Decision Rule - SAD PERSONS Score

SAD PERSONS Score:

-Sex = male [0 points/1 point]
-Age <19 or >45 years [0 points/1 point]
-Depressed symptoms [0 points/2 points]

-Past psychiatric history or suicide attempts [0 points/1 point]
-ETOH/drug use history [0 points/1 point]
-Rational thought loss [0 points/2 points]
-Separated, divorced or widowed or sickness with 3 or more prescription medications [0 points/1 point]
-Organized plan or serious attempt [0 points/2 points]
-No social support [0 points/1 point]
-Stated intent (or ambivalence) [0 points/2 points]

Note: This score was originally developed by Hockberger and Rothstein at the Harbor-UCLA Medical Center in 1988, as a scoring tool to predict the need for hospitalization in individuals at risk for suicide. After analysis of 119 patients, Hockberger and Rothsetin identified a score ≥ 6 as having a sensitivity of 94% and a specificity of 71% for predicting the need for psychiatry directed hospitalization (P<0.001).

This should not be used as your sole justification in determining someone does or doesn't need to be admitted.  This is most useful as a way of remembering suicidal risk factors, and for making a case in documentation for admission.  It is especially helpful for newer students and residents to remember and organize the questions they will ask as part of medical clearance of a suicidal patient.  It is included as a "Decision Rule" for ease of organizing it as a template on this site, even though it does not perfectly fit that description.

http://www.emdocs.net/emergency-department-tips-tricks-managing-suicidal-patient/

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MDM - Suicidal Ideations (Admit)

[##]-year-old [male/female] with [depression/suicidal ideations] with history and exam consistent with likely [presumptive diagnosis].

Initial consideration in this patient included major depressive disorder, adjustment disorder, suicide attempt (intentional overdose and self-injury amongst others), alcohol or other substance related mood disorders, and organic causes of altered mental status among others.

Patient presented to the ED [due to concerns over suicidal thoughts/after police were called due to suicidal comments/after his coworkers/supervisor noted suicidal comments].  On initial exam the patient was noted to be hemodynamically stable [with/without] evidence of intoxication.  Patient noted to have [no] evidence of [likely] self-injury [specify].  Labs [were/were not] ordered [and unremarkable as noted above/notable for elevated ethanol level without other evidence of overdose, illicit drugs or significant toxins].  The patient expressed [passive suicidal ideations/no suicidal ideations] in the ED [with/without] plan [specify].

Patient medically cleared based on history, exam, and workup as noted above with no evidence of significant medical instability or medical condition causing or contributing to psychiatric condition at this time.  The patient was considered to be [moderate/high] risk for suicide based on consideration of risk factors, including [access to a firearm/suicidal plan involving lethal means/poor access to outpatient care or social support/unwillingness to safety contract in the ED/a SAD PERSONS score of ## points consistent with high risk]. 

Patient was evaluated by [mental health provider name] who agreed with need for admission.  Concerns for safety and plan for admission were discussed with the patient, who is [voluntary/involuntary] with plan for admission at this time.

http://www.emdocs.net/medical-clearance-of-psychiatric-patients-pearls-pitfalls/
https://edsmartchart.blogspot.com/2020/06/physical-exam-psychiatric-mental-status.html
https://edsmartchart.blogspot.com/2020/06/decision-rule-sad-persons-score.html