risk assessment and management in psychiatry Flashcards
what kind of risk factors exist? (3)
- static - historical
- stable - long term but not fixed
- dynamic - changing over time - more manageable
what is at risk in mental disorder?
- self
- others
- to own mental health
why is risk assessment important?
- identify adverse outcomes
- rank outcomes in likelihood
- differentiate what we can change and what we can’t
- risk management
deaths from suicide annually?
1 million
suicide vs homicide in UK?
10x
gender ireland suicide?
m>f when young
but female rates in young have doubles in last 10yrs
year of suicide decriminalised?
1993
1995 - task force, prevention measures
how many people commit suicide in ireland per year
600
people who commit suicide - rate of mental prob, previous attempts?
60%
36% previous attempt
what is parasuicide?
self harming action that is non habitual and has a non fatal outcome
BASICALLY DSH
NB risk factor for completed suicide - risk in year after 30-50x
what’s the national registry of self harm?
collects data on people presenting to ED with DSH - covers all general and paeds EDs in ireland
most common methods DSH?
drug OD
- tranquilisers
- paracetamol
- antidepressants/mood stabilisers
second most common is cutting - more in younger
alcohol and DSH?
in 40% of DSH presentations
repetition of DSH?
higher risk with cutting
high risk repetition
what is anomic suicide?
happens when attachment between the person and society are strained
media and suicide
reporting of suicide - increased rates- there are guidelines for responsible reporting
economics and suicide?
lower rates in war
higher in economic prosperity and decline
occupations with high rates suicide?
doctors - poor help-seeking, stigma
vets
armed and police forces
risk factors for suicide?
- male
- social class 1 + 4
- single
- unemployed
- elderly
- chronic pain/ill
- previous attempts
- ideation
- mental illness
- substances
- fhx
- recent hosp d/c
is DSH a risk for suicide?
yes
rational suicide
without a mental illness
still often change mind
still should try to prevent
rate of death in 1st attempt of suicide?
55%
most who die by suicide never referred to psych
if someone says they attempted suicide what do you want to ask about?
- before: plan/events/final acts/note/knowledge of method used - perceved lethality
- during: what, where, how avoided discovery, did they contact anyone
- after: how were they discovered, regret, future plans?
parasuicide questions?
- post discharge accommodation
- substance abuse
- intention to repeat
- has it changed anything
- will they engage with MHS?
what is SADPERSONS?
assesses RFs in patients after an episode of self harm
outline SADPERSONS
- sex
- age
- depression hx
- previous attempt
- ethanol
- reality break - psychosis/delirium
- social support
- organised plan
- no spouse
- sickness
people with mental health are likely to ________ crime
be the victims of
mental health problems ______ violence
have a small association with
homicide by the mentally ill is _______
not increasing
homicides by the mentally ill are mostly due to _______
system failures
RFs for violence
- personal - previous violence
- illness related - psychotic, substance abuse
- mental state - planning, threats, anger, command hallucinations
- situational - access to weapons
what is an SPJ?
structured professional judgement- combination of clinical and actuarial risk assessment - ex. is the HCR 20
purely clinical risk assessment efficacy -
not great
MHA and risk?
can involuntary treatment if risk to self or others or a risk to their mental health
