Suicide

Question 1

What are the risk factors for suicide

Answer 1

1- Previous suicide attempt*
2-Age( 25-44, >65
3- Psyciatric disorders
-Mood disorders ( depression, bipolar)
-Anxiety disorder
- Schizophrenia
- Substance abuse( esp Alcohol)
-eating disorder
-adjustment disorder
-conduct disorder
personality disorder( borderline, antisocial
4- Medical problems
chronic medical illness, eg AIDS, COPD, CHF, Asthma
5-Social: Single, living alone, recent loss, stressor
6- Medications: SSRI, Gabapentin, lamotrigine, tramadol

Question 2

What are the protective factors for suicide

Answer 2

Social contacts
Pregnancy
Religion
Parenthood

Question 3

What are the components of suicide assessment

Answer 3

1- Ideation
    Active/passive, Intensity, Frequency, quality, duration, coping strategies
2- Intent: 
     Ambivalence, Reason to die vs reasons to live
3: Plan: 
    Specific, accessibility, lethality, likelihood of completion, preparation, final arrangements.
4- Past attempts
5- Mental status examination
    Appearance
    Affect
    Thoughts:
     Judgement:
     Orientation
6- Others:
      Substance use
        Recent Stressors

Question 4

What are the high risk features of suicide

Answer 4

1- Intent to die by suicide
2-active plan
3-Prior attempt: esp recent, impulsive, intent, lethal
4- Ongoing preparatory behavior
5-acute major mental illness
6- substance use disorder
7-chronic pain/medical condition
8-turbulent psychosocial status
9-limited reasons for living

Question 5

Elements of suicide risk factor assessment

Answer 5

SAD PERSONS
Sex: 1 if male, 0 if female
Age: 1 if pt is 24-44, + 65
Depression
P-Previous attempt
E: Ethanol abuse
R: Rational thinking loss
S: Social support lacking
O: Organized plan
N: No spouse ( 1 if divorced, widowed, separated, single + male)
S: Sickness ( 1+ if chronic , debilitating , severe
0-2 ( low risk)
3-4 ( watch closely)
5-6 ( consider hospitalization)
>7 ( hospitalized)

Question 6

Suicide management of high risk patients

Answer 6

1- Do not leave the patient alone
2- remove potentially dangerous objects from room
3-hospitalization -needs to be considered strongly
4-if pt refuses to be hospitalized - complete form for involuntary admission

Question 7

suicide management for moderate/low risk pts

Answer 7

1-make a safety plan that pt will
-not harm themselves
- avoid alcohol/drugs , situation that may trigger suicidal thoughts
-follow up with you at a designated time
-contact a health care worker, call a crises line, or go to ER if they feel unsafe or increase suicidal thoughts
2- aggressively treat underlying psychiatric illness with medications
- SSRI, Lithium, ECT, CBT)
avoid drugs with overdose potential ( TCA, MAOI, SNRI)
-aggressively treat anxiety and insomnia
-

Question 8

In a suicidal patient with suspected overdose dont miss screening for which 2 substances

Answer 8

1- Acetylsalicylic acid

2-acetaminophen

Question 9

Dont miss screening for which patients in ED for suicide?

Answer 9

Trauma patients