Suicide

Question 1

Asking mom with kids and depression: must add

Answer 1

Ever wish your kids were not born?

Question 2

Predictors of suicide?

Answer 2

Hopelessness
Insomnia

High levels of loss of pleasure
High anxiety
Recent onset of panic attacks

Question 3

If GP, and presented with suicide: give what?

Answer 3

Antidepressants

Make sure they can sleep

Question 4

When to see someone who is alcoholism intensely for 1-2 months post?

Answer 4

After loss of significant relationship

Question 5

Other predictors of suicide?

Answer 5

Previous failed attempt (100x) especially if older

First day-week-month after discharge from a psych unit
Early dementia
Alcohol
Aging isolated makes
Chronic pain
Family Hx
Low cholesterol (building block for serotonin)
Low serotonin metabolite in CSF (5HIAA)

Question 6

What influences suicide?

Answer 6

Spring
Children
Partners
Mondays
The media - details or glamorized

Question 7

Youth suicide increased risk factors

Answer 7

Self harm
Copycat suicide
80% discussed with close friends/family

Question 8

Youth suicide pathways? 3 groups

Answer 8

Depressive perfectionist if pathway
Aggressive impulsive cluster
Disintegrating cluster

Question 9

Politically correct terms:

Answer 9

Died from suicide (not committed)
Complete suicide (not successful)

Question 10

Attempted suicide

Answer 10

Seek oblivion
Circumstances (indicator of determination)
Psychiatric history

Question 11

Parasuicide is?

Answer 11

Deliberate self harm

Or suicide but survived

Question 12

How to assess determination to die

Answer 12

Sudden decision? Or something thinking about for a while?
anyone contacted after the act?
Were there precautions against discovery.

Question 13

Suicide prevention how to ask?

Answer 13

1. Wish you didn’t wake up in the morning?
2. Actually wish you were dead?
3. Self-rating of active suicide risk on 0-10scale

Question 14

Extended suicide prevention questions

Answer 14

Thought of doing something
Contemplated ways, check internet?
Plans
Preparations
Been close to attempt
Attempts in past especially planned
Willingness to use violent methods (85% of suicides)

Question 15

When in doubt for preventing suicide?

Answer 15

Give them antidepressant

Question 16

How to start antidepressant in suicidal patients?

Answer 16

Low dose for 2 days
Normal dose 1 week;consider increasing at end of week 1

Ensure sedation (and sleep) in anxious or agitated suicidal patients = quitiapine 25mg or benzodiazepines (won’t OD)

Or sedating antidepressant: mirtazipine or Agomelatine)

Question 17

Intervention techniques in suicide to say:

Answer 17

You would never advise a friend to die

Tell yourself what you would tell a friend!

Question 18

Intervention techniques include:

Answer 18

Maintain HOPE.

• Reassurances guarantees of recovery
• withhold/mislead info re lethality (copycat suicides)
• allow access to non-fatal oblivion
• See them freq. promise me you won’t hurt yourself before I see you. –Be available
• Don’t take alcohol/drugs
• urgent referral
• voluntary or compulsory admission

Question 19

What are Non-lethal medications to give in suicide?

Answer 19

Benzos, quetiapine

Question 20

Intervention techniques beware of:

Answer 20

Giving gifts
Suddenly calmness
“Terminal malignant alienation”

Desensitized to suicide

Question 21

Major predictor of suicide?

Answer 21

Hopelessness