DSH, suicide and risk assessment Flashcards
How many people die every year worldwide due to suicide?
800,000
Does everyone who self harms have a psychiatric illness?
No; only a small percentage
Does everyone who commits suicide have a psychiatric illness?
No; but the majority
Which gender is more susceptible to suicide?
Men
Which methods do men and women respectively tend to favour in suicide attempts?
Men; hanging
Women; posioning
Which season has the highest and lowest rates of suicide respectively?
Spring = highest Autumn = lowest
Which professions have the highest rates of suicide?
Unskilled workers Construction workers Doctors Dentists Farmers
Which specialities of medicine have the highest rates of suicide?
GP
Anaesthetists
Psychiatrists
Public health doctors
Who is most at risk in the US if there is a gun in the house?
Yourself
83% of domestic gun fatalities are due to suicide
What physical illnesses confer the highest rate of suicide?
Neurodegenerative diseases
Which neurotransmitter has been seen to be lower in the CSF of those with a history of DSH?
Serotonin
Reduced binding to 5-HT transported sites in the ventral prefrontal cortex
Can you see anything on neuroimaging of those who show high lethality DSH than those who show low lethality DSH?
High lethality; reduced prefrontal cortex activity
Is there a relationship between suicide and genetics?
MZ twins have a 13.2% concordance rate
DZ twins have a 0.7% concordance rate
Does the media have an impact on suicides?
YES
If a media outlet reports on a suicide, tells in detail the method and the difficulties the person faced, suicide rates will increase
Is there a link between cigarette smoking and suicide?
Yes, increases risk
Link between cholesterol and DSH/ suicide?
Lower levels of cholesterol confer a higher risk of DSH/ suicide
What is the single strongest risk factor for suicide?
History of DSH; risk of suicide in 12 months after DSH is 1%
Who is more at risk of suicide post DSH?
Older Male Unemployed or retired Single, separated or divorced Isolated Poor health Psych history Violent DSH Suicide note History of DSH
What people are more likely to develop chronic self harm?
Previous DSH Personality disorder Alcohol or other drug abuse Previous psych history Unemployed Low socio-economic group Criminal record 25-54 years of age Single, separated, divorced
What is hopelessness a good indicator of?
Eventual fatal self harm
Management of a suicidal patient
Calm patient Crying yes; aggression no. Be supportive but firm Direct the interview Provide privacy Distract the patient Deep breathing
Good ways to phrase questions around suicide?
“I realise things have been really bad; has it ever got so bad you thought life wasn’t worth living?”
“How close have you come/ What stopped you?”
“What might help you stop getting to that point again?”
“what are things that would help you keep going?”
What is important to elicit when speaking to a suicidal patient or someone who has self harmed?
Antecedents
Episode of self harm
Mental state then and now
What is the more long term management of DSH/ suicidal ideation/intention?
Bolster self-esteem and problem solving
Discuss personal matters with a stranger takes bravery
Any relief from discussing probelms indiactesthey may discuss things again
Look for past episodes when they have solved problems
Use family/ friends
Safety plan; Suicide?Help! App
What organisations can be helpful to signpost patient to and involved in their care?
Psychiatry/ psychology CPN Counselling: cruse, rape crisis, womens refuge Social work Addictions Samaritans
What language is helpful to use when describing patients will suicidal intent?
Passive death with
Suicidal ideation vs suicidal intention
Mild/ mod/ severe
Fleeting/ intermittent/ constant
Purpose of a suicide risk assessment?
Establish patients intent
Assess seriousness and perceived seriousness of attempt
Assess how they feel about the attempts
How can you establish intent?
Start of with the day in question and obtain a narrative/ autobiographical timeline of what happened
Use open questions and then later use closed questions
What are key points to establish about the current episode of self harm?
Before
During
After
What should be asked when talking about before the episode of self-harm?
Was there a precipitant
Was it planned, or impulsive?
Did the patient carry out any final acts (suicide note, leaving a will, terminating contract e.g. mobile phone, gas and electricity)
Any precautions taken against discovery? e.g. closing curtains, locking doors, going somewhere remote
Was alcohol used?
What is important to elicit about what happened during the episode of self harm?
What method Were they alone? Where were they? What went through their mind Did they think the self harm would kill them What did they do straight after?
What is important to elicit about what happened after the episode of self harm?
Did the patient call anyone? How did they get to A+E? Who were they found by?
How did they feel when help arrived?
How do they feel about the attempt now? Do they regret it?
What is the patients current mood?
Do they still feel suicidal?
If they were to go home today, what would they do?
If they were to feel the same again, what would they do differently?
Any protective factors?
Will they accept treatment?
Specific questions about overdose?
What meds? Where did you get them from? How many? What did you take them with? What did you think it would do? What made you decide to take them? How long haev you been thinking about taking an overdose? What did you do after? How did you get to the hospital?
Specific questions about cutting
Where are the cuts?
Number of cuts?
How deep?
Can you describe how you felt whilst cutting?
How did you feel when you saw the blood?
What were you hoping the cutting would do?
How to screen for depression?
Check for cardinal symptoms; anhedonia, low mood, anergia
How to screen for psychosis?
Are the thoughts to harm ever not your own
Do you ever feel like there are voices that you can hear telling you to harm yourself
If YES; how to they know the voices are not their own worries in their head?
What co-existing psychiatric conditions should you screen for in a suicide risk assessment?
Depression
Psychosis
Alcohol dependency
Anorexia
What should you enquire about in past medical history?
Previous episodes of self harm (what methods, any professional help)
Any psychiatric diagnosis or admissions to psychiatric hospitals
Medical conditions (any chronic pain or illnesses that increase risk of suicide)
What should be asked in social history when assessing suicide risk?
Living situation; who is at home, where, good support network, able to manage activities of daily living
CHILDREN; are they being neglected, are they witnessing the episodes, any thoughts of harm towards the children
Occupation (are they coping financially)
Alcohol
Recreational drugs
What is a good example of a saftey plan?
Support of family friends
Recognise stressors
Avoid harmful alcohol use when stressed
If they feel like that again who can they tell?
Suggest: use support network, GP, phone local support line, present to A+E before overdose, contact local mental health services
What are appropriate agencies to signpost to?
GP Housing services Citizen's Advice Bureau Alcohol and Drugs services Domestic Violence Services Counselling Services
Demographics that increase the suicide risk?
Male Older Widowed/ separated/ single Living alone/ social isolation Low income/ unemployed Certain occupation e.g. doctor, farmer Family history of suicide
What characteristics of the self harm itself point towards a high risk of suicide?
Final acts Researching of methods, preparation High perceived lethality Precautions against being found Violent methods Patient discovered by change Patient resists/ tried to evade medical intervention Downplaying of seriousness
