Psychiatric emergencies Flashcards
Percentage of global mortality due to suicide
1-2%
Suicides per 100,000 per year
8 per 100,000
Demographic in which suicide rates are increasing
Young men
Most common method of completed suicide among men
Hanging
Percent of male suicides caused by hanging
40%
Percent of male suicides caused by OD
20%
Percent of male suicides caused by self poisoning by car exhaust fumes
10%
Most common method of female suicide
OD
Percent of female suicides caused by OD
46%
Percent of female suicides caused by hanging
27%
Percent of female suicides caused by drowning
7%
Age with highest rate of suicide in most countries
> 75
Ethnic demographic in the UK with particularly high suicide rates among women
Asian
Types of doctor at highest risk of suicide
Anaesthetists
GPs
Psychiatrists
Sex with highest excess suicide rate among doctors
Women
Percentage of patients with completed suicide who had depression
36-90%
Percentage of patients with completed suicide who had alcohol misuse
43-54%
Percentage of patients with completed suicide who had drug abuse
4-45%
Percentage of patients with completed suicide who had schizophrenia
3-10%
Percentage of patients with completed suicide who had an organic mental disorder
2-7%
Percentage of patients with completed suicide who had a personality disorder
5-44%
Percentage of patients with a mood disorder who will die by suicide
6-10%
Factors which increase the risk of suicide among people with depression
History of impulsive or aggressive behaviour
Alcohol and drug misuse
Cluster B personality disorders
History of attempted suicide
Most important risk factors which increase the risk of suicide among patients with depression
History of attempted suicide or DSH
Increase in risk of suicide among people with a history of attempted suicide
40x higher
Lifetime risk of suicide among people with alcohol dependence
7%
Increased rate of suicide among people with alcohol use disorders compared to the general population
10x higher
Increased rate of suicide among people with drug dependence or abuse compared to the general population
15x higher
Increased rate of suicide among people who drink heavily compared to the general population
3.5x higher
Increased rate of suicide among people with anorexia nervosa than the general population
20x higher
Lifetime risk of suicide among people with schizophrenia
6%
Increased rate of suicide among people with schizophrenia compared to the general population
10x higher
Male:female ratio of completed suicide
2-4:1
Most common age for completed suicide in males
25-34
Most common age for completed suicide in females
15-24
Most common psychiatric diagnoses in completed suicide
Depression
Alcohol dependence
Psychiatric diagnoses which do not show an increase in suicide
Learning disability
Dementia
OCD - if no concurrent depression
Percentage of completed suicides with a history of DSH
40-60%
Percentage of patients with DSH who will repeat within a year
30%
Percentage of patients who complete suicide who were in contact with mental health services within a year of their death
25%
Percentage of patients who complete suicide who were on a psychiatry outpatient register
25%
Percentage of patients who complete suicide who were under the influence of alcohol
25%
Percentage of patients who complete suicide who had drank alcohol within 6 hours of their death
50%
Percentage of patients who complete suicide who had been seen by a psychiatrist within the previous week
12.5%
Percentage of patients who complete suicide who had seen a health worker in the previous 3 weeks
33%
Percentage of patients who complete suicide who had seen a GP in the last 4 weeks
66%
Percentage of patients who complete suicide who had seen a GP in the last week
40%
Most common methods of inpatient suicides
Hanging with belts or on curtain rails
Percentage of inpatient suicides occurring in the first week of admission
25%
Percentage of inpatient suicides occurring while the patient was on general observations
80%
Percentage of patients who complete suicide who were non-compliant with medications
20%
Percentage of patients who complete suicide who were within 3 months of discharge from the ward
25%
Percentage of patients who complete suicide within 28 days of discharge from hospital
0.1-0.2%
Percentage of suicides which are preventable
22%
Risk of suicide within 1 year of DSH
0.7%
Risk of suicide within 1 year of DSH in males
1.1%
Risk of suicide within 1 year of DSH in females
0.5%
Increased risk of suicide among people within 1 year of DSH compared to the general population
66x higher
Percentage of inpatient suicides involving patients on leave
33%
Percentage of post-discharge suicides which occur before the first check up
35-66%
Percentage of Black Caribbean patients who completed suicide in England and Wales who had schizophrenia
75%
Percentage of suicides involving homeless people
1-3%
Lifetime prevalence of suicidal ideation
9.2%
Lifetime prevalence of suicidal plans
3.1%
Lifetime prevalence of suicidal intent
2.7%
Percentage of people who transition from suicidal ideation to plan and intent who do so in the first year
60%
Most common method of suicide attempt
OD
Sex with highest rates of suicide attempts
Female
Marital status with highest risk of completed suicide
Widowed
Marital status with lowest risk of completed suicide
