2- Suicide Flashcards
What is suicidal ideation and what is the difference between passive and active SI?
Thoughts about suicide
- Passive- feelings like someone wouldn’t care if they were dead
- Active- actually thinking about killing themself
What is a suicidal plan (w/ means)?
Plan for how they would attempt suicide (often comes w/ active SI)
W/ means- is there access to carry out plan
What is suicidal intent?
Intention to act on suicidal plan
How does suicide contribute to death in the US?
10th leading cause
What is the prevalence between men and women with respect to epidemiology of suicide?
Women attempt more often but men are more likely to die from suicide
What are the biggest RFs for committing suicide? (6)
- Previous suicide attempt
- Current/ past psych illness
- Current sxs
- FH
- Stressors
- Change in tx
What psych illnesses/ disorders are RFs for suicide?
Mood, psychotic, substance use, PTSD, ADHD, TBI, cluster B personality, conduct, recent onset
What current sxs are RFs for suicide? (7)
Anhedonia, impulsivity, hopelessness/ despair, anxiety/ panic, insomnia, command hallucinations, psychosis
What aspects of FH are RFs for suicide? (4)
Completed suicide, attempted suicide, psychiatric hospitalization, child abuse
What stressors are RFs for suicide? (9)
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
What changes in treatment are RFs for suicide?
Recent psych hospitalization, change in provider, hopelessness/ dissatisfaction w/ tx, non-compliance/ lack of treatment
When a pt has had a recent psychiatric hospitalization, when are they at the highest risk for suicide?
3 days, then decreases after 30 days
What warning signs are a/w suicide? (12)
- 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
What are considered observable high risk behaviors a/w suicide?
Agitated, anxious, psychomotor activity, emotional liability, global insomnia, appetite disturbance, high level distress, desperation, akathisia, alcohol intoxicated
What are considered observable low risk behaviors a/w suicide?
Somnolent/ sleepy/ sleeping, calm, hungry/ eating, self-directed actions, future directed actions, manipulative
Are low risk and absent risk factors considered protective against suicide?
NO
What are the protective factors against suicide? (8)
- 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
In what circumstances must you perform a suicide risk assessment? (6)
- 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)
What things are important to adress when asking about suicide?
Number of attempts/ most recent attempt, method, outcome, feelings, treatment
What type of questions should be asked about suicide in a pt with auditory hallucinations?
Do the voices ever tell you to do specific things?
Do they ever try to get you to hurt or kill yourself?
In general, it is import to take what approach in the eval of suicide risk?
Nonjudgemental and supportive
What is key to the suicide risk assessment?
Get as much info as possible
(ideation, plan, intent, pt location, belief about lethality, conditions under which pt would act, means)
What rating scale is used for suicide?
Columbia-suicide severity rating scale
What are some challenges to suicide assessment risk?
Intoxication, threatening pts, disagreement w/ recommendation, countertransference issues
If a pt presents intoxicated and you need to perform a suicide risk assessment, what should you do?
Wait until sober, but keep safe in the meantime
Pt presents to your office who you think needs a suicide risk assessment but is threatening you. What should you do?
Call security or police if necessary
What should you consider if a pt is in disagreement with you recommendation after suicide risk assessment?
Need for involuntary tx
(or minor whose guardian does not agree)
With respect to challenges to suicide assessment, your feelings about the pt such as anxiety, frustrations and denial, are considered what?
Countertransference issues
When considering suicide risk in a minor, what is important to consider?
Role of parents
What is included in the management of suicide risk? (6)
- Stabilize medical conditions
- Safe containment
- Repeated obs/ assessment
- Consider initiation of tx
- Remove/ tx modifiable RFs
- Disposition
Physical/ chemical restrait, supervision (1:1 sitter), and removing dangerous objects is included as part of what in the management of suicide risk?
Safe containment
What are the options for disposition for a pt with suicide risk?
Home with outpt f/u
Admission to medical unit
Voluntary/ involuntary admission in inpt psych unit
