Class 7 + 8

Question 1

Epidemiology suicide

Answer 1

10th cause of death, 3rd leading cause 15-24. 11 suicides per day. 90% of those who commit suicide have a mental health problem. 80% of people who die of suicide are men.

Question 2

Etiology suicide

Answer 2

Sociologic factors: egoistic: not strongly integrated in a group. Altruistic: excessive integration in a group. Anomic: integration in society is disturbed (divorce, loss of job).
Freud: aggression turned inward against an introjected love object.
Lost love object, narcissistic injury, rage and guilt, identify with a suicide victim, need for punishment, hopelessness, avoid humiliation, developmental stressors, loss of sense of control.
Decrease in serotonin
Hereditary (especially same gender)

Question 3

Risk factors suicide

Answer 3

history of suicide attempts, psychiatric disorder, hopelessness, divorce, homosexual, occupation (physicians, law enforcement, dentist, artist, mechanic, lawyers, insurance agents), unemployed, military service, chronic pain, neurological disorder, traumatic brain injuries, childhood adversity, rural residence, family history of suicide, homelessness, live alone, have lost a loved one, or have experienced a failed relationship within one year; and possibly in patients with a history of violent behavior in the previous year, the anniversary of a significant relationship loss is also a time of increased risk, low IQ, violence and political coercion are associated with increased rates of suicide, as are economic downturns, advanced paternal age, after discharge, first week of hospitalization.

Question 4

Protective factors suicide

Answer 4

Social support and family connectedness is protective against suicide, while family discord increases the risk of suicide. Pregnancy decreases the risk of suicide, as does parenthood, particularly for mothers. Religiosity and participating in religious activities is associated with a lower risk of suicide. Being in a relationship, being engaged in work/ school.

Question 5

suicide attempt

Answer 5

a self injurious act committed with at least some intent to die as a result of the act. don’t have to actually hurt themselves

Question 6

interrupted attempt

Answer 6

when person starts to take steps to end their life but someone/ something stops them

Question 7

aborted attempt

Answer 7

when person starts to take steps to end their life but they actually stop themselves

Question 8

colombia suicide severity rain scale components

Answer 8

suicidal ideation, intensity of ideation, suicidal behaviour,

Question 9

Dx Greater violence risk:

Answer 9

epilepsy of temporal and frontal lobe, tumor in the limbic system or frontal lobe, trauma to the brain, encephalitis, schizo, MDD, SUD (speed, methamphetamine, cocaine) , BAD, neurocognitive disorder, antisocial, bpd, intermittent explosive

Question 10

etiology of violence

Answer 10

Modeling, operant conditioning, neurophysiological disorders, biochem, socioeconomic: poverty, environmental: physical crowding, moderately uncomfortable temperature, use of subs.

Question 11

Rx for violence

Answer 11

Clozapine decreases impulsivity, 
Trazodone 12,5-25 mg, 
SSRIS for violent elderly patients with dementia
Clonidine, propanolol, pindolol, 
mood stabilizer (epival especially) 
LAI

Question 12

4 key interview techniques to maximize validity of interview contente

Answer 12

Behavioral incident: describe a specific event; what did you do when you got home? Get them comfortable telling their narrative
Gentle assumption: how often do you think about suicide
Sx amplification: amplify number
Denial of the specific

Question 13

Worst demographic for violence

Answer 13

young men in low socioeconomic status

Question 14

Goal of risk assessment and management:

Answer 14

• Identify which circle an individual is in
• Identify individuals at risk for moving into a
smaller circle and prevent this from happening

Question 15

Parasuicide

Answer 15

any nonlethal, deliberate self-harm behavior.

Question 16

Elements of patient history most predictive of a serious suicide attempt

Answer 16

• Severe anxiety (92%) and/or panic attacks (80%)
• Depressed mood (80%)
• Recent loss of close personal relationship (78%)
• Alcohol or substance abuse (68%)
• Feelings of hopelessness (64%), helplessness (62%), and worthlessness (29%)
• Insomnia, anhedonia, chronic deteriorating medical illness
• Inability to maintain job or student status (36%)
• Recent onset of impulsive behavior (29%)
• Recent diagnosis of a life-threatening illness (e.g., cancer, AIDS) (9%)

Question 17

Proximal

Risk for suicide individual

Answer 17

• Intensely stressful life event
• Argument w/ parents, girlfriend /boyfriend
• Personal failure / humiliation
• Incarceration
• Perceived loss of independence
• Other life event, losses
• Hopelessness
• Intoxication
• Panic attack?
• Stroke?

