Patient with thoughts of suicide and self harm Flashcards

1
Q

Risk factors for suicide: epidemiological, psychiatric, past history

A
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

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2
Q

SAD PERSONS risk

A
Sex (male)
Age 
Depression
Prior attempt
Ethanol
Rational thinking loss
Suicide in family
Organised plan
No spouse
Serious illness
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3
Q

Clinical presentation

A
Hopelessness
Anhedonia
Insomnia
Anxiety++
Impaired consciousness
Psychomotor agitation
Panic attacks
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4
Q

Approach to every patient

A

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

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5
Q

What is passive ideation

A

Would rather not be alive but has no active plan

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6
Q

Assessment of suicidal ideation

A

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

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7
Q

Assessment of suicide attemtp

A
Setting
Planned
Intoxication
Medication attention
Time lag from attempt to ED
Expectations of lethality, dying
Reaction to survival
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8
Q
Management-
General
Depression
Alcohol
Personality
Psychosis
Parasuicidal
Long term
A

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

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9
Q

Self harm

A

Any act done with the knowledge it is harmful

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10
Q

Key areas to assess in suicide attempts

A

Suicide risk factors
Suicide intent
MSE
Current social support

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11
Q

What factors suggest +suicide intent

A

Planning
Precautions taken to avoid discovery/rescue
Dangerous method
No help was sought after the act

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12
Q

How to assess ideation

A

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

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13
Q

What considerations to make in management

A

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

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14
Q

Define self harm

A

Any act done with knowledge it is potentially harmful

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15
Q

Define suicide

A

Intentionally and successfully ending one’s life

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16
Q

Psychiatric illness as a risk factor

A

90% who commit suicide have diagnosable mental illness

Those recently d/c from acute centre have ++risk of suicide

17
Q

Psychiatric illness associations- specific conditions

A

Unipolar depression- 20X risk, anxiety, insomnia
BPAD- 15X risk
Schizophrenia- 8.5 X risk, young, intellifent, unemployed, good insight, recurrent
Alcohol- lifetime risk 3-4%, males, poor work, social isolation, previous self harm
Personality- BPD ++ 10% will die
Eating disorders- 30 X risk. Strongest association with suicide

18
Q

Components of MSE

A

Current mood state
Other psychiatric illness
Current suicidality
Protective factors

19
Q

Immediate management considerations

A

Does the patient need in-patient psychiatric care to preserve safety
Would they benefit from in home/crisis care
Any existing social supports that could be called on
Reducing access to means of harming

20
Q

Long term management considerations

A

Management of psychiatric illness
Optimise social functioning
Crisis planning