Married
Rate of self harm in the UK per year
3 per 1000 per year
Percentage of patients with DSH who eventually complete suicide
10%
Demographic risk factors in the SAD PERSONS score used to assess immediate suicidal risk
Sex
Age
Depression
Previous attempt
Ethanol abuse
Rational thinking loss
Social support lacking
Organised plan
No spouse
Sickness (physical)
Number of true false statements in the Beck Hopelessness Scale used to assess suicidal risk
20
Score on the Beck Hopelessness Scale indicating severe suicidal risk
15-20
Number of items on the Beck Scale for Suicidal Ideation
24
Maximum score on the Beck Scale for Suicidal Ideation
48
Maximum score on the Beck Hopelessness Scale
20
Suicidal ideation in the past year among adolescents
15%
Medications approved for immediate management of aggression
Lorazepam 1-2mg oral/IM
Haloperidol 5mg oral/IM
Olanzapine 5-10mg IM
Promethazine 25-50mg oral
Medications used for acute dystonia
Procyclidine 5-10mg IM
Benztropine 1-2mg
Medication used for decreased respiratory rate following benzodiazepine use
Flumazenil
First line medication used for catatonia
Lorazepam
Medications used for NMS
Dantrolene 2-3mg/kg
Bromocriptine 2.5-10mg TDS
Dose of haloperidol to use for elderly confused/agitation patients
0.5mg
Percentage of people with epilepsy who complete suicide
10%
Most common psychiatric diagnosis associated with suicide
Depression
Country where females have a higher completed suicide rate than males
China
Percentage of people with a psychotic illness who DSH over their lives
25%
Phase of bipolar disorder with the highest risk of suicide
Depressive phase
Percentage of men with bipolar disorder who die by suicide
8%
Percentage of women with bipolar disorder who die by suicide
5%
Increased risk in suicide among people who have been hospitalised for bipolar disorder compared to the general population
15x higher for men
22x higher for women
Suicidal ideation in the past year among adolescent girls
22%
Suicidal ideation in the past year among adolescent boys
8.5%
Percentage of patients who have DSH on a given day who will die by completed suicide in the next 24 months
1%
Percentage of people who die by suicide who have a diagnosable psychiatric disorder at the time of their death
90%
Affect of passive or active movement on the increased muscle tone seen in catatonia
Decreases the tone
Most common socioeconomic group for suicide attempts
5
Decade in which ECT was introduced as a treatment for the first time
1930s
Risk factors for acute dystonia
Young age
Male sex
Recent alcohol or cocaine use
Previous dystonia
Dehydration
Hypocalcaemia
Use of potent antipsychotics
Affect of economic recessions on suicide rates
Rates increase
Affect of wars on suicide rates
Rates decrease
Affect of media reporting on celebrity suicides on suicide rates
Increase transiently
Hours after last alcohol intake when DTs usually start
48-72 hours later
Percentage of patients with dementia who show inappropriate sexual behaviour
7-25%
Mood disorder with the highest suicide risk
Bipolar II
Percentage of people with bipolar I who attempt suicide
17%
Percentage of people with bipolar II who attempt suicide
22%
Percentage of people with depression who attempt suicide
12%
Factors which increase suicide risk in a first episode of psychosis
More depressive symptoms
Poorer functioning
Longer DUP
Higher awareness of illness
More frequent cannabis use
Percentage of patients with a first episode of psychosis who attempt suicide
35%
Most important risk factor for suicide in a first episode of psychosis
Depression during or after
Association between antidepressants and early risk of suicide
Increased in people aged <25
Neutral in people aged 25-64
Decreased in people aged >64
Core features of NMS
Exposure to a dopamine antagonist within 72 hours before symptoms started
Hyperthermia
Rigidity
Risk of suicide within 2 years of DSH
1%
Proportion of self harm episodes which occur in people aged >65
5%
Risk of suicide within 10 years of DSH
3%
Percentage of patients with DSH who will repeat in their lifetimes
40%
Percentage of patients with DSH who will repeat at least five times within a year
10%
Lifetime prevalence of DSH without suicidal intent
2%
Increased rate of suicide among patients with epilepsy compared to the general population
3x higher
Annual prevalence of DSH
0.5%
Lifetime prevalence of DSH
6%
Percentage of acute presentations of poisoning involving paracetamol
30-40%
Age group with the highest rate of suicide
45-49
Most common method of completed suicide
Hanging
Percentage of 15 year olds in the UK who have ever self harmed
22%
Average suicide rate in England
1 in 10000
Average suicide rate in England for mental health service users
1 in 1000
Percentage of completed suicides which occur in people aged >65
20%
Condition most associated with murder suicide
Depression
Most common substance taken in overdose
Paracetamol
Likely most important factor in the reduction of inpatient suicides over the last 20 years
Removal of ligature points
Medication that should be combined with IM haloperidol when it is used for rapid tranquilisation
IM promethazine
Lifetime prevalence of suicide among people with alcohol dependence
7%
Percentage of patients who present to ED with DSH who visited their GP in the previous month
50%
