[16] Suicide Flashcards

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1
Q

What is suicide?

A

Suicide is a fatal act of self-harm initiated with the intention of ending one’s own life

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2
Q

What is attempted suicide?

A

The act of intentionally trying to take one’s own life with the primar aim of dying, but failing to succeed in this endeavour

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3
Q

What is a risk assessment in a psychiatric context?

A

Assessing the risk of self-harm, suicide, and/or risk to others

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4
Q

What are some protective factors against suicide?

A
  • Children at home
  • Pregnancy
  • Strong religious or spiritual beliefs that suicide is immoral
  • Strong social support
  • Positive coping skills
  • Positive therapeutic relationship
  • Supportive living arrangements
  • Life satisfaction
  • Fear of the physical act of suicide
  • Fear of disapproval by society
  • Responsibility for others
  • Hope for the future
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5
Q

What are the clinical risk factors for suicide?

A
  • History of DSH or attempted suicide
  • Psychiatric illness
  • History of childhood sexual or physical buse
  • Family history of suicide or suicide attempt in first-degree relatives
  • Medical illness
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6
Q

How much does a history of DSH increase the risk of suicide?

A

50-100x compared to general population

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7
Q

What psychiatric illnesses increase the risk of suicide?

A
  • Depression
  • Schizophrenia
  • Substance misuse
  • Alcohol abuse
  • Personality disorder
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8
Q

What features of a medical illness increases the risk of suicide?

A
  • Physically disabling
  • Painful
  • Terminal
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9
Q

What are the socio-demographic risk factors for suicide?

A
  • Male gender
  • Age between 40-44
  • Unemployment and low socioeconomic status
  • Certain occupationals
  • Access to lethal means
  • Low social support, living alone, or institutionalised
  • Marital status - single, widowed, seperated, or divorced
  • Recent life crisis, e.g. bereavement, family breakdown
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10
Q

How much more likely are men to commit suicide than women?

A

3x

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11
Q

Why are male suicide attemps more likely to be successful?

A

Because they are more likely to be violent

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12
Q

What occupations are at an increased risk of suicide?

A
  • Vets
  • Doctors
  • Nurses
  • Farmers
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13
Q
A
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14
Q

What characteristics do individuals who are suicidal usually have?

A
  • Preoccupation with death
  • Sense of isolation and withdrawal from society
  • Emotional distance from others
  • Distraction and lack of pleasure
  • Focus on the past
  • Feelings of hopelessness and helplessness
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15
Q

How is suicide investigated?

A
  • History
  • MSE
  • Medical investigations according to the method, e.g. drug levels
  • Questionnaires - Tool for Assessment of Suicide Risk, Beck Suicide Intent Scale
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16
Q

What information can help you determine the risk of suicide in terms of how serious the attempt was?

A
  • Was a note left behind?
  • Was the attempt planned or impulsive?
  • Had they attempted to avoid discovery?
  • Was help sought afterwards?
  • Violent method?
  • Were they any final acts, e.g. sorting out finances, writing a will
17
Q

How should a suicidal patient be managed acutel?

A
  • Ensure safety
  • Medically stabilise if they have attempted suicide
  • Risk assessment
  • Admission to hospital or observation in a safe place
    *
18
Q

How should a patients safety be ensured after a suicide attempt?

A

Immediate action should include removing means for suicide and ensuring the safety of the patient and others

19
Q

When is admission to hospital or observation in a safe place indicated?

A

If the individual poses a high and immediate risk of suicide

20
Q

When might the Mental Health Act be required after a suicide attempt?

A

If the patient refuses help and there is evidence of mental illness

21
Q

How should a suicidal patient be managed on a more long-term basis?

A
  • Psychiatric treatment
  • Involvement of the Crisis Resolution and Home Treatment team on discharge
  • Consider referral to secondary care, or outpatient and community treatment
  • Implement prevention strategies
22
Q

When should referral to secondary care be considered in suicidal patients?

A
  • Suicidal ideation clearly stated
  • Underlying psychiatric illness is severe
  • Lack of social support
  • Presentation change for an individual who has repeatedly self harmed
23
Q

When might Crisis Resolution and Home Treatment team be instrumental?

A

In providing support immediately following discharge

24
Q

Who might outpatient and community treatment be more suitable for in suicidal ideation?

A

Those with chronic suicidal ideation, but no history of previous significant suicide attempts

25
Q

What is required for management of chronic suicidal ideation in an outpatient and community setting to be successful?

A

A strong support network and easy access to outpatient and community facilities

26
Q

Give some individual suicide prevention strategies

A
  • Detect and treat underlying psychiatric disorders
  • Urgent hospitalisation under the Mental Health Act
  • Involvement of Crisis Resolution and home treatment team
27
Q

Give some population level suicide prevention strategies

A
  • Public education and discussion
  • Reducing access to means of suicide, e.g. encouraging patients to dispose of unwanted tablets, safer prescribing, safety rails at high places
  • Easy, rapid access to psychiatric care or support groups, e.g. Samarians (who provide emergency 24 hour support)
  • Decreasing social stressors, e.g. unemployment and domestic violence
  • Reducing substance misuse