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5. Psychiatry > 2- Suicide > Flashcards

2- Suicide Flashcards

1
Q

What is suicidal ideation and what is the difference between passive and active SI?

A

Thoughts about suicide

  • Passive- feelings like someone wouldn’t care if they were dead
  • Active- actually thinking about killing themself
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2
Q

What is a suicidal plan (w/ means)?

A

Plan for how they would attempt suicide (often comes w/ active SI)

W/ means- is there access to carry out plan

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3
Q

What is suicidal intent?

A

Intention to act on suicidal plan

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4
Q

How does suicide contribute to death in the US?

A

10th leading cause

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5
Q

What is the prevalence between men and women with respect to epidemiology of suicide?

A

Women attempt more often but men are more likely to die from suicide

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6
Q

What are the biggest RFs for committing suicide? (6)

A
  • Previous suicide attempt
  • Current/ past psych illness
  • Current sxs
  • FH
  • Stressors
  • Change in tx
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7
Q

What psych illnesses/ disorders are RFs for suicide?

A

Mood, psychotic, substance use, PTSD, ADHD, TBI, cluster B personality, conduct, recent onset

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8
Q

What current sxs are RFs for suicide? (7)

A

Anhedonia, impulsivity, hopelessness/ despair, anxiety/ panic, insomnia, command hallucinations, psychosis

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9
Q

What aspects of FH are RFs for suicide? (4)

A

Completed suicide, attempted suicide, psychiatric hospitalization, child abuse

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10
Q

What stressors are RFs for suicide? (9)

A

Humiliation/ shame/ despair, chronic pain/ acute medical problem, abuse, substance intoxication/ withdrawal, pending incarceration, homelessness, legal problem, inadequate social support/ isolation, perceied burden on others

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11
Q

What changes in treatment are RFs for suicide?

A

Recent psych hospitalization, change in provider, hopelessness/ dissatisfaction w/ tx, non-compliance/ lack of treatment

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12
Q

When a pt has had a recent psychiatric hospitalization, when are they at the highest risk for suicide?

A

3 days, then decreases after 30 days

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13
Q

What warning signs are a/w suicide? (12)

A
  • Feeling like a burden
  • Feeling trapped or in unbearable pain
  • Isolated
  • Expressing hopelessness
  • Increased anxiety
  • Increased anger/ rage
  • Increased substance use
  • Extreme mood swings
  • Sleeping too much/ too little
  • Talking/ posting about wanting to die
  • Making plans for suicide
  • Looking for a way to access lethal means
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14
Q

What are considered observable high risk behaviors a/w suicide?

A

Agitated, anxious, psychomotor activity, emotional liability, global insomnia, appetite disturbance, high level distress, desperation, akathisia, alcohol intoxicated

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15
Q

What are considered observable low risk behaviors a/w suicide?

A

Somnolent/ sleepy/ sleeping, calm, hungry/ eating, self-directed actions, future directed actions, manipulative

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16
Q

Are low risk and absent risk factors considered protective against suicide?

A

NO

17
Q

What are the protective factors against suicide? (8)

A
  • Children/ family responsibility
  • Pregnancy
  • Cultural/ religious beliefs
  • Life satisfaction
  • Positive social support
  • Effective clinical care/ provider support
  • Easy access to interventions/ support
  • Skills in problem solving, conflict resolution
18
Q

In what circumstances must you perform a suicide risk assessment? (6)

A
  • ER/ crisis eval
  • Initial pt eval w/ psych complaint
  • Abrupt change in clinical presentation
  • Worsening/ lack of improvement w/ tx
  • Significant loss/ psychosocial stressor
  • New physica/ mental illness (esp if life threateningm disfiguring, severe pain)
19
Q

What things are important to adress when asking about suicide?

A

Number of attempts/ most recent attempt, method, outcome, feelings, treatment

20
Q

What type of questions should be asked about suicide in a pt with auditory hallucinations?

A

Do the voices ever tell you to do specific things?

Do they ever try to get you to hurt or kill yourself?

21
Q

In general, it is import to take what approach in the eval of suicide risk?

A

Nonjudgemental and supportive

22
Q

What is key to the suicide risk assessment?

A

Get as much info as possible

(ideation, plan, intent, pt location, belief about lethality, conditions under which pt would act, means)

23
Q

What rating scale is used for suicide?

A

Columbia-suicide severity rating scale

24
Q

What are some challenges to suicide assessment risk?

A

Intoxication, threatening pts, disagreement w/ recommendation, countertransference issues

25
Q

If a pt presents intoxicated and you need to perform a suicide risk assessment, what should you do?

A

Wait until sober, but keep safe in the meantime

26
Q

Pt presents to your office who you think needs a suicide risk assessment but is threatening you. What should you do?

A

Call security or police if necessary

27
Q

What should you consider if a pt is in disagreement with you recommendation after suicide risk assessment?

A

Need for involuntary tx

(or minor whose guardian does not agree)

28
Q

With respect to challenges to suicide assessment, your feelings about the pt such as anxiety, frustrations and denial, are considered what?

A

Countertransference issues

29
Q

When considering suicide risk in a minor, what is important to consider?

A

Role of parents

30
Q

What is included in the management of suicide risk? (6)

A
  • Stabilize medical conditions
  • Safe containment
  • Repeated obs/ assessment
  • Consider initiation of tx
  • Remove/ tx modifiable RFs
  • Disposition
31
Q

Physical/ chemical restrait, supervision (1:1 sitter), and removing dangerous objects is included as part of what in the management of suicide risk?

A

Safe containment

32
Q

What are the options for disposition for a pt with suicide risk?

A

Home with outpt f/u

Admission to medical unit

Voluntary/ involuntary admission in inpt psych unit

5. Psychiatry (19 decks)

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