Behavioral Medicine

Question 1

What is suicide?

Answer 1

• Suicide is a complex human behavior with biologic, sociologic, and psychological roots that results in a self-inflicted death that is intentional rather than accidental

Question 2

Who is more likely to attempt suicide?

Answer 2

• Boys more frequently complete suicide, but girls attempt it more often. (Girls tend to choose less lethal methods like overdose, cutting; boys will choose firearms or hanging)

Question 3

How do we diagnose or identify a person contemplating suicide?

Answer 3

• Even though risk factors for suicide are known, it is not possible to predict who will commit suicide
• Assess signs and symptoms, correlate with other clinical variables such as psychiatric and substance abuse history, gender, age, race, prior history of suicide attempts, and recent traumatic life events
• Key questions: Are you having any thoughts about harming yourself or taking your life? Have you developed a plan? What is your plan?

Question 4

What is the treatment or approach to a patient contemplating suicide?

Answer 4

• Immediate hospitalization; remove all potentially lethal items
• Psychotherapeutic intervention, trustful atmosphere, coping strategies; remove motivation for suicide; involve parents and relatives, guidance counselor
• Pharmacotherapy depends on the accompanying diagnosis

Question 5

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Answer 5

Depression

Question 6

What is depression?

Answer 6

• Pathologic sadness or despondency not explained as a normal response to stress and causing impairment in function
• Recurrent condition that generally continues into adulthood

Question 7

What causes depression?

Answer 7

• Genetic predisposition
• Catecholamine hypothesis: Depression is caused by a deficit of norepinephrine at the nerve terminals throughout the brain
• Cortisol hypothesis: Larger quantities of cortisol metabolites in blood and urine, abnormal diurnal variation

Question 8

How do we diagnose depression?

Answer 8

• Depressed mood with at least five of the following signs lasting more than 2 weeks:
  • Depressed mood
  • Loss of interest in activities

-	Plus four or more of the following for 2 weeks or longer:
•	Sleep disturbance
•	Weight change or appetite disturbance
•	Decreased concentration
•	Suicidal ideation
•	Psychomotor agitation or retardation
•	Fatigue or loss of energy
•	Feelings of worthlessness or inappropriate guilt

Question 9

How do we treat depression?

Answer 9

• A combination of treatments for depression may be necessary. Childhood depression should be treated with behavior modification before medication
• TCAs, SSRIs. TCAs have risk of lethal overdose- look for convulsions, coma, and cardiac arrhythmias in toxicity
• For adolescents, CBT and SSRIs appear to be most effective
• The use of antidepressant medication in adolescents may increase risk of suicidal thoughts and behaviors during initial weeks due to disinhibition