Emergency Psych Flashcards
1
Q
Derived from the latin word which means self murder
A
Suicide
2
Q
A spectrum where people just think about it and neved do anything, but there are some who killa themselves
A
Suicide
3
Q
In psychiatry, suicide is…
A
A primary emergency
4
Q
Suicide
A
Optimum care but the patient may still die
Impossible to predict
Almost always a result of mental illness
5
Q
Most common mental ilnness associated with suicide
A
Depression
6
Q
Prime suicide site in the world
A
Golden gate bridge in san francisco
7
Q
Suicides committed since the bridgd opened in 1937
A
1600 suicides
8
Q
2nd most common leading cause of death
A
Suicide
9
Q
Age of most suicides
A
15-29 yrs old
10
Q
Nunber of yearly death by suicides
A
800 000
11
Q
1 death occurs every
A
40 seconds
12
Q
Percentage where suicides occur in low income countries
A
79%
13
Q
Most common methods used in suicides globally
A
Pestocides, hanging, firearms
14
Q
Are suicides preventable? Yes or no
A
Yes
15
Q
Effective prevemntive measures in suicides
A
Restricting access to means
Responsible media reporting
Introducing alcohol policies
School based interventions
Training of health workers in early identification and treatment
Follow up care and community support
16
Q
Most countries currently have a national suicide prevention strategy
A
No
17
Q
Percentage in the WHO mental health action plan 2013-2020
A
10%
18
Q
FRACTION in the UN sustainable development goals 2030
A
1/3
19
Q
Risk factors in suicide
A
Gender
Age
Religion
Marital status
Occupation
Physical health
Mental illness psychiatdic px
20
Q
Commit suicide 4x as often as women
A
Men
21
Q
Attempt suicide or have suicidal thought 3x as often as men
A
Women
22
Q
More likely to commit suicide
A
Men
23
Q
Uses firearms, hanging or jumping from high places
A
Men
24
Q
More commonly take an overdose of psychoactive substances or poison
A
Women
25
Most common method used in suicide
Hanging
26
For all age vrouls suicide is rare before
Puberty
27
Suicide rate ___ with age
Increase
28
Among men suicide peaks after
45 yrs old
29
Among women, more completed suicides occur after
55 yrs old
30
Older persons attempt suicide
Less
31
Older persons attempt suicide less but
Are more successful
32
T/f : older people are more ambivalent and their mind tend to not get fixed and they are not thingking of wanting to die
False
33
Degree of orthodoxy and integration
Religion
34
More accurate measure of risk in this category than simple institution
Degree of orthodoxy and integration
35
Adherecs t correct or accepted creeds in religion
Orthodoxy
36
Lessens risk of suicide especially if there are children at home
Marriage
37
Register an overall rate nearly double that of married couples
Single, never married persons
38
Increases suicide risk especially in men
Divorce
39
3x more likely to kill themselves after divorce
Men
40
Have high rates of suicides when loved one died
Widow, widowers
41
Suicide occur more frequently in persons who are socialized but have a family history of suicides
False should be socially isolated
42
People who take their lives on the day a member of their family did
Anniversary suicides
43
Homosexuals appear to have higher rates of suicides
True
44
In general protects against suicide
Work
45
The higher the persons social status the less risk of suicide
False higher
46
Drop in social status decreases risk of suicide
False inc
47
Greatest risk of suicide among professions
Physicians
48
Other professions at risk
Law enforcement, dentist, artist, mechanics, lawyers, insurance agent
49
Ophthalmologisy are considered to be at greatest risk of suicide
False dapat psychiatrist, 2nd ophthal, 3rd anesthesiologist
50
Had medical attention within _ months of death
6 months
51
About _ of all who commit suicide
1/3
52
Estimated to be important contributing factor in 1/2 of all suicides
Physical illness
53
Physical illnesses that lead to suicide
Loss of mobility, disfigurement, intractable chronic pain
54
Alcohol have higher rates of suicides
True
55
Diagnosed mental disorder is _ of all persons who sommit or attempt suicide
95%
56
Percentage of depressive disorder
80%
57
Percentage of schizophrenia
10%
58
Dementia or delirum
5%
59
Among person with mental disorder _ are alcohol dependent
25%
60
A history of impulsive behavior or violent acts that are at highest risk of suicide
Persons with delusional depression
61
Age of diagnosed substance abuse and antisocial personality disorder
Less than 30 yrs old
62
Diagnosed of mood disorder and cognitive disorder
More than 30 yrs old
63
_ risk for suicide of psychiatric px than of non patients
3-12x
64
Male and female psychiatric in patients
5-10x ĥigher
65
Never been admitted
3-4x
66
Tend to be hospitalized
Severe mental disorder
67
Psychiatric diagnosis of greatest risk
Mood disorders
68
Best indicator that a patient is at increased risk of suicide
Previous suicide behavior
69
Studies shows that about _ of depressed patients who commit suicide have made previous attempt
40%
70
Within _ months of first attempts
3 months
71
Highest risk of a second suicide attempt, must tell the family to be on guard
Within 3 months of first attempt
72
French social scientist , widely regarded as the founder of french school of sociology
Emile durkheim
73
Emile durkheim has 3 categories
Altruism
Egoistic
Anomic
74
Not strongly integrated into any social groups
Egoistic
75
Suicide stemming from excessive integration into social group
Altruistic
76
Integration into society is disturbed so that they cannoth follow customary norms of behavior. Also there is breakdown of social values
Anomic
77
Theory of mourning a d melancholia by sigmund freud
78
Aggression turned inward against introjected ambivalenty cathected love object
