10/13 Suicide - Jones Flashcards
suicide
intentional self-destruction
one of five modes of death
- natural, accidental, suicide, homicide, unknown
components of suicide
- what contributes?
biological
- low csf 5-HIAA (metabolite of serotonin)
- genetic component?
suggested: victims of childhood abuse often commit suicide
- child abuse may change the way the brain processes cortisol
psychological
social
- social learning theory model - possibility that someone can learn suicide as a coping mechanism
survivors of suicide
each suicide leads to major life disruption for at least 18 surviving others
suicide survivors are at increased risk for suicide
why is suicide assessment important in physicians’ professional lives?
errors of omission
- failure to assess depression, substance abuse, agitation, HOPELESSNESS
- failure to assess suicide risk
- failure to consult
- failure to intervene
- failure to document
errors of commission
- lethal supplies of medicine
what makes suicide assessment an art?
ambivalence : have to determine which side of suicide people are on through your assessment
Myth 1
people who talk about suicide don’t really commit suicide
75-80% of those who commit suicide have given repeated warning signs, often talking about suicide
all statements about suicide must be taken seriously until fully evaluated
Myth 2
alsking a person who isnt suicidal will put the idea into his/her head
there is minimal risk of introducing the idea to a non-suicidal person
openly asking about suicide may be life-saving
suicide progress
demographic risk factors
clinical risk factors
individual risk factors
HAZARD: something the individual encounters that upsets their equilibrium
psychology/warning signs
suicidal ideation
method/choice
intent
action
death by suicide
when to employ suicide assessment
- evaluating every new patient
- after a suicide attempt (no matter how trivial)
- when a person speaks of suicide
- in presence of negative/dysphoric affect and increased energy
- when you think someone is depressed/HOPELESS
elements of suicide assessment
interviewing individual and collateral sources about:
- demographic risk factors
- clinical risk factors
- individual risk factors
- psychological state
- presence of warning signs
- suicide ideation, method, intent, actions
special focus on short-term, dynamic risks that might be reversible with treatment
pay attn to your own internal thought and feeling states (“listen with third ear”
demographic risk factors for suicide
male
gay, lesbian, bisexual, trangender
anything but married (single, divorced, separated, widowed)
- unmarried male at 3.8x risk, female 2.8x risk
adolescent (15-24) or geriatric (65+)
living alone and/or socially isolated
Caucasian, Native American
occupation: physician, dentist, police officer, lawyer
unemployment
clinical risk factor for suicide
CHRONIC PAIN (physical or emotional)
chronic illness
terminal illness
LOSS of physical fx (incl neuro disorder)
HIV/AIDS
dialysis, dependency issues
and of course, comorbidity
individual risk factors
history of prior attempts
- consider when (first/recent), chances of dying (objective vs subjective)/rescue, planned vs impulsive, intent (warning vs attempt to conceal)
family history of suicide spectrum, physical/sexual abuse, drug abuse
“contagion effect”
importance of perceived loss
HAZARD (3 weeks or so)
CRISIS resulting → how upset is the person?
usual COPING MECHANISMS?
any SIGNIFICANT OTHERS?
psychology of suicide
DEPRESSED/desperate
anhedonia
anxious/agitated
angry/hostile
isolated/withdrawn
guilt/shame
dysphoric mood with agitation
HOPELESS, Helpless, Hapless
suicide warning signs
HOPELESSNESS
talking about suicide, death, no reason to live
withdrawal and social isolation
recent/threatened severe (perceived) LOSS
making final arrangements
prior suicide attempt
risk-taking behavior
incr use of drugs/alcohol
unwilling to “connect” with potential helpers
