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and treated. Continued use of the tools can be used as measures to track a patient’s response to pharmacotherapy and psychotherapy.37

Assessment of suicidal ideation is critical. A healthcare professional may ask the following questions:

  • “Have you thought of suicide?” or “Have you thought about killing


  • “Do you think you will?”

  • “Have you thought about it or have a plan?”

If any of the above questions are answered with a positive response, the healthcare professional should ask the individual to promise not to harm him/herself. At that time, clinical support must be obtained as well as placement in the least restrictive environment necessary to keep the suicidal individual safe. The hospital may not be the only safe disposition if there is family/friend support in the home. The psychiatrist or psychologist must assess the placement even if it is in the home, as well as what course of action to follow. The plan may consist of multiple outpatient visits per week with medication intervention. Keeping in mind that some medications take some time until they reduce clinical pathology, safety of the individual is paramount. Adherence to the medication is also critical with constant checks of the pill counts, observed administration of the medication and/or a safety plan.

Diagnosis is communicated to hospitals, clinics, and insurance companies by a five axis diagnostic code. This code is found by the comparison of criteria following evaluation in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM, published by the American Psychiatric Association, is a handbook that lists different categories of mental disorders with criteria for diagnosing them. It does not address the method of the evaluation or treatment. The DSM is used less frequently by health professionals who do not specialize in mental health.

Summary of Key Points about Major Depression, Bipolar Disorder, and Dysthymia

To summarize the major points made about Major Depression, Bipolar Disorder, and Dysthymia, each is discussed on pages 18-19. For detailed diagnostic information and further criteria, consult the DSM-IV or the Surgeon General’s report at http://www.surgeongeneral.gov/library/mentalhealth/ chapter4/sec3.html




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