risk assessment Flashcards
define suicide
A fatal act of self injury, undertaken with more or less conscious
self-destructive intent, however vague and ambiguous
Define para-suicide
– Similar to suicide – but for whatever reason the victim survived
the attempt
define deliberate self harm
– An act of self harm where the action was not with the intention
of death, but to cause harm
main correlates for depression
Greater severity of illness Self neglect Hopelessness Alcohol abuse Impaired concentration History of suicidal behaviour
main correaltes for schizophrenia
Positive psychotic symptoms Post psychotic depression Young and male First decade of illness Relapsing pattern of illness Recent discharge from hospital Social isolation Good insight into illness
main correlates for alcohol abuse
Male sex Longer duration of problems Single/divorced/widowed Multiple substance abuse Comorbid depression
main correlates for personality disorder
depressive or alcohol abuse
borderline PD at a higher risk
chronic physical illness
Increased risk in patients with chronic neurological,
gastro-intestinal, cardiovascular disorders, cancers.
• Severe chronic pain leads to increased riskdepression.
• Disfigurement, especially in women
• Chronic physical illness can lead to limitations
including loss of job, role, family, money, etc
what is deliberate self-harm
The behaviour is self-initiated
• harm is intended (intention to kill is low)
• results in injury or harm
Two main types:
• self-poisoning
• self-injury
ass w repeated self-harm
Previous self-harm/ psychiatric contact • Alcohol / Drug misuse • Unemployment/ Social class V • H/o trauma, sexual or physical abuse • Criminal record/ history of violence • Single / divorced / separated • Family history- 4 fold increase risk, twin and adoption studies
motives underlying deliberate selfharm
Wish to die, cry for help, communication with others,
unbearable symptoms
physiological characterisitcs
Impulsivity, cognitive rigidity, problem-solving deficits,
hopelessness
copiing mechanism
Temporary relief of anxiety, stress, emotional numbness,
sense of failure
history for RA
• Triggers
• Preparation
– Planning in advance, final acts
• Circumstances
– Alone, precautions against discovery, alcohol, the
act itself, what did they think would happen?
What did they want to happen?
• After the act
– Didn’t seek help, regret failure, intent
What lead up to it? • Depression? • Schizophrenia? • Personality disorder?
What about now?
• Ideation
• Intent
• Plans
Rest of Mental State Examination e.g. psychosis, depression,
anxiety etc.
• Rest of a full psychiatric history: past psychiatric history
(including past DSH), past medical history, medication, drugs
and alcohol, social history, forensic history, family history,
personal history
• COLLATERAL
