Patient with thoughts of suicide and self harm Flashcards
Risk factors for suicide: epidemiological, psychiatric, past history
Epidemiological: 15-24 yo, >65 Male White Living alone, no children Stressful life events Access to firearms Incarcerated Low SES Occupation: farmer, vet, nursing, doctor
Psychiatric: Mood Anxiety Schizophrenia Substance Eating Adjustment Conduct Borderline personality
Past:
Prior attempt
FHx of attempts/completion
SAD PERSONS risk
Sex (male) Age Depression Prior attempt Ethanol Rational thinking loss Suicide in family Organised plan No spouse Serious illness
Clinical presentation
Hopelessness Anhedonia Insomnia Anxiety++ Impaired consciousness Psychomotor agitation Panic attacks
Approach to every patient
Have you thought about harming/killing yourself
Passive/Active ideation
How would you do it?
Do you have a plan? (inent)
What is stopping you?
Past attempts->lethality, outcomes, medical intervention
What is passive ideation
Would rather not be alive but has no active plan
Assessment of suicidal ideation
Onset and frequency
Control over suicidal ideation
Lethality- do you want to end your life, what do you think would happen if you actually did xyz
Access
Time and place
Provacative factors- what makes you feel worse
Protection- what keeps you alive
Final arrangements
Practiced attempts/aborted attempts
Ambivalence- must be a part of you that wants to live
Assessment of suicide attemtp
Setting Planned Intoxication Medication attention Time lag from attempt to ED Expectations of lethality, dying Reaction to survival
Management- General Depression Alcohol Personality Psychosis Parasuicidal Long term
Ensure adequate documentations
Thorough history, MSE
Consider hospitalisation for higher risk
Safety plan for lower risk->agreement to not harm themselves, avoid alcohol, drugs, situations that may trigger suicidal thoughts.
F/U at designated time
Contact HCW, crisis line, go to ED if feel unsafe/suicidal feelings return
Depression- hospitalise if severe/psychotic, OP with support/SSRI
Alcohol- abstinence, usually resolves, ATODS
Schizophrenia: hospitalisation
Parasuicide: psychotherapy, crisis intervention
Personality: crisis intervention, ?hospitalise
Long term:
Treatment of psychiatric illness
Optimise social functioning
Crisis planning
Self harm
Any act done with the knowledge it is harmful
Key areas to assess in suicide attempts
Suicide risk factors
Suicide intent
MSE
Current social support
What factors suggest +suicide intent
Planning
Precautions taken to avoid discovery/rescue
Dangerous method
No help was sought after the act
How to assess ideation
Feeling like life isn’t worth living
Feeling like you want to end it all
How close are you to going through with your plan
Anything that might stop you from following through
What considerations to make in management
Do they require inpatient psychiatric care to ensure safety
Would they benefit from home treatment
Do they have existing social support
Reduce access to means of harm- tablets, fire arms
Define self harm
Any act done with knowledge it is potentially harmful
Define suicide
Intentionally and successfully ending one’s life
