History Taking - Self Harm/suicidal

Question 1

What questions should you ask about objective information?

Answer 1

1. Exactly what was taken?
2. Where and when was it taken?
3. Was anyone else present?
4. Were any precautions taken to avoid discovery?
5. Was there a suicide note?
6. Was there any other act in anticipation of death? (e.g. making a will)
7. Was action taken to alert possible helpers after taking the overdose?

Question 2

What questions should you ask about the subjective experience?

Answer 2

1. What was the patient’s stated intent?
2. What was the patient’s estimate of lethality of the substances taken?
3. Evidence of recent / psychiatric illness, notably symptoms of depression or psychosis.
4. Is there a past history of psychiatric illness or self harm?
5. Is there any evidence of drug or alcohol abuse?
6. Recent precipitating life event?
7. Any family history of mental illness
8. Social support at home?

Question 3

What questions are important to ask when assessing suicide risk?

Answer 3

Assessment of history:
Seriousness of attempt
Previous self harm
Presence of mental illness (e.g. depression)
Use of drugs / alcohol
Identification of support person
Assessment of mental state/patient thoughts:
Anything changed?
Regrets about attempt
Current intent (i.e. any suicidal thoughts / plans)
Any reasons for stopping repeat
Feelings re future

Question 4

What are the screening questions for depression?

Answer 4

How have you been feeling in your spirits / mood?
Have you been rather weepy / crying a lot recently?
Have you been sleeping?
What is your energy like?
What is your interest in things like?
Can you concentrate OK?

What is your appetite like?
How is your weight doing?
Do you find your mood changes throughout the day?
Do you find yourself waking up earlier than normal?
Have you noticed any change in your sex drive recently?

Question 5

If low mood is detected, how do you assess how low?

Answer 5

Have you been feeling hopeless / guilty / worthless?
Sometimes people feel so low they do not want to go on any more. Have you felt like that?
Any thoughts of harming yourself?
Any thoughts of ending your life?
How does the future look?