Psychiatric Emergency-Piasecki Flashcards
What is the suicide homocide ration in Nevada?
twice as many suicides as homicides
What are psychiatric emergencies?
-Harm to self
(suicide intent, parasuicidal behaviors)
-Harm to others
(homicidal intent, domestic, workplace and school violence)
**some states include threat to property as well
People living in rural Nevada commit suicide at a much more than (blank) the rate of the nation as a whole. What populations have the highest rates of suicide?
twice
Military> geriatric
Nevada is the worst state for social health because….?
- high rates of child abuse
- teenage suicide
- teenage drug abuse
- lack of high school completion
- lack of health insurance coverage
- greatest rate of suicide among those over 65
- high rates of homicide
- high rates of food stamp coverage
What is parasuicide?
attempting suicide with no intent of completing
Suicide in the US
Ranks (blank) as cause of death and (blank) cause of death for men in Nevada.
Every (blank) minutes
69 men, 16 women each day
1 in 65 people is a “survivor”– close relative of a person who died by suicide
11th
#6
18
What is the suicide belt?
What are reasons for this?
it is a consolidated area in the US with high rates of suicide… Nevada is in it
-Rural, elevation, culture, access to care
The suicide belt overlaps with ares of (blank).
What are risk factors?
higher major depression
-genetics, child abuse, trauma, substance abuse, etc.
What is the most common way that people kill themselves?
firearms> suffocation> poisoning> other> fall
What is the most common way that people attempt suicide and do not complete it?
Overdose> cutting/piercing
What season has the most suicides?
spring (March>February)
(blank) attempt suicide more often than the other gender but (blank) die by more suicide.
What is the highest risk groups?
Women
Men
Whites and American Indians/Alaskan Native AND Elderly (esp. 45-59)
Rate of suicide has (blank) for 5-14 year olds
Still less than 10 per 100,000
doubled
Are female or male high school students more suicidal?
female
What age is at the highest risk for suicide?
elderly (up to 75 per 100,000)
What is the link between suicide and serotonin?
decreased serotonin in CSF linked to violents/suicide-> may be an impulsivity thing
Is there a genetic component to suicide
yup, increased concordance in MZ twins AND if you adopt a kid whos biologic parent was suicidal that adopted kid will have a much higher suicidal risk
What are the demographic risk factors for suicide?
- Gender: M>F 3:1
- Medical illness: cancer, AIDS, COPD, hemodialysis
- Nonmarried > “partnered”
- Religion: Protestant> Catholic or Jewish> no religion
- Women physicians, military
- Family history
- Incarceration
- Psychiatric diagnosis
What disorders have a risk between 5-15% of suicide?
Major depression/ Bipolar disorder: 15%
Alcoholism- 15%
Schizophrenia- 10%
Personality Disorders 5-10%
Speaking about suicidal patients:
(blank) or more saw a primary care MD within weeks before death
Most spoke about suicide the (blank) of their death
50%
day
What are the precipitating circumstances for suicide?
Intimate partner problem> disclosed intent to take life> physical health problems> job problem> financial problem
How do you perform suicide assessment?
-Ideation
-Plan (lethality)
-Means (access)
-Deterrents
Social situation
-supports
-what has changed since patient presented?
What are the screening tools for depression?
What is question 9?
ASQ (used in EDs)-> screening tool about mood
Beck depression inventory
Question 9.
- I don’t have any thoughts of killing myself.
- I have thoughts of killing myself, but I would not carry them out.
- I would like to kill myself.
- I would kill myself if I had the chance.
Demographic risk factors are not predictive in (blank). Why?
short term
- describes populations, not individuals
- no validated assessment tool that “scores” suicide risk
- Screening and clinical assessment
What is parasuicidal behavior?
What are examples of these behaviors?
What disorder is this associated with?
A maldaptive solution to chronic problems where you attempt suicide but the intent is not to die….
- self mutilation (cutting, burning)
- overdose
- deliberately going into diabetic ketoacidosis
-Borderline Personality Disorder
What does forensic psychiatry do?
- risk assessment
- competency
- legal insanity
Violence is a (blank), not a diagnosis.
symptom
safety preempts all other interventions
What are the clues for violence?
- history
- threats
- weapons
- hypervigilance
- physical findings
How do you manage potentially violent patients?
- show of force (not going by yourself)
- set a collaborative tone
- verbal limits
- know when to stop interview-leave, get help
How do you get the profile of violence?
- history of violence
- age/gender/gang affiliation
- substances
- antisocial personality disorder
- psychopathy
- self destructive behavior
How do you assess violence?
- current substance use (drug screen/ blood alcohol concentration)
- MSE: paranoia, cognitive impairment, auditory hallucinations
- Past history of violence
What are the physicians obligations to calling police about violence?
Duty to warn and protect but nevada doesnt have a statute so we operate “as if”-> rarely you can violate confidentiality.
-Should enlist patient as a participant in wanring others
Who can do the legal 2000? what is it? and in what instances can you do it?
MDs and other health care professionals (must personally observe the patient)
- danger of harm to self or others
- danger from inability to care for self
- mentally ill (excludes dementia, seizures or substance related)
What is the commitment process of the legal 2000?
- 72 hour hold
- court hearing after 72 hours
- judge decides: Civil commitment or release
- if committed-a record is established and tracked with gun registry
What is competency?
a legal term that states you are sound of mind and have the capacity to do things:
- make a will
- strand trial
- make medical decisions
- manage own finances
What is a patient with capacity able to do?
Communicate a Choice
Understand the Facts
Understand the Potential Consequences
Rationally manipulate information
How often should you test for capacity?
at 2 different points in time (see how much info is retained)
T or F
mental illness in itself does not excuse criminal behavior.
T
What things do you need to be considered “not guilty by reason of insanity”?
Delusional and did not know what he was doing OR
Did not realize it was illegal
