Risk Assessment Flashcards
How can patients pose a risk to themselves?
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
Who else do patients pose a risk to?
Others
What is the problem with risk?
It is often dynamic, so has to be assessed and reassessed as it can change in a very short period of time
Define suicide
A fatal act of self injury
Define parasuicide
A near-fatal act of self injury i.e. for whatever reason, the patient survives
Define deliberate self harm
An act of self injury or poisoning where the action was not with the intention of death, but to cause harm
How many people, world wide, commit suicide every year?
1 million
Who are more likely to commit suicide, males or females?
Males
Which age group has the highest rate of suicide in the UK?
Ages 40-44
Who are more likely to self harm, men or women?
Women
What is the most popular method of suicide?
Hanging
What should we always ask a pt with mental health problems when we see them?
Why?
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
What time has the highest risk of suicide of a MH patient?
During an inpatient stay and in the 14 days following discharge
Name some risk factors for suicide in general
Living alone Mental illness Physical illness Chronic illness Unemployment Forensic history
What are the main clinical correlates between bipolar disorder and risk?
Severity of illness Self neglect Hopelessness Alcohol abuse Impaired concentration Hx of suicidal behaviour
What are the main clinical correlates between schizophrenia and risk?
Positive psychotic symptoms Young Male Post-psychotic depression Within first decade of illness Relapsing pattern Social isolation Insight
Who is at risk of accidental suicide?
Pts with personality disorders
How can a pts occupation increase risk?
Gives them access to weapons or relevant knowledge to help them self harm, harm, or commit suicide
Which occupations are at higher risk of suicide?
Doctors Dentists Vets Farmers Soldiers
What are the two main types of deliberate self harm?
Self-poisoning and self-injury
Give some reasons that pts give for self harming
To prevent themselves from doing anything more serious/destructive
To feel something
To distract from something/Temporary relief
Cry for help
Unable to cope
What are some psychological characteristic of pts who self-harm?
Impulsive
Cognitive rigidity
Problem-solving deficits
Hopelessness
When can we assess risk factors?
In psychological Hx and examination
What factors should be identified?
- Modifiable risk factors
- Protective factors
- Specific suicide enquiry
Under specific suicide enquiry, before or after an attempt, what sorts of questions should be asked?
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?
What % of homicide victims are male?
69%
What % of homicide victims know their killers?
50% of male
75% of female
What age group has the highest homicide victim rate?
Children under the age of 1
What sort of MH symptoms cause a very small increase in risk to others?
Specific persecutory delusions/hallucinations
Command auditory hallucinations