Mourning and melancholia
79
Theory of man against himself
Karl meningers theory
80
An american psychiatrist, an advocate of social justice and the founder of meninger school of psychiatry
Karl meninger
81
Suicide as inverted homicide because of a patient's anger towrcs another person
Man against himself
82
Freuds concept of thanatos
Self directed death instinct
83
Components of hostility in suicide
Wish to kill
Wish to be killed
Wish to die
84
They believe that much can be learned abkut psychodynamics of suicidal patients from their fantasies about what would happen and the consequences if they commnit suicide
Contemporary suicidologist
85
May experience kverwhelming affects like rage and guilt, may also identify with a suicide victim
Lost a love object or recieved a narcissistic injury
86
Undelie mass suicides such as those at masada or jonestown buy the heavens gate cult
Group dynamics
87
Biological Factors
Low 5-hydroxyindoleacetic
88
Tends to run in the family
Suicidal behavior
89
Have significantly higher concordance
for both suicide and attempted suicide
Monozygotic twin pairs
90
Have two (2) alleles: U and L_
Tryptophan Hydroxylase (TPH)
91
Presence of _ is associated with:
> Increased risk of suicide attempts
> Repetitive suicidal behavior
L allele
92
Reduced capacity to hydroxylate
‘Tryptophan to 5-HT in the synthesis of
Serotonin results t
Low central serotonin turnover
93
Patients who injure themselves by self-mutilation but who
usually
Parasuicidal behavior
94
Parasuicidal behavipr female to male ratio
3:1
95
Parauicidal behavior incidence among psych px
50 times more than the general population
96
_ have cut themselves over several years due to their:
o Anger at themselves or others, and
o Relief of tension or wish to die
o Alcohol and other substance abuse are common
o Most cutters have attempted suicide
Cutters
97
Cutters cut coarsely not delicately
False the other way around
98
Cutters usually cut with a
"Razor blade, knife, broken glass/ mirror
99
Cutters commonly cut their
Wrist arms thighs and legs
100
Cutters infrequently cut their
Face breast abdomen
101
Most cutters claim to experience pain
False no pain
102
Prediction of para suicide
Done via clinical exam
103
High risk characteristics of suicide
Male
45 yrs old
Alcohol dependence
Violent behavior
Prev. Suicidal behavior
Prev psychiatric hospitalization
104
«The suicide rate is 50 times higher than
to those who are not
Alcohol dependence
105
Questions about suicidal feelings and behaviors are asked
Directly
106
Most suicides among psychiatric patients are not preventable
False preventable
107
Itis often associated with suicide
Inadequate assessment or treatment
108
Suffering so great and intense, or chronic and unresponsive
to treatment —uncommon
Inevitable suicide
109
Other patients have the following dse at risk for suicide
Severe Personality Disorder
o Highly impulsive & commit suicide spontaneously
o Often when dysphoric, intoxicated or both
110
Evaluation for suicide
- Complete Psychiatric History
- A thorough Mental Status Examination (MSE)
- Inquiry about Depressive symptoms, suicidal thoughts,
intents, plans, and attempts
111
Increased risk of suicide are implied on the following
o A lack of future plans
o Giving away personal property
o Making a will, and
o Recently experienced a loss
112
Decision to Hospitalize
- It depends on the diagnosis
: The severity of Depression
: Suicidal ideation
- The patient and the family’s coping abilities
: Patient’s living situation
: The availability of social support
- The absence or presence of risk factors for suicide
113
Outpatient
- Ask patients who are considered suicidal to agree to call
o When they become uncertain about their ability to
control their suicidal impulses
Patients who can make such an agreement with a doctor
with whom they have a relationship
o It reaffirms the belief that they have sufficient
strength to control such impulses and to seek help
‘In return for a patient’s commitment, clinicians should be
available to the patient 24 hours a day
114
‘In return for a patient’s commitment, clinicians should be
available to the patient
24 hrs
115
Preventive Measures for dealing with a Suicidal Person
Reducing the psychological pain By modifying the patient’s stressful environment
: Enlisting the aid of the spouse employer friend
: Building a realistic support
: Offering alternatives to suicide
116
They are difficult to treat and exhaust caretakers
- Constant observation by special nurses
Chronically suicidal px
117
Seclusion and restraints cannot prevent suicide
when a patient is resolute ./ or when pxis determined to do it
Constant observation by special nurses
118
may be necessary for some severely Depressed patients
Ect
119
procedure in which small
electric currents are passed through the brain triggering a brief
seizure as a treatment for Depression & other psychiatric conditions
Et
120
Suicide px should be treated with Vigorous treatment with
antidepressant or antipsychotic , supportive therapy
121
PX should be persuaded from making major life decisions while they are suicidally depressed
False disuaded
122
o They are at a particular risk
o As the Depression lifts — patients become
energized and are able to put their suicidal plans into action
- Patients recovering from a suicidal Depression
123
Paradoxical Suicide activating the effect of
Serotonergic drugs
124
suddenly appear to be at peace — they
have reached a secret decision to commit suicide
Paradoxical Suicide
125
Although common, some patients lie to the Psychiatrist
about their suicidal intent
False rare
126
Persons receiving treatment for a psychiatric disorder
Inevitable suicide
