Suicide Flashcards
1
Q
Suicide
A
Self injurious behavior that was intended to kill oneself and was fatal
2
Q
Suicidal Ideations
A
thoughts about killing oneself; these may include a plan
3
Q
Suicide Attempt
A
Self-injurious behavior intended to kill oneself, but is not fatal
4
Q
Suicide threat
A
thoughts of engaging in self injurious behaviors that are verbalized DESPITE NO INTENTION OF DYING
5
Q
Suicide Gesture
A
Lead others to believe that one wants to die WITHOUT THE INTENTION OF DYING
6
Q
Self injurious behavior accompanied with ANY intent to die, even if the patient is ambivalent would be classified as
A
a suicide attempt
7
Q
T/F suicide attempts are far more common than suicide deaths
A
true
8
Q
Assisted suicide and euthanasia
A
are not considered suicide
9
Q
Common methods of suicide
A
Firearms
Hanging
presticide ingestion
10
Q
use of antidepressants
anxiety
past suicide attempts
marital/romantic problems
Alc/Substance abuse
Male gender
Fire arms
social isolation
older age
depression
white
Are all considered what
A
Common themes in those who have comiitted suicide
11
Q
psychiatric illness is a strong predictor of…
A
suicide
12
Q
T/F: there is a direct association with the severity of a psych illness and risk of suicide
A
true
13
Q
Suicide is concentrated when
A
in the days and weeks following psych inpatient hospitalization
14
Q
Most common psych disorders with suicide (8)
A
Depression
Alcoholism/substance abuse
BPD
schizophrenia
personality disorders
anxiety disorders w/ panic disorders
PTSD
delerium
15
Q
among patients with depression, hx of suicide attempts are correlated mostly with what?
A
feelings of worthlessness and hopelessness
16
Q
A patient has no ties to society and feeling guilty is at high risk of what?
A
Suicide
17
Q
Depression + anxiety= increased risk of
A
suicide
18
Q
slightly increased risk of suicidal thoughts and behaviors among children and adolescents is seen when?
A
in the first few weeks of antidepressant treatment
19
Q
What must be considered by providers prior to prescribing antidepressants due to their increased risk of suicidal thoughts in the first few weeks?
A
do the benefits of antidepressants outweigth the risks
20
Q
when prescribing a child/adolescent on antidepressant therapy, what should a provider do?
A
start low dose
closely monitor for increased suicidal thoughts and behaviors
21
Q
What is the strongest single factor predictive of suicide?
A
prior hx of suicide attempts
22
Q
The highest rates pof suicide is seen in
A
older men (75+)
23
Q
suicide in males is
A
3-4x higher than females
24
Q
mortality from suicide is higher in what gender?
A
men
25
Races with higher incidence/risk of suicide in men
american indians/Alaska natives
whites
26
how does occupation affect risk for suicide?
risk= greater in LEAST SKILLED WORKERS (laborers, office cleaners)
unemployment and economic strain= higher risk
27
How does marital status affect risk of suicide?
risk of suicide is 2x greater in non-married individuals
28
Why do experts suspect there is lower risk of suicide in married individuals?
marriage increases social integration and meaning within ones life
29
what was found in terms of suicide and sexual minorities?
lifetime suicide attempts was 4x greater in sexual minorities
30
Military service hx and risk of suicidde
rate of suicide in military vertans exceeds gen pop rates
31
T/F: Patients with GENERAL MEDICAL ILLNESSES: asthma, cancer, COPD, CAD, DM,. spine disorders, stroke, recent surgeries, chronic or terminal illnesses have higher risk of suicide
true
32
Chronic pain is prevalant in
people who die of suicide
33
what is the association between TBI injuries and suicide?
TBI is associated with completed suicide
(rate is doubled)
34
Risk of suicide attempts is 2-4x greater in adults who suffered what?
childhood abuse or other adverse childhood experiences
35
risk suicide attempts are 2x greater in adults who suffered what?
childhood sexual abuse
36
How do a history of family suicide affect the risk of suicide attempts?
increased risk in people with a family history of suicide
37
People who live WHERE have a higher risk of suicide?
rural areas
38
Most suicides in the US involve
firearms
39
What is the recommended firearms safety plan for patients who have an increased risk of suicidal behavior?
removing or restricting firearms by storing them locked, unloaded, and separate from ammunition
40
How does limiting access to firearms affect suicide?
decreases the number of firearm suicides WITHOUT an increase in suicide by alternative methods
decreases firearm suicides and overall rate of suicides
41
why does restricting firearms work in decreasing risk of suicide?
