104 - Suicide Flashcards
Antidote to heroin
Naloxone
How common are psychiatric disorders in the general population
21% prevenlance
Definition of prevelance
How much disease is present in the population
Definition of Incidence
How many new cases of disease occur over a given time
Most common psychiatric disorders
Anxiety disorders
Hierarchy of psychiatric disorders
Organic Bipolar Schizophrenic Depression Anxiety disorder
Why is the order of the hierarchy of psychiatric disorders important?
Disorders higher on the list may include symptoms of disorders further down
4s ‘D’s’ of organic disorders
Dementia - global cognitive deficit
Delirium - acute disorientation
Drugs - Impact/withdrawal - prescribed/recreational
Disease - Psych symptoms of physical disease
What is bipolar disorder?
Periods of hyper and hypomania as well as depression
Symptoms of bipolar disorder
Elated mood, irritability, overspending, pressure of speech, flight of ideas, increased energy, lack of sleep, delusions of grandeur, mood convergent hallucinations
What is pressure of speech
Thinking faster than can talk
What is mood convergent hallucinations
Mood appropriate hallucinations
Treatment for bipolar disorder
Acute - Antipsychotics/Benzodiazepines
Maintenance - Mood stabilisers and anticonvulsants
Genetic contributions to major psychiatric disorders
Strong genetic component to schizophrenia
Some genetic component to bipolar disorder
Less genetic component to depression
Environmental factors also important
Bipolar disorder - Aetiology
1% prevalence, M/F equally affected, onset gradually in 20’s
Risk in patients who attempt suicide
15% repeat in 1yr
1% die - 100x increase in risk of suicide.
Risk assessment for suicide after self harm. Need to consider
Characteristics of self harm
Characteristics of person
Characteristics of situation
What is Anorexia?
Pts restrict food intake and compulsively overexercise. BMI
Psych disorder with highest death rate
Anorexia
Symptoms of anorexia
Depression, Weight loss, amenorrhoea, fear of weight gain, distorted body image.
Affects 10x F than M, onset in adolescence.
Treatment of anorexia
Depends on age. Controlled weight gain + CBT (adults) or family therapy (adolescents)
Impact of anorexia on depression
Patients may be depressed as anorexia affects serotonin levels. As gains weight, depressions should improve.
What is bulimia?
Intense cravings for food - overeat and then purge to prevent weight gain. Preoccupation with weight.
Treatment for Bulimia
High dose SSRIs and CBT
3 core symptoms of depression
Low mood
Anhedonia
Decreased energy
Clinical depression if
Low mood and anhedonia present for >2 weeks
Becks Cognitive triad is
Pessimistic thoughts about
Self
World
Future
Depressions associated with
Socioeconomic deprivation and genetic component. 2x F as M affected.
How is severity of depression determined
Number of symptoms, severity of symptoms and impact on patients day to day life.
Treatment depends on
Severity of depression
Can be managed in primary care
Treatment of mild depression
Lifestyle changes, exercise, counselling, monitoring
Treatment of moderate-severe depression
CBT, antidepressants, Electroconvulsive therapy
Reoccurrence of depression
50% (higher if severe depression) - will be more severe if reoccurs
What do drug treatments for depression try to do and why?
Aim to increase serotonin production as levels of serotonin and noradrenaline are low in depression
What is a first rank symptom of schizophrenia
A symptom that suggests schizophrenia if it is present in the absence of a disorder higher up the hierarchy of psychiatric disorders. Patients may not have any of these symptoms but can still have depression.
What are the first rank symptoms of schizophrenia
A - Auditory hallucinations in 3rd person
B - Broadcasting - think others can hear thoughts
C - Control, delusions of - think someone else is controlling their actions
D - Delusional perception - perceives things have a special meaning for just them
E - Echo - Think thought spoken aloud just after they say them
Diagnostic criterial for schizophrenia -
1st rank symptom or persistant delusion present for >1 month in absence of drug intoxication/withdrawal, brain disease or prominent affective symptoms
Treatment of schizophrenia
Antipsychotics (dopamine blockers), modified CBT, rehab family interventions
Effect of increase in [dopamine]
Parkinsons medications act to increase dopamine and an overdose of these medications can cause schizophrenia like symptoms. Likely induced by the increased dopamine levels.
Suicide attempt risk factors
Social isolation Social class Spring peak - no known reason Prison or involvement with police 25% known to mental health services 2/3 expressed suicidal ideas 1/3 left note
Assessment of patients after self harm - consider
Immediate risk of suicide
Subsequent risk of suicide
Current medical/social problems
Suicide attempts with high risk of death if:
Premeditated Precautions to avoid detection Attempted in isolation Timed to minimise discovery Final acts in anticipation Suicide note Violent methods Patient thought irreversible/lethal methods used Patient wanted to kill themselves Regrets survival No attempt to seek help Multiple previous attempts with intent to die Stated they wanted to die prior to attempt
What is self harm?
Intentionally self poisoning or self injury, irrespective of motivation or suicidal intent
Why is cutting more associated with suicide than overdose as self harm?
Developing capacity for self harm - getting past instincts not to hurt self
Antibiotics not suitable for use when taking Warfarin
Erythromycin - do not give. Inhibits warfarin metabolism and can lead to overdose.
Avoid macrolides.
Problems with morphine/codeine use in elderly
Can overdose more easily - need to be cautious - cardiac arrest - check for pinpoint pupils/change in BP
First thing to do in suspected poisoning
Poison promotes vomiting - PROTECT AIRWAY
Poisoning - Need to consider
Contamination - protect staff Injuries - self inflicted/accidental Actually unconscious? risk to staff Mixed drug injection Other causes of problem - head injury?
Investigations for poisonings
Serum/urine for forensics Toxicology screen - not used clinically Venous blood gas - check acid/base balance, anion gap. osmole gap. ABG Cardiac monitoring
Antidote to opioids
Naloxone
Antidotes to paracetamol
Acetylcysteine/Parvolax
Methionine
Use of stomach pumps in poisoning
Not used - cause harm
Use of activated charcoal in poisoning
Single dose within 1hr of poisoning in PROTECTED AIRWAY
Not all drugs.
Tricyclic overdose signs/symptoms
‘Red as a beet, dry as a bone, blind as a bat, hot as a hare and mad as a wet hen’
How do tricyclics act
Acts on parasympathetic nervous system - antimuscarinic
If neurotoxicity has occurred in tricyclic poisoning then what has also occurred?
Cardiactoxicity
Codeine effect on pupils
Constricts - pinpoint
If overdose and low respiratory rate think
Opiods
Symptoms of MDMA overdose
M - Mydriasis - dilated pupils
D - Delerium
M - Melting - hyperthermia
A - Agitation
Antidote to Beta blockers
Glucagon
Symptoms of paracetamol overdose
Jaundice - harmful to liver
Abdo pain
Nausea and vomiting
Durkheim’s model of suicide
Anomic - Lost or alone
Altruistic - Would be better for others if they were gone
Egoistic - Detached from society
SSRIs
Citalopram, Fluoxetine, Sertraline
When use monoamine-oxidase inhibitors?
Severe depression only.
Signs of benzodiazepine overdose
Drowsiness/Coma
Signs of TCA overdose
Large pupils
Coma
Hypothermia
Arrythmias/hypotension
