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Sudden Improvement Among High-Risk Suicidal Patients: Should It Be Trusted?

Dr. Simon is clinical professor of psychiatry and director of the Program in Psychiatry and Law, Georgetown University School of Medicine. Send correspondence to him at 8008 Horseshoe Ln., Potomac, MD 20854 (e-mail: risimonmd{at}aol.com). Dr. Gutheil is with Beth Israel Deaconess Medical Center and the Department of Psychiatry, Harvard Medical School, Boston.

There is a long-standing belief that patients with depression and suicidal tendencies are particularly vulnerable to suicide when their depression shows signs of improvement. The authors discuss the clinical challenges of distinguishing real from feigned signs of recovery. Whereas genuine clinical improvement is a process, sudden patient improvement is a suspect event. The authors discuss clinical indicators that distinguish the two. They emphasize the importance of gathering corroborating evidence through communications with staff and the patient's family. Suicide risk assessment is necessary throughout the patient's illness and recovery.

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