Suicidal thoughts Flashcards
What are the risk factors for suicide attempts
male sex (hazard ratio (HR) approximately 2.0)
history of deliberate self-harm (HR 1.7)
alcohol or drug misuse (HR 1.6)
history of mental illness
depression
schizophrenia: NICE estimates that 10% of people with schizophrenia will complete suicide
history of chronic disease
advancing age
unemployment or social isolation/living alone
being unmarried, divorced or widowed
What are the risk factors for suicide completion
Before
Planning – well thought out plan is a major risk factor
Leaving a written note
Final acts e.g. sorting out finances
Pre-existing: male, previous attempts, mental disorder, poor physical health, Hx abuse, lack of social support
During
Efforts to avoid discovery e.g. locking doors
Being alone at the time
Violent method
Belief that it would be fatal
After
Lack of help seeking following act
Sorrow, regret or anger at failure
Persistent suicidal ideas
Persistence of the trigger
What are the protective factors against suicide
Family support
Having children at home
Religious belief
Social cohesion
How should suicidal thoughts be explored
Sounds like you’ve been feeling terrible recently. Has it gotten so bad that you’ve thought of ending your own life? Do you sometimes feel that you can’t go on
Can you tell me exactly what you’ve been thinking
Have you come close to acting on these thoughts
Have you made any preparations, written a note or a will
Do you have the tablets at home/have you bought a rope/have you been to the train station
What has stopped you
What has helped you to stay strong and not act on these thoughts?
What should be ascertained post-suicide attempt
Can you tell me exactly what happened
- How many tablets, what did you take with them, did you drink alcohol
- Was there anyone around
- What happened afterwards
Did you prepare
- Writing a will or goodbye letters
- How did they acquire the equipment needed
- Did they research methods
- Did they visit potential locations or rehearse
Ask what they thought would happen (did they think it would be lethal)
Ask how they feel now. Has anything changed, how does it feel to be alive
What is the management for suicide attempts
Assess and treat physical consequences e.g. fractures, burns, blood loss
Medical management e.g. laceration care
Senior review and assess mental capacity, especially if they are trying to leave hospital
Close observation
Contact family
Psychosocial assessment and care plan development
Consider admission if persistent high risk → admit to psych ward for further assessment with restricted leave and 1:1 nursing
Bio: relevant medications e.g. SSRIs
psycho: CBT
Social: encourage to seek support, group activities, care plan development
What is the management for suicide attempt specifically via overdose
Continuous obs
Consult ToxBase.org
Consider activated charcoal if within 1 hour of ingestion (NOT if corrosive)
What must be done for patients prior to discharge after a suicide attempt
Care plan
Crisis plan (how to handle future thoughts of self-harm or suicidal ideation)
Access to crisis support
Risk management plan, prevent access to means of self-harm
Discharge planning meeting, arranging aftercare with clear written communication with the primary care team
Liaison with CMHT ± school team if relevant
What is the treatment for paracetamol overdose
N-Acetylcysteine
What is the treatment for benzodiazepine overdose
Flumazenil
What is the management for insulin overdose
Glucagon
What is the management for opiate overdose
Naloxone
What is the management for digoxin overdose
Digoxin-specific antibody fragments (Digibind)
What is the management for iron salt overdose
Desferrioxamine mesylate
What is the management for lithium, salicylate or valproate overdoses
Haemodialysis
