Long-term treatment of chronically suicidal patients.

Chronically suicidal persons with chronic psychiatric disorders (dysthymia, recurrent depression, alcoholism/addiction, schizophrenia, personality disorders) challenge the experience and resourcefulness of psychiatrists. The author reviews his 30 years of experience with these patients and makes six recommendations for long-term treatment: (1) a team approach using consultants and ancillary therapists, (2) flexible therapeutic plans combining medication with psychotherapy, (3) care in monitoring transference and countertransference, (4) brief hospitalization at turning points in the patient's life or in the treatment, (5) decisions based on risk-benefit evaluation, and (6) appropriate record keeping. He also summarizes effective treatment approaches with patients who have chronic psychiatric disorders.