急诊精神病学中的自杀和自残行为：弥合风险评估和临床决策
Suicidal and self-harm behaviors in emergency psychiatry: bridging risk assessment and clinical decision-making.
摘要(中文译文)
自杀行为与非自杀性自伤（NSSI）是精神科急诊环境中的主要临床挑战。尽管对危险因素已有大量研究，自杀行为的预测与管理仍然复杂，常需要在不确定条件下快速决策。为急诊环境中自杀与自伤行为的评估和管理提供一个实用、以临床为基础的框架，整合当前证据与真实世界临床实践。本叙述性综述结合精神科急诊照护的临床经验，综合文献中的关键发现。核心领域包括概念定义、自伤的功能、自杀风险评估及急性管理策略。自伤行为常具有多种个体内和人际间功能，包括情绪调节、抗解离机制和危机沟通。自杀风险评估应超越静态危险因素模型，纳入意图、计划、矛盾心理和保护性因素（包括活下去的理由）等动态要素。在急诊环境中，管理应优先考虑治疗性参与、情绪确认和协作决策。区分急性风险与慢性风险对于恰当处置至关重要，包括住院与门诊管理。在急诊情境中有效管理自杀与自伤行为需要一种整合的、以患者为中心的方法，将结构化评估与临床判断相结合。强调治疗联盟和个体化照护计划可能改善结局，超越传统风险分层模型。
Abstract
Suicidal behavior and non-suicidal self-injury (NSSI) represent major clinical challenges in psychiatric emergency settings. Despite extensive research on risk factors, the prediction and management of suicidal behavior remain complex, often requiring rapid decision-making under conditions of uncertainty. To provide a practical, clinically grounded framework for the assessment and management of suicidal and self-harm behaviors in emergency settings, integrating current evidence with real-world clinical practice. This narrative review synthesizes key findings from the literature alongside clinical experience in psychiatric emergency care. Core domains include conceptual definitions, functions of self-harm, suicide risk assessment, and acute management strategies. Self-harm behaviors frequently serve multiple intrapersonal and interpersonal functions, including emotional regulation, anti-dissociative mechanisms, and crisis communication. Suicide risk assessment should move beyond static risk factor models and incorporate dynamic elements such as intent, planning, ambivalence, and protective factors, including reasons for living. In emergency settings, management should prioritize therapeutic engagement, emotional validation, and collaborative decision-making. The distinction between acute and chronic risk is critical for appropriate disposition, including hospitalization versus outpatient management. Effective management of suicidal and self-harm behaviors in emergency contexts requires an integrative, patient-centered approach that combines structured assessment with clinical judgment. Emphasis on therapeutic alliance and individualized care planning may improve outcomes beyond traditional risk stratification models.
如何引用
AMA
Íñigo Alberdi-Páramo, Irene Rodrigo-Holgado, Marina Díaz-Marsá. Suicidal and self-harm behaviors in emergency psychiatry: bridging risk assessment and clinical decision-making.. Frontiers in psychiatry. 2026; doi:10.3389/fpsyt.2026.1843176.
APA
Íñigo Alberdi-Páramo, Irene Rodrigo-Holgado, Marina Díaz-Marsá (2026). Suicidal and self-harm behaviors in emergency psychiatry: bridging risk assessment and clinical decision-making.. Frontiers in psychiatry. https://doi.org/10.3389/fpsyt.2026.1843176
GB/T 7714
Íñigo Alberdi-Páramo, Irene Rodrigo-Holgado, Marina Díaz-Marsá. Suicidal and self-harm behaviors in emergency psychiatry: bridging risk assessment and clinical decision-making.[J]. Frontiers in psychiatry, 2026 doi:10.3389/fpsyt.2026.1843176.
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