Mental state examinations, risk assessment and safeguarding Flashcards
State the 2 types of risk to self
- Deliberate self-harm
- Suicide
State the M:F ratio of self-harm and peak age of incidence
M:F of 1:1.5 (more common in females), but varies depending on age
Female peak incidence: 15-19
Male peak incidence: 20-24
State the M:F ratio of suicide and peak age of incidence
M:F of 3:1 (more common in males)
Male peak incidence of 50-55
Identify risk factors for suicide
Medical:
- Previous suicide attempt
- Family history of suicide
- Mental illness
- Chronic physical illness
- Childhood abuse
Demographic/social:
- Male gender
- Age (40-45 in men)
- Single / living alone
- Unemployment
- Financial issues
- Recent significant life event
- Access to means
Identify risk factors for inpatient suicide
- Previous suicidal behaviour
- Presence of delusions
- Violence to property
- Forensic history
- Recent bereavement
Identify risk factors for post-discharge suicide (after inpatient stay)
- Suicidal behaviour prior to admission
- Unplanned discharge
- Lack of continuity of care
- Unemployment
Suggest some factors that increase suicide risk in depression
- Previous suicide attempts
- More severe depression
- Elderly
- Self neglect
- Hopelessness
- Alcohol abuse
Suggest some factors that increase suicide risk in bipolar disorder
- Male
- First depressive episode
- Illicit drug use
- First degree family history of suicide
Suggest some factors that increase suicide risk in schizophrenia
- Previous suicide attempts
- Male
- Early onset of disease
- Depressive symptoms
- High IQ
- Positive symptoms e.g. hallucinations
- Delay in treatment
- Recent discharge from hospital
- Substance abuse
Suggest some factors that increase suicide risk if someone engages in substance abuse
- Previous suicide attempts
- Male
- Older age
- Long duration of abuse
- Use of alcohol / multiple substances used
- Single
- Comorbid depression
Which personality disorder has the highest risk of suicide and which is second highest
1st = emotionally unstable (borderline) personality disorder
2nd = narcissistic personality disorder
List some physical illnesses that increase the risk of suicide
- Chronic disorders
- Chronic pain
- Cancer
- HIV
- Physical disability e.g. stroke, paralysis
List some methods of self-harm
- Ingestion of toxins
- Cutting
- Burning
- Punching
- Scratching
- Wound healing interference
- Hair pulling
List the peak age of self-harm and whether it affects M:F more
11-25 years
Higher in females
List some risk factors for self-harm
- Previous self-harm
- History of trauma or abuse
- Alcohol / drug misuse
- Unemployment / low socioeconomic status
- Forensic history / violence
- Single
- Chronic physical health problems
- Severe life stressors
State some motives underlying deliberate self-harm
- Wish to die
- Communication
- Unable to cope with thoughts/feelings
- Temporary relief
- Relieve sense of numbness
- Punishment / sense of failure
Suggest some potential management options for patients posing a risk to self for self-harm / suicide
- Reduce access to means if possible
- Treat any underlying psychiatric disorder
- Further support in community e.g. crisis team
- Inpatient admission
State some risk factors for risk to others (e.g. homocide)
- Dissocial personality disorder
- Alcohol / drug misuse
- Schizophrenia with delusions or hallucinations
Briefly outline the levels of observation on the ward
Level 1 = general observation hourly, patients do not need to be kept in sight and are generally low risk to themselves and others (minimum level of observation for inpatients)
Level 2 = intermittent observation, every 5-30 minutes, for patients that pose a potential risk but not an immediate risk
Level 3 = continuous observation (within eyesight), nominated staff member allocated to observe at all times
Level 4 continuous observation (within arms length), nominated staff member allocated to observe at all times at close proximity
