants, nurse practitioners, and residents.

CME Credits: 
4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 05/01/2022.

Specialty CME Credits: 
Included as part of the 4 credits, this CME activity is eligible for 4 Behavioral Health CME credits, subject to your state and institutional approval.

Goals: Upon completion of this activity, you should be able to: (1) demonstrate medical decision-making based on the strongest clinical evidence; (2) cost-effectively diagnose and treat the most critical presentations; and (3) describe the most common medicolegal pitfalls for each topic covered.

About This Issue:
Though there is growing evidence that shows that ED patients present with high rates of depression and suicidal ideation, there are some novel strategies that emergency clinicians can use to quickly identify patients most at risk:

• What are the DSM-5 symptoms for major depressive disorder (MDD)?
• Is it necessary to diagnose MDD in the ED?
• What are the differences between suicidal thoughts, ideation, gestures, and plans? How can you tell?
• Are all suicidal patients “depressed?”
• When is it appropriate to ask a patient whether they’ve been thinking about suicide?
• What are the uses and validation evidence for PHQ-9, ED-SAFE PSS-3, C-SSRS, SAFE-T, ICARE2?
• What are the 7 things that emergency clinicians are recommended to do when assessing patients with exacerbating psychiatric complaints?
vLethal-means counseling, no-suicide contracts, safety planning, zero suicide: what works, and how are they administered?
• Do intoxicated patients need to sober up before evaluating them for suicidality?
• What is the status of using inhaled ketamine (esketamine) in the ED?

Objectives:
 Upon completion of this article, you should be able to:
• Identify the key signs and symptoms of major depressive disorder and its variants
• Identify risk factors in depression and suicide in patients presenting in the ED
Assess for suicide risk in the ED
• Explain the rationale for inpatient versus outpatient management of depression and depression with suicidal ideation.