Suicidal

Question 1

What are specific situations that you should consider suicide especially?

Answer 1

Consider suicide as a possibility in single-vehicle road traffic collisions, pedestrians struck by automobiles, falls, shootings and stabbings

Question 2

Describe the mnemonic MOMMAS2 can assist in recalling the focused psychiatric assessment.

Answer 2

M: Memory long and short term
O: Orientation to person, place and time
M: Mood (a symptom), “How do you feel?” “Happy,” “Mad,” “Sad?”
M: Mentation Ask about hallucinations, delusions, paranoia
A: Affect (a sign), How does the patient act? What are the eye contact, speech and demeanor?
S: Speech Is it organized and logical or disorganized and tangential?
S: Suicidality Is there a plan, intent, objective, preparation and/or rehearsal?

Question 3

What patients are at low risk for suicide?

Answer 3

Patients at lower risk for suicide include those with few significant risk factors (low SAD PERSONS score), patients with a supportive home environment and reliable access to healthcare, and younger females with “hesitation cuts” or non-lethal ingestions, and assert a strong wish to live

Question 4

What can you do to help lower a persons risk of suicide?

Answer 4

Patients who commit to return if anything worsens and have specific follow-up in 48 hours also are at lower risk for suicide.

Often providers discuss a “contract for safety” to ensure the patient promises not to commit suicide and will seek help if he or she has further suicidal thoughts; however, there is no evidence that this is an effective means of preventing suicide.

Question 5

Who commits suicide more frequently and who attempts more frequently?

Answer 5

Males 4X more likely to commit suicide

Women more likely to attempt

Question 6

What is the SAD PERSONS Scale?

Answer 6

S = Sex (male)
A = Age (<19 or >45)
D  = Depressive symptoms and hopelessness*
P = Previous suicide attempt or psychiatric illness
E= Excessive alcohol or drug use
R= Rational thinking loss*
S = Single, separated, divorced or widowed
O = Organized or serious suicide attempt*
N = No social support
S = Stated future intent*

Give 2 points for each positive answer marked with a *. All other positives score 1 point.
SCORE
5 or below = Low risk, consider potential discharge
6-8 = Moderate risk, consider psychiatric consult
9 or more = High risk, likely admission

Question 7

What are the 3 ways to obtain a psychiatric evaluation?

Answer 7

There are 3 options to obtain psychiatric evaluation: voluntary admission, involuntary psychiatric admission and discharge with close outpatient psychiatric follow-up.

Question 8

Who is at extremely high risk of suicide?

Answer 8

Elderly men with access to guns are a group at extremely high risk of suicide