Depression and Suicide Flashcards
Risk factors for suicide:
NO TOOL IS ENDORSED- no scale exists that accurately predicts suicide risk.
Clinician judgement re risk level. Then consider how likely this risk is to change on DC.
Male
<19, >45
Separated/ divorced/ widowed
Unemployed or retired
Chronic illness/ chronic pain
Psychiatric diagnosis
Isolated
Indigenous / refugee
PHX Trauma
Previous attempts
Violent/ lethal/ available method planned
Preparation and premeditation
Not telling anyone/ planned to avoid discovery
‘Final acts’
Lack of remorse
Hopelessness
Precipitatant not resolved or likely to reoccur
What is the risk of suicide after a DSH attempt?
1-2% of people who have attempted suicide, go on to complete suicide within 1 year.
That risk is 4-7% at 10+ years. Hospitalisation reduces short term risk of suicide, but not long term risk.
After DSH, risk of repetition is 10% within a week, and 15% in a year.
Diagnostic criteria for depression:
‘Depressive episode’- ICD
‘Major depression’- DSM
Criteria very similar:
For AT LEAST 2 WEEKS
MOST OF THE DAY
ALMOST EVERY DAY:
Depressed mood, unable to be influenced
Markedly diminished pleasure or interest in activities
Fatigue/ loss of energy
Loss of confidence/ self esteem (not in DSM)
Self reproach or unreasonable guilt
Recurrent thoughts of suicide
Poor concentration or indecisiveness
Psychomotor agitation or retardation
Insomnia or hypersomnia
Change in appetite
4+ for ICD diagnosis, 5+ for DSM
MUST include AT LEAST THE FIRST TWO (depressed mood, ahedonia)
Also:
- Not better explained by other psych or oreganos Dx
- Impairment in social/ occupational functioning
Differentials for depression:
PSYCHIATRIC
- Grief (allow for up to 6mo)
- Adjustment disorder (precipitant, less persistence, good/bad days, can lift out of mood)
- Bipolar with depressive episode (different Mx and prognosis)
- Catatonia (schizophrenia)
- Dysthymia
- Anxiety
- Personality disorder (borderline, antisocial)
ORGANIC
Hypothyroid
Hypocalcaemia
Stroke
Pancreatic/lung Ca (paraneoplastic)
Parkinson’s
Huntington’s
Dementia
MS
CNS tumour
Pontine haemorrhage/ ‘locked in’
Neurosyphilis
AIDS
Hypoactive delirium
SUBSTANCES
Alcohol
Amphetamine withdrawal
History- taking in depression:
1- Social circumstances
- Living, employment, relationships, support
2- Stressors/ precipitants
3- Symptoms/persistance/ duration (ICD)
4- MSE
5- RISK ASSESSMENT
6- Consider organic differentials
7- Disposition/ support options
Risk factors for postpartum depression:
PHX depression
Antenatal depression
Current abuse
Birth trauma
Previous stillborn/miscarriage
Formula fed
Smoker
Low SES
Single parent
Unplanned
‘Tricky’ baby
