B7.066 Big Case: Depression and Suicidal Behavior

Question 1

suicide epidemiology

Answer 1

> 1 million worldwide annually
leading cause of unnatural death
10th leading cause of death in the US

Question 2

distal risk factors for suicide

Answer 2

male gender
older age
being single
psych diagnoses (mood, anxiety and thought disorders, BPD)
fam history
substance use disorder
lethal means
aggressive/impulsive traits
serious/terminal illness

Question 3

proximal risk factors for suicide

Answer 3

hopelessness
rage
anger
recklessness
feeling trapped
increased substance use
social withdrawal
anxiety
agitation
hyper and hyposomnolence
mood changes
lack of purpose
major psychosocial losses
undertreatment of a diagnosis

Question 4

gold standard for suicide risk assessment

Answer 4

clinical judgement
can be variable, but typically leans toward being more conservative (i.e. admitting a patient to the hospital rather than sending them home)

Question 5

use of actuarial models in suicide risk assessment

Answer 5

typically increase accuracy
can be combined with clinical judgment but cannot replace
slim majority adopt into practice (66%)

Question 6

suicide warning sign

Answer 6

earliest detectable sign that indicates heightened risk for suicide in the near term

Question 7

warning sign vs risk factor

Answer 7

warning sign = feature of the developing outcome of interest (suicide)
risk factor = distinct construct that predicts or may be causally related to suicide

Question 8

suicide prevention strategies

Answer 8

awareness and education
screening 
treatment interventions
means restriction 
media

Question 9

outcomes of screening and education and awareness

Answer 9

marginal effects
increased detection and treatment of depression
non-significant decrease in suicide attempts

Question 10

pharma interventions to prevent suicide

Answer 10

antidepressants
mood stabilizers
antipsychotics

Question 11

psychotherapy for suicide prevention

Answer 11

cognitive
dialectical behavior
interpersonal
psychoanalytic
intensive care + outreach

Question 12

outcomes in pharma and psychotherapy for suicide prevention

Answer 12

90% of completed suicides involve a psych diagnosis and 80% of those are untreated
antidepressant therapy is inversely correlated with suicide (except in children)
psychotherapy reduces suicide by 50%
follow up care reduced suicide relapses

Question 13

outcomes of means restrictions and media

Answer 13

lethal means result in higher death rates- pro active legislation and infrastructure planning results in lower suicide rates
mixed effects seen in media-blackouts on reporting have reduced suicide rates

Question 14

steps in suicide intervention

Answer 14

lessons from self-injurious behavior:

1. develop an active therapeutic stance
2. balancing validation and change
3. fostering self agency
4. connection of action and feelings

Question 15

developing an active therapeutic stance

Answer 15

therapy frame: establishing therapeutic policies (targets for change, boundaries, expectations)
develop attachment: support, adherence to therapy work, corrective relational experiences

Question 16

balancing validation and change

Answer 16

emotional validation: identify emotions, expression, acceptance of person and feelings
behavioral changes: acceptance of emotions with promotion of alternative behavior

Question 17

fostering self agency

Answer 17

importance of flexible responses to patient behavior
avoiding interpretations
let patients define their own feelings/responses

Question 18

connections of actions and feelings

Answer 18

help connect the dots: recognize external triggers, internal cues, quantification of emotion associated with a suicide attempt
encourage alternative solutions

Question 19

components of suicide intervention plans

Answer 19

warning signs of crisis
internal coping strategies
social contacts
family members
professional and agency contact
means restriction

Question 20

psychotherapy models for suicidal ideation and suicide

Answer 20

cognitive psychotherapy (CT)
dialectical behavior therapy (DBT)
mindfulness-bases cognitive therapy (MBCT)

Question 21

cognitive psychotherapy

Answer 21

applicable to suicidal ideation across diagnoses

Question 22

dialectical behavior therapy (DBT)

Answer 22

some selectivity to patients with BPD

Question 23

mindfulness-bases cognitive therapy (MBCT)

Answer 23

combinational approach, mindfulness with cognitive therapy techniques

Question 24

reflective rumination

Answer 24

associated with suicide history, future attempts and likelihood for suicidal ideation

Question 25

entrapment

Answer 25

a desire to escape from an unbearable situation tied with perception that all escape routes are blocked
mediates relationship between rumination and suicidal ideation