[16] Suicide Flashcards
What is suicide?
Suicide is a fatal act of self-harm initiated with the intention of ending one’s own life
What is attempted suicide?
The act of intentionally trying to take one’s own life with the primar aim of dying, but failing to succeed in this endeavour
What is a risk assessment in a psychiatric context?
Assessing the risk of self-harm, suicide, and/or risk to others
What are some protective factors against suicide?
- 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
What are the clinical risk factors for suicide?
- 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
How much does a history of DSH increase the risk of suicide?
50-100x compared to general population
What psychiatric illnesses increase the risk of suicide?
- Depression
- Schizophrenia
- Substance misuse
- Alcohol abuse
- Personality disorder
What features of a medical illness increases the risk of suicide?
- Physically disabling
- Painful
- Terminal
What are the socio-demographic risk factors for suicide?
- 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
How much more likely are men to commit suicide than women?
3x
Why are male suicide attemps more likely to be successful?
Because they are more likely to be violent
What occupations are at an increased risk of suicide?
- Vets
- Doctors
- Nurses
- Farmers
What characteristics do individuals who are suicidal usually have?
- 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
How is suicide investigated?
- History
- MSE
- Medical investigations according to the method, e.g. drug levels
- Questionnaires - Tool for Assessment of Suicide Risk, Beck Suicide Intent Scale
What information can help you determine the risk of suicide in terms of how serious the attempt was?
- 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
How should a suicidal patient be managed acutel?
- Ensure safety
- Medically stabilise if they have attempted suicide
- Risk assessment
- Admission to hospital or observation in a safe place
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How should a patients safety be ensured after a suicide attempt?
Immediate action should include removing means for suicide and ensuring the safety of the patient and others
When is admission to hospital or observation in a safe place indicated?
If the individual poses a high and immediate risk of suicide
When might the Mental Health Act be required after a suicide attempt?
If the patient refuses help and there is evidence of mental illness
How should a suicidal patient be managed on a more long-term basis?
- 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
When should referral to secondary care be considered in suicidal patients?
- Suicidal ideation clearly stated
- Underlying psychiatric illness is severe
- Lack of social support
- Presentation change for an individual who has repeatedly self harmed
When might Crisis Resolution and Home Treatment team be instrumental?
In providing support immediately following discharge
Who might outpatient and community treatment be more suitable for in suicidal ideation?
Those with chronic suicidal ideation, but no history of previous significant suicide attempts
What is required for management of chronic suicidal ideation in an outpatient and community setting to be successful?
A strong support network and easy access to outpatient and community facilities
Give some individual suicide prevention strategies
- Detect and treat underlying psychiatric disorders
- Urgent hospitalisation under the Mental Health Act
- Involvement of Crisis Resolution and home treatment team
Give some population level suicide prevention strategies
- 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
