Questions have been raised concerning electrodermal hyporeactivity and suicide risk detection

• Question #1.
  How can a behaviour like suicide with such numerous and complex underlying factors be reduced to practically only one?

Reply to Question #1.
There are other examples of reduction of the suicide to single factors:

– Irrespective of the underlying factors, if there is no method available for committing suicide, the suicide will not be committed.

– Irrespective of the underlying factors, if an occasion for committing suicide is lacking, there will not be a suicide.

– Similarly, irrespective of the underlying factors, if the psychological capability for killing oneself is lacking, there will most probably not be a suicide.

• Question #2.
  When a depressed patient also happens to be electrodermally hyporeactive, how likely is it that the patient will commit suicide?

Reply to Question #2.
The method for detecting electrodermal hyporeactivity can absolutely not be used for predicting suicide. The method possesses an extraordinary sharp ability to detect those depressed patients who are capable to commit suicide. Then, it is the skill and experience of the staff of health care unit that influences the risk of suicide.

• Question #3.
  If we know that a patient is capable to commit suicide according to the test and that capability may persist for years, then we do not dare to allow a temporary leave or a discharge. This force us to keep the patient at the ward for years. Better not to know, isn’t it?

Reply to Question #3.

There are several arguments against this statement and question. Here are three:

– The capability may be fatal as long as reasons to die dominate. To determine that, is a matter of experience and skill of the special psychiatrist in charge. For example, imagine a patient who during a couple of months have suffered from a severe depression with suicide risk, who suddenly lets the doctor know that she feels much better and she at last is not thinking of taking her life, and wants to get a leave over the weekend for coming home for celebrating her father’s birthday, and before that visit her hair dresser to look fine. Everybody become relieved and happy that at last the patient shows signs of recovery. The patient is allowed to take a leave, and she goes directly to hang herself. If it was known that this patient was capable of taking her life according to the EDOR test, the doctor in charge would wait a week or two before a leave to confirm what she is reporting. The benefit of the test is to warn and to call on suicide preventive measures for this patient, particularly. The possible extra time at the ward can make the difference between life or death.

– There exists another factor that is known to be related to suicide risk and that is maintained not only during years, but for the rest of the life: A previously performed suicide attempt with death intent. Is repeatedly shown to be strongest related to the occurrence of future suicide among clinical signs and a sign that is one of the most important indications that are considered in the suicide risk assessment. As far as known, the knowledge of the occurrence of that sign has not resulted into unmanageable numbers of patients at the ward.

– In which other medical disciplines does one refrain from applying a simple diagnostic method that can give information of fatal complications in a disorder?

• Question #4.
  If we got to know that a patient is electrodermally hyporeactive, what shall we do?

Reply to Question #4.

There is of course much we can do.

– Today it is mainly patient administrative and organizational measures that can be taken. We have a strong indication that this patient requires special attention to the development of her depressive and suicidal processes and maybe also individual suicide preventive measures for hindering a suicide attempt. It is of highest value to as early as possible find out which type of antidepressant treatment that suits this patient.

– The spontaneous recovery seems to be extended over 1 to several years In the near future, we will most probably be aware of today available and future means for curing the dysfunctional factor. Knowledge is growing fast within this area.

• Question #5.
  When a patient gets a positive test result, which information can I give?
  Isn’t it dangerous to tell a patient that she has a capability to take her life?

Reply to Question #5.
In clinical use at an open care clinic for general psychiatry, Redakliniken AB, Linköping, Sweden, the test was positively accepted by the staff and by the patients, even by those who got a positive test result. A frequent comment was that the patient felt that she perceived being more carefully investigated and taken care of than usual. The message of a positive test result was in some cases given together with offers of for example specific care or intervention. Any open negative reaction has not been reported. It can be imagined that the patient herself and her relatives may feel a considerable relief of feelings of guilt when it is understood that a suicide attempt was made possible because of a biological dysfunction, and that when this is known, the patient will get special care.