Piasecki: Psychiatric Emergencies and Forensic Psychiatry

Question 1

What is the ratio of suicide to homicide in Nevada?

Answer 1

2:1

Question 2

T/F: People living in rural Nevada commit suicide at much more than twice the rate of the nation as a whole
Geriatric even higher
Military higher yet

Answer 2

True

Question 3

Ranks as the 11th cause of death

*#6 cause of death in men in Nevada

Answer 3

suicide

Question 4

How are most suicides committed?

Answer 4

firearm

Question 5

Most common gender to commit suicide? Most common race?

Answer 5

male; whites and american indian/Alaskan native

Question 6

Why might the Western states have increased prevalence of suicide?

Answer 6

more depression in these states
more gun ownership?
elevation

Question 7

Which age group is at the highest risk for suicide?

Answer 7

elderly

Question 8

Which small molecule might be decreased in the CSF in patients who commit suicide, especially violent suicide?

Answer 8

5HT

Question 9

Does suicide have a genetic link?

Answer 9

yes! increased concordance in monozygotic twins

Question 10

Which medical illnesses lead to increased suicide risk?

Answer 10

cancer
AIDS
COPD
hemodialysis

**chronic illnesses w suffering each day and little hope to improve

Question 11

T/F: People who are married are at a decreased risk of suicide

Answer 11

true

Question 12

Increased risk of suicide in these psych disorders

Answer 12

major depression/bipolar
alcoholism
schizophrenia
personality disorders

Question 13

T/F: 50% or more of suicide pts will have seen their primary care doc w/i weeks before their death. In addition, most people spoke about their suicide the day of their death.

Answer 13

True

Question 14

What are some reasons that people commit suicide?

Answer 14

intimate partner problems
physical health problems
finances
job problems

Question 15

What is used to screen for depression?

Answer 15

ASQ in EDs

Beck depression inventory

Question 16

How do you intervene if you think someone might be suicidal?

Answer 16

consultation (refer them to ER)
hospitalize them
suicide precautions (while in the hospital, observe them, put them in PJs, search their belongings)
follow up

Question 17

Do demographic suicide risk factors help predict short term outcomes for individuals?

Answer 17

no, they describe populations, not individuals

Question 18

What do we have in NV for suicidal pts?

Answer 18

crisis call center

Question 19

Intent: not to die
A maladaptive solution to chronic problems
Behaviors may include self mutilation, overdose
Not taking care of a medical condition

Answer 19

parasuicidal behavior

Question 20

What are some clues to a violent patient?

Answer 20

history of violence
age/gender/gang affiliation
**substance use
antisocial personality disorder
psychopathy
self destructive behavior

Question 21

3 ways you can assess violence?

Answer 21

look for current substance abuse
do an MSE: look for paranoia, cognitive impairment, hallucinations
past history of violence

Question 22

What is our duty as a physician if we encounter a violent patient?

Answer 22

it’s our duty to warn and protect the target of violence (call the police)

Question 23

What form of suicide results in the most deaths by suicide? What form of suicide results in unsuccessful suicide?

Answer 23

firearm; poisoning (OD)

Question 24

Which progressions increase the risk for suicide?

Answer 24

women physicians

military

Question 25

Things included in suicide assessment

Answer 25

ideation
plan
means
deterrents

Question 26

This preempts all other interventions when it come to violence

Answer 26

safety

Question 27

What is Legal 2000?

Answer 27

involuntary hospitalization of a person who is violent or self injurious

Question 28

What is capacity?

Answer 28

a person’s ability to make a will, stand trial, make medical decisions, manage their finances

**if a person has capacity, they can communicate a choice, understand the facts, understand the consequences, rationally manipulate info

Question 29

In Nevada, a person would be found not guilty by reason of insanity if…

Answer 29

they are delusional
did not know what they were doing
they did not appreciate wrongfulness