Risk Assessment

Question 1

How can patients pose a risk to themselves?

Answer 1

Via:

• Self harm
• Suicide
• Driving (if they shouldn’t be)
• Vulnerability to exploitation by others (e.g. financially, sexually)
• Non-compliance and lack of insight

Question 2

Who else do patients pose a risk to?

Answer 2

Others

Question 3

What is the problem with risk?

Answer 3

It is often dynamic, so has to be assessed and reassessed as it can change in a very short period of time

Question 4

Define suicide

Answer 4

A fatal act of self injury

Question 5

Define parasuicide

Answer 5

A near-fatal act of self injury i.e. for whatever reason, the patient survives

Question 6

Define deliberate self harm

Answer 6

An act of self injury or poisoning where the action was not with the intention of death, but to cause harm

Question 7

How many people, world wide, commit suicide every year?

Answer 7

1 million

Question 8

Who are more likely to commit suicide, males or females?

Answer 8

Males

Question 9

Which age group has the highest rate of suicide in the UK?

Answer 9

Ages 40-44

Question 10

Who are more likely to self harm, men or women?

Answer 10

Women

Question 11

What is the most popular method of suicide?

Answer 11

Hanging

Question 12

What should we always ask a pt with mental health problems when we see them?

Why?

Answer 12

If they are having suicidal thoughts/thoughts of self harm

75% of suicide victims had contact with their GP within a year of committing suicide

Question 13

What time has the highest risk of suicide of a MH patient?

Answer 13

During an inpatient stay and in the 14 days following discharge

Question 14

Name some risk factors for suicide in general

Answer 14

Living alone
Mental illness
Physical illness
Chronic illness
Unemployment
Forensic history

Question 15

What are the main clinical correlates between bipolar disorder and risk?

Answer 15

Severity of illness
Self neglect
Hopelessness
Alcohol abuse
Impaired concentration
Hx of suicidal behaviour

Question 16

What are the main clinical correlates between schizophrenia and risk?

Answer 16

Positive psychotic symptoms
Young
Male
Post-psychotic depression
Within first decade of illness
Relapsing pattern
Social isolation
Insight

Question 17

Who is at risk of accidental suicide?

Answer 17

Pts with personality disorders

Question 18

How can a pts occupation increase risk?

Answer 18

Gives them access to weapons or relevant knowledge to help them self harm, harm, or commit suicide

Question 19

Which occupations are at higher risk of suicide?

Answer 19

Doctors
Dentists
Vets
Farmers
Soldiers

Question 20

What are the two main types of deliberate self harm?

Answer 20

Self-poisoning and self-injury

Question 21

Give some reasons that pts give for self harming

Answer 21

To prevent themselves from doing anything more serious/destructive
To feel something
To distract from something/Temporary relief
Cry for help
Unable to cope

Question 22

What are some psychological characteristic of pts who self-harm?

Answer 22

Impulsive
Cognitive rigidity
Problem-solving deficits
Hopelessness

Question 23

When can we assess risk factors?

Answer 23

In psychological Hx and examination

Question 24

What factors should be identified?

Answer 24

• Modifiable risk factors
• Protective factors
• Specific suicide enquiry

Question 25

Under specific suicide enquiry, before or after an attempt, what sorts of questions should be asked?

Answer 25

Why would/did they do it?
Was it impulsive or did they set out plans?
Did they plan for when they died/set their affairs in order?
What were the circumstances?
How do they feel now, after the event? What do they regret?
Any future plans/intentions?

Question 26

What % of homicide victims are male?

Answer 26

69%

Question 27

What % of homicide victims know their killers?

Answer 27

50% of male

75% of female

Question 28

What age group has the highest homicide victim rate?

Answer 28

Children under the age of 1

Question 29

What sort of MH symptoms cause a very small increase in risk to others?

Answer 29

Specific persecutory delusions/hallucinations

Command auditory hallucinations