Question 18

Proximal

Risk for suicide environment

Answer 18

• Contagion, e.g. death of acquaintance

* Firearm in home

Question 19

Distal Risk individual

Answer 19

Mental disorder
Substance use / abuse disorder
Comorbidity
Neurochemical vulnerability
Family history of mental disorder/ suicidality
History of physical/sexual abuse
Previous suicide attempt

Question 20

Distal Risk environment

Answer 20

Disruptive / dysfunctional, family environment
Easy availability of firearms
Stigma against mental illness
Environment with few protective factors
Community violence?
Cultural depression / cultural grief?

Question 21

Protection suicide individual

Answer 21

Enhancement of coping skills
Early identification of mental/ substance use disorder?
Appropriate treatment for mental/substance use disorder?
Appropriate medication management?

Question 22

Protection suicide environment

Answer 22

Family cohesion
Social support?
Access to mental health and
substance abuse services?
Responsible firearm storage?
Appropriately trained front-line providers?

Question 23

Predatory violence

Answer 23

• The killer or perpetrator has often thought out the violence beforehand, frequently derives pleasure from the violent act itself, and feels little if any remorse.
• Seen in many rapists, sadistic perpetrators of children, and individuals with sociopathic personality structures.

Question 24

Affective violence

Answer 24

• Impulsive violence caused by intense anger and emotion
• Often in response to interpersonal stress
• Frequently under the influence of alcohol and drugs
• Frequently seen in marital violence, child and elder abuse, and violence undertaken at the job or in the streets

Question 25

Biologically

induced violence

Answer 25

• Pathophysiology
• Includes individuals who are suffering from biochemical
abnormalities such as schizophrenia, or mania.
• Structural damage
• includes people suffering from diseases such as brain tumors, partial complex seizures, intracranial infections, brain trauma, multiple sclerosis, and Alzheimer’s disease.

Question 26

Proximal

Risk homicide individual

Answer 26

• Argument w/ parents, girl friend / boyfriend`?
• Personal failure / humiliation?
• Intoxication

Question 27

Distal Risk homicide individual

Answer 27

• Mental disorder — esp: Schizophrenia (55%), Substance use / abuse disorder (41%)
• Comorbidity
• Neurochemical vulnerability
• Family history of antisocial parent
• Previous violence

Question 28

Distal Risk homicide environment

Answer 28

• Adverse childhood environment (marital problems, alcoholism, depression, drug abuse, and anxiety conditions, such as panic disorder and phobias in the parents)
• Low economic status
• Environment with few protective factors
• Community violence?

Question 29

homicide individual protection

Answer 29

Enhancement of coping skills
Early identification of mental substance use disorder?
Appropriate treatment for mental and susubstance use disorder?
Appropriate medication management?

Question 30

homicide environment protection

Answer 30

Family cohesion
Social support?
Access to mental health and substance abuse services?
Appropriately trained front-line providers?

Question 31

Hierarchy of safety

Answer 31

You- Patient- Community

Question 32

Essential Points to ensuring your patient’s safety

Answer 32

Good interview style

Never completely trust the information provided by a suicidal or homicidal patient - Your assessment is incomplete without an accurate mental status examination and until you obtain colla al information

Never romise a patient confidentiality

Question 33

How to interview about suicide

Answer 33

Presenting suicide events: past 48h
Recent suicide events: last 2 months
Past suicide events: all the life
Immediate suicide events: now

Question 34

questions for Violence Assessmen

Answer 34

• What is the worst act of violence?
• Approximately how many acts of violence have
occurred?
• When was the most recent act of violence?
• Has violence been done to anyone in the past
against whom there is current violent ideation or
fantasy?
• Has a weapon been used in the past and, if so, is
it being considered for use presently?
• Is there an arrest and jail history related to
violence?

Question 35

The Management of Suicidality

Answer 35

• Psychotherapy: cognitive therapy, DBT for bpd, problem solving, interpersonal, CBT
• Li: bipolar
• Clozapine: schizo
• ECT

Question 36

Psychotherapy for violence

Answer 36

CBT individual/ group

Question 37

Prh armacotherapy for Violence

Answer 37

Antipsychotics
Mood stabilizers, especially epival
Clozapine
LAI