bc suicidal ideations are transient and oftem impulsive + firearms are more lethal than other methods
42
T/F: Federal and state laws do not permit clinicians to ask patients about gun ownership and they cannot discuss gun safety with their patients
False
Clinicians can ask about firearm ownership and discuss gun safety
43
Describe the prototypical suicidal patient?
older white male of german ancestry who drinks alc excessively, owns a gun, is divorced and lives alone, has depression and anxiety, has tried to kill himself in the past, and was most recently started on an antidepressant
44
Protective factors against suicide
family connectedness and having faith
45
what is the purpose of a suicide risk assessment
to review risk factors and protective factors
WITH A FOCUS ON IDENTIFYING MODIFIABLE TARGETS FOR INTERVENTION
46
T/F: people who are asked about suicidal thoughts are more likely to have increased suicidal ideations
FALSE
47
does asking patients about suicide/ bringing it up put the thought in the patients head/increase ideations?
NOPE
48
T/F: Patients appreciate the opportunity to discuss their suicidal thoughts and may not verbalize those issues without being promoted
TRUE
49
what is the 1st step in evaluating suicide risk?
determine the presence of ideations (INCLUDING CONTENT AND DURATION)
50
Active suicidal ideations
thoughts of taking action to kill oneself
"I want to kill myself"
51
passive suicidal ideations
wish or hope that death will overtake oneself
52
if an ideation is present, what is an important follow up question to ask the patinet?
if (or how) the patient has been controlling these thoughts
53
what are important inquiries to include if a patient is having suicidal ideation
if the patient has thoughts of harming others first before harming themselfs
54
The presence of a suicide plan and the degree of intent can be elicited by asking the following questions (5)
has a specified plan be formed ( method, place time)
are the means of commiting suicide accessible
lethality of the plan
likelihood of rescue
have preparations been made
55
A patient comes into your clinic and is disconnected or disengaged, and they show lack of rapport during the clinical interview. What are you concerned about
this patient has an increased risk of suicide
56
At a clinical visit, what are the factors that would prompt you to believe that your patient is at an increased risk of suicide?
patient is disconnected and disengaged
the patient shows lack of rapport during the clinical interview
57
what is the first priority for patients who have attempted suicide in reducing the immediate risk?
medical stabilization in hospital
58
______________ is nearly always indicated for patients with suicidal behavior or imminent high risk of suicide
hospitalization
59
suicide attempt with lethal means
attempt that included steps to avoid detection
ongoing ideations of disappointment that attempt was unsuccessful
inability to openly and honestly discuss the attempt
inability to discuss saftey planning
lack of alterative for adequate monitoring and treatment
All of these are considered
Factors that put one at increased risk for suicide
60
If a patient is high risk of suicide and does not agree with hospitalization, what may be the necessary next step
involuntary hospitalization
61
In order to admit a patient to hospitalization involuntarily, what must clinicians certify?
certify that the patient is a danger to self or others, or is at imminent risk of harm bc of inability to adequately care for oneself
62
Patients who are admitted to the hospital against the will or the will of their guardians (do/do not) maintain autonomy for consent for treatment
DO
63
when is the only time that medications can be administered to an involuntarily hospitalized patient without their consent?
when the medication is necessary for stabilization during a behavioral crisis
64
Can daily medications deemed necessary for treatment be administered during involuntary hospitalizations without the consent of the patient?
No. Need court order
65
What type of patient may be eligable for partial hospitalization or day programs?
patient at risk of suicide but its not imminent who needs aggressive treatment
66
Outpatient therapy is contingent on what?
a saftey plan
67
what is a safety plan?
specifies how the the patient can cope with recurrent suicidal urges
widely used therapeutic tool
68
are patients who agree to a safety plan still considered high risk?
yes
69
T/F: the safety plan does not protect patients or clinicians, and is NOT a substitute for through evaluation, sound clinical judgement, and meaningful therapeutic interaction
True
70
as part of the safety plan, clinicians may also ask the pateint to _____________ or agree to _________
contract for safety; no harm contract
71
what does contracting for safety mean?
it implies that the patient can promise the cliniciansWhat that they will not try to harm themselves when they have suicidal thoughts
72
Do contracts for safety decrease suicide attempts?
no evidence that it reduces suicide;
MAY PROVIDE FALSE SENSE OF SECURITY
73
options for reducing immediate risk for suicidal individuals?
hospitalization
partial hospitalization
Intensive outpatient program
Outpatient
74
what is more important when asking a patient to contract for safety?
to have open dialouge with the patient and establish a therapeutic alliance
75
what are 4 useful interventions for outpatient management of suicidal individuals?
