Suicide

Question 1

Define suicide?

Answer 1

Refers to the act of intentionally ending one’s own life.

Question 2

What is a suicidal ideation?

Answer 2

Thoughts, ideas or ruminations about taking one’s own life. It could range from malicious thoughts to well planned strategies and could potentially include: thinking of dying, considering suicide as a solution to problems and writing a suicide note.

Question 2

What is an attempted suicide?

Answer 2

Actions taken to intentionally harm oneself with the intent to die but resulting in survival.

Question 3

What is a completed suicide?

Answer 3

Intentional act of taking one’s own life resulting in death.

Question 4

What is suicidal behavior?

Answer 4

Encompasses both suicidal ideation and attempted suicide.

Question 5

Globally, rank the methods of suicide?

Answer 5

-Hanging (43% of global suicides)
-Poisoning(22%): pesticides, medications, or other substances
-Firearms(12%)
-Drowning(6%)
-Jumping from heights(5%): buildings, bridges, or cliffs

Question 6

What are the common methods of suicide in the following regions: Asia, Europe, US and Africa?

Answer 6

Asia: Pesticide poisoning(60%)
United states: firearms(51%)
Europe: hanging(45%)
Africa: poisoning (30-40%)

Question 7

What are the commonest methods of suicide between men and women?

Answer 7

Males: firearms, hanging, and jumping from heights

Females: poisoning and drowning.

Question 8

What are the 2 categories for the risk factors?

Answer 8

1.Biological Factors
2. Psychosocial factors

Question 9

List5 biological risk factors for suicide?

Answer 9

1.Affective disorders:
Major depressive disorder
Bipolar disorder
2.Schizophrenia
3.Eating disorders- Anorexia nervosa, Bulimia nervosa and binge eating disorders
4.Alcohol or substance use disorder
5.Anxiety

Question 10

List 7 psychological factors of suicide?

Answer 10

1.Previous suicide attempt(most important risk factor)
2.Access to lethal means e.g. firearms
3.Social isolation.
4.Relationship issues (e.g. divorce)
5.Stigma or discrimination(e.g. LGBTQ community)
6.Family history of suicide or mental illness
7.Unemployment or financial hardships

Question 10

What are the protective factors for suicide?

Answer 10

Individual factors:
Resilience and coping skills
Sense of purpose and meaning
Spiritual or religious beliefs

Social factors:
Community involvement and engagement
Social support groups

Family factors:
Stable and supportive family environment
Positive family values and traditions

Community factors:
Access to mental health resources
Community based support programs
Public awareness and educational campaigns on mental health

Question 11

What is the approach to a suicidal patient?

Answer 11

History taking -Risk assessment
Mental status Exam

Question 12

What is risk assessment for suicide?

Answer 12

It is a thorough and an extensive evaluation to identify individuals at risk of suicidal behaviour.

Question 13

What is the goal for suicide risk assessment?

Answer 13

The goal of a suicide risk assessment is to determine the level of suicide risk at a given time and to provide the appropriate clinical care and management.

Question 14

What are the 5 pieces of information to obtain when assessing risk?

Answer 14

1. Evidence of suicidal ideation
   Have things been so bad lately that you have thought about suicide?
   How often do you have these thoughts? How long? Are the thoughts getting stronger? Any in the past 24hours?
2. Current plan
   Have you made any plans to take your own life?
   Planned method? Where would it occur? Access to lethal means?
3. 3. History or previous attempts
      Have you ever tried to take your own life before?
      How many attempts? how long ago?
      4.Current risk factors
      Have you been going through upsetting events lately?
      Relationships breakup, family conflict, job loss or unemployment, chronic illness, grief or loss, trauma.
      5.Evidence of protective factors
      Do you have anyone to support you?
      Family, GP, colleagues, partner
      6.Evidence of protective factors- personal coping strategies
      What has helped you through tough times?
      Reasons to live:
      Strategies used to manage previous crises

Question 15

List 4 standardised suicide risk assessment tools used to assess suicide?

Answer 15

1.Columbia Suicide Severity Rating Scale (C-SSRS)
2.Suicidal Ideation Questionnaire (SIQ)
3.Beck Depression Inventory(BDI)
4.Patient Health Questionnaire PHQ-9)

Question 16

What are the 4 things we look for in the mental status exam when assessing a suicidal pateint?

Answer 16

Mood and affect
Thought process and content
Cognitive function
Insight and judgement

Question 17

What is the general approach to management of suicide?

Answer 17

1.Treatment of any underlying comorbid psychiatric disorders that could potentiate suicidal behaviour
2.Remove hazardous objects from the patient’s environment that could be used in a suicide attempt (e.g. remove firearms from the home)
3.Involve the family of the patient to understand the patient’s psychological and social context.

Question 18

What is the risk of acute management in a patient with an imminent risk of suicidal behaviour?

Answer 18

Risk reduction by actively preventing the patient from suicidal behaviour and assuring the patient’s safety

Question 19

What is the acute management of patient with imminent suicidal behaviour?

Answer 19

1.Hospitalization- preferably admission to a psychiatric unit
2.Remove hazardous objects from the patient’s environment that could be used in a suicide attempt
3.DO NOT leave the patient alone even with his or her family

Question 20

What is the long term management of a suicidal patient?

Answer 20

Pharmacological therapy:
1.Mood stabilisers- LITHIUM is an effective mood stabiliser in suicidal patients with major depressive disorder.
2.Antidepressants: SSRIs- can initially cause increased activity, which may lead to increased suicidal behaviour in adolescents, especially within the first few weeks of treatment.
3.Tricyclic antidepressants, MAOIs, venlafaxine: avoid if possible since lethal overdoses can occur relatively easily with these medications.
4.Antipsychotics

Psychotherapy:
1.Cognitive behavioural therapy
2.Dialectal behavioural therapy

Psychosocial support:
1.Improvement of social circumstances that constitute risk factors for suicidal behaviour
2.Development of personal skills that have a protective effect (e.g. problem solving and coping skills)

Question 21

What are the 6 steps followed when seeing an outpatient suicidal patient?

Answer 21

1.Create a patient tailored safety plan that will include:
Identifying any possible triggers and how to cope thereof
Contacting any available emergency services
Reaching out for support from close family members and/or friends
Removing lethal means
2.Prescribe medications as per the patient’s requirements within safe dosage levels and any possibilities of toxicity
3.Psychotherapy
4.Follow up and monitoring:
Schedule for regular appointments with the patient
Adjust the treatment plan where necessary
5.Crisis plan
6.Education of family members on symptoms

Question 22

What is the suicide prevention strategy used?

Answer 22

The WHO LIVE LIFE strategy

Question 23

Describe the elements of the WHO LIVE LIFE strategy

Answer 23

1.Limiting access to the means of suicide
2.Interacting with the media for responsible reporting of Suicide
3.Fostering Socio emotional life skills in young people
4.Early identification and support everyone affected by suicide and self harm