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Assessment of Dangerousness Flashcards

1
Q

What percentage of suicide is associated with mental illness?

A

> 90%

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2
Q

What is passive suicidal ideation?

A

Passive: no intent but would prefer to be dead

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3
Q

What is active suicidal ideation?

A

Active: Has plan and wants to carry it out

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4
Q

What 3 psychiatric conditions are significant risk factors for suicide?

A

1) Affective disorder
2) Drug or alcohol abuse
3) Schizophrenia

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5
Q

Major depression accounts for what percentage of completed suicides?

A

50%

- May be highest in recovery phase

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6
Q

What percentages of completed suicides involve intoxication at the time of death?

A

20%

- Substance abuse may coexist with affective illness and raises risk

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7
Q

Why does schizophrenia increase risk of completed suicide?

A
  • Risk increased with delusions, paranoia, or command hallucinations urging self-destruction
  • Risk may be increased with akathisia (internal sense of physical distress-ADR) or abrupt discontinuation of neuroleptics
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8
Q

Which psychiatric disorder is associated with increased suicide attempts?

A
  • Character disorders
    • Dysphoric patients frequently attempt suicide
    • Impulsivity predisposes to suicide attempts and to suicide
    • Even manipulative gestures can be fatal (attention seeking)
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9
Q

What is the most important risk factor for suicidal ideation and attempts?

A
  • Risk of completed suicide is 100x greater in year following an attempt
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10
Q

What are the two peaks (age) of suicidal ideation?

A

15-24 years and > 60 years

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11
Q

What is the gender prevalence of suicide attempt/completion?

A
  • Woman 3x more likely to attempt suicide

- Men 3x more likely to complete suicide

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12
Q

What is the associations with medical illnesses and suicidal ideation?

A
  • Severe or chronic illness are highest risk (especially elderly)
    • Highest risks with AIDS, cancer, traumatic brain injury, MS, epilepsy, lupus, stroke, spinal cord injuries, Huntington’s, Parkinson’s
  • Recent hospital discharge also leads to increased risk
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13
Q

What are the roles of genetics and family history in regards to suicidal ideation?

A
  • Both genetics and family history contribute to increased risk for suicidal ideation/attempt
    • Biological markers
      decreased CSF levels of 5-HT and 5-HIAA
    • HPA axis hyperactivity
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14
Q

What are the social risk factors related to suicidal ideation/attempt?

A
  • Marital status risk
  • Bereavement
  • Living alone, loss of relationship, anniversary of loss
  • Being unemployed and unskilled
  • Poverty
  • Presence of firearms in home
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15
Q

What is the #1 means of suicide attempt?

A

Guns/shooting

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16
Q

How is suicidal ideation evaluated?

A

1) Remove sharp objects, belts, shoelaces, and other items that could be used for self-harm
2) Supervision if needed
3) Thorough history
4) Collateral information
5) Assess risk factors
6) Assess risk to rescue ratio

17
Q

How is suicidal ideation assessed?

A

1) Ask about suicidal thoughts and intent
2) Ask about plans for suicide
3) Determine if there are plans for the future
4) Determine, “Why now?”

18
Q

What are characteristics/”red flags” in children and adolescents for suicidal ideation?

A
  • Progressively declining school work
  • Irritability, impulsivity
  • Substance abuse
  • Bereavement or rejection
  • Cluster phenomenon
19
Q

What are characteristics/”red flags” in elderly patients for suicidal ideation?

A
  • High suicide rate, more lethal means

- Assess social situation carefully

20
Q

What is the major “red flag” for post partum women for suicidal ideation?

A
  • lack of maternal instinct

- i.e. someone else would be a better parent, children would be alright without mother

21
Q

What are the main treatment options for a suicide attempt/ideation?

A
  • Voluntary admission to psych facility
  • Involuntary admission to psych facility
  • Medical admission if needing treatment of medical issues related to attempt
  • Protection (from self and others)
22
Q

What are the primary outpatient treatment of suicidal patients?

A
  • Psychopharmacology
  • Psychotherapy
  • Social supports
23
Q

Which specific treatments decrease risk of suicide?

A
  • Lithium
  • Clozapine
  • Electroconvulsive therapy (ECT)
24
Q

What is the Tarasoff warning?

A

Medical professionals have the legal duty to:

  • Duty to warn intended victim
  • Duty to protect intended victim
25
What internal factors lead to an increased risk towards violence?
- Acute psychosis - Mania - Personality disorders (including antisocial) - Substance abuse - Organic injury (e.g., metabolic issues, TBI) - Delirium, dementia - Low IQ - Impulsivity - Motive
26
What external factors lead to an increased risk towards violence?
- Available target - Provocative target - Perceived Stress - Weapons - Facilitating environment - Family environment - Employment or housing instability - Low income - Availability of firearms
27
What are the characteristics of aggression?
- Overt behavior - Involving intent to inflict noxious stimulation or to behave - - Destructively towards another organism - May be impulsive or premeditated - Most often not due primarily to psychiatric etiology - Legal system
28
What are the traits of agitation?
- State of poorly organized and aimless psychomotor activity | - Stems from a state of physical and mental unease
29
What are the signs and symptoms of agitation?
- Agitation is a medical emergency presenting with: - motor restlessness, hyperactivity, irritability, decreased attention, increased distractibility, increased reactivity, increased mood lability, uncooperative or inappropriate behaviors
30
What are signs/symptoms that agitation is due to a primary medical issue?
- New onset agitation in an adult over age of 45 with no psychiatric history - Presentation is not consistent with known psychiatric history - Medical abnormalities/withdrawal
31
What behavioral/verbal interventions can be made to manage agitation?
- Eye contact (avoid staring, watch facial expressions) - Interpersonal space (distance, altitude, movement) - Posture (relaxed, open handed, equal egress, 45 degree) - Don't touch
32
What environmental interventions can be made to manage agitation?
- Isolate (decrease interpersonal stimulation) | - Destimulate (decrease other stimulation: noise, lights
33
What physical interventions can be made to manage agitation?
- Restraint
34
What are the advantages of verbal de-escalation?
- Can save you time with disposition - More limited options for patients in restraints - May need to wait for patient to wake up if overly sedated - Diminishes risk of patient or staff harm - More positive ED experience

Psych Block 2 (22 decks)

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