1) involving family members or close people to regularly monitor the patient for safety until patient is further stabilized
2) provide the patient 24 hour access to clinical support in the case of urgent need
3) restricting all access to lethal means (particularly firearms & medications
4) specify coping strategies
5) Treat psych order aggressively
76
Once immediate safety is insured, what should clinicians do for a suicidal patient?
address underlying factors (including precipitating events, ongoing life difficulties, and mental disorders)
77
What are examples of precipitating events of suicide?
death of a loved one
loss of a job
breakup of marriage
school or social failure
sexual identity crisis
trauma
78
What should clinicians do if they believe that patients attempt to suicide is due to an intolerable life circumstance?
refer for treatment
encourage engagment of community, religious, and family supprt
79
Patients discharged from inpatient psych care are at.....
high short term risk, particularly if there is a break in continuity of care
80
In pateints with unipolar major depression of BPD, what treatment can prevent suicide?
lithium
81
How can lithium help in patients with unipolar depression or BPD who are suicidal?
monotherapy (or with antidepressants or antipsychotics)
prevent mood episodes
reduce aggression and impuslivity
82
Patients with ACUTE MAJOR DEPRESSION who manifest suicidal ideations or behavior are generally treated with what?
antidepressants
83
What antidepressants should we avoid giving to acute major depression patients with suicidal ideations? why?
TCAs or MAOIs
may be lethal if taken at high doses
84
what is the drug of choice in a potentially suicidal, depressed patient? why?
SSRIs
less likely to be lethal in OD
85
when is the only time we will presribe MAOIs, TCAs or Venlafaxine to depressed suicidal patients?
when initial SSRI therapy is ineffective
86
How do we treat patients with suicidal ideations who are at risk of OD on any medications?
hospitalization
87
Ketamine
standard anesthetic drug studied for its possible treatment for acute suicidal ideations in ER setting
88
Buprenorphine
used for opioid disorder and is potentially addictive but still another experimental treatment for severe suicidal ideations
89
Experimental treatments for severe/acute suicidal ideations
Ketamine
Buprenorphine
90
After a suicide attempt, what may prevent subsequent attempts?
psychotherapy
91
what is the most effective psychotherapy for suicidal pateients?
CBT or problem solving therapy
92
when ECT used in suicidal patients?
Used for severely depressed suicidal patients
frequently provids a rapid response that may be life-saving in the short term, and perhaps long term
93
Adjunctive interventions for managing suicidal pateints
interventions that address social isolation and provide a bridge between an ER visit and oupatient care may help to reduce suicide (phonecalls)
94
what adjunctive therapy was found to be effective in suicidal pateints after crisis stabilization?
sending letters to patients
95
Risk of suicide is _____________ in the days and weeks following discharge from psych hosptialization, espeically if patients perceive that they have lost a therapeutic support system
increase
96
At what time period is a patient discharged from psych hosptialization at the highest risk for suicide
first week following discharge
97
What can help to decrease suicide rates of patients who are discharged from psych hospitalizations?
scheduling the first f.u visit as soon as they are released (within the first week)
98
What are Post-Suicide interventions for
intended to help family, friends, and coworkers to
1) understand why suicide victims cill themselves
2) decrease the assumption of inappropriate guilt for death
99
Post-suicide interventions were designed to
identify those at risk of suicide, as well as prevent PTSD, complicated grief, and dpresseve syndromes
100
Suicide is the ______________ leading cause of death among all children in the US
4th
101
____________ is common in pre--pubertal children, but _________ are rare in terms of suicide
ideation; attempts/completion
102
suicidal ideations are more common in what subsets of adolescents
high school girls (more likely to come up with a specific plan)
103
suicide attempts are most likely to occur in what subset of adolescents?
girls
104
Suicide deaths are most likely to occur in what subset of adolescents?
boys
105
Factors that INCREASE the risk of suicidal behavior in children and adolescents
PSYCH DISORDERS
previous attempts
fam hx of mood disorders or suicidal behaviors
hx of physical or sexual abuse
exposure to violence or peer victimization
antidepressant medications
106
Emotional and cognitive factors that may precipitate suicidal behaviors in adolescents
hopelessness
helplessness
despair
impaired problem solving
107
Before suicide, adolescents often perceive their future to be
negative and hopeless
108
Before suicide, adolescents often perceive themselves and others as
powerless to change in their dire circumstances
109
what are other risk factors for suicide attempts in teens (9)
poor self esteem
impulsivity
risk-taking behaviors
aggressivenes
delinqunet behavior
family dysfunction
parents that are neglectful, rejecting, cold
non-intact family
run away
110
risk of suicide in teens is amplified by
EXPOSURE TO SUCIDE (fam, friend, SOCIAL MEDIA)
access to means
alc and drug use
social stress and isolation
