Suicide Flashcards
What percentage of suicide attempts are due to overdose?
70-90%
What percentage of overdoses are “successful”?
2-11%
What are the top two causes of death in 15-24 year olds?
- Accidents
2. Suicide
What precipitates most adolescent suicide attempts?
Interpersonal conflicts (relational conflict)
Pneumonic for Warning Signs of Suicide
IS PATH WARM
What does IS PATH WARM stand for?
I: ideation S: substance abuse P: purposelessness A: anxiety T: trapped H: hopelessness W: withdrawal A: anger R: recklessness M: mood change
QPR in Suicide Prevention
Q: question
P: persuade
R: refer
Suicide form of CPR
What is the intention of QPR?
Offer hope through positive action
Types of Direct Verbal Clues
"I've decided to kill myself" "I wish I were dead" "I'm going to commit suicide" "I'm going to end it all" "If (such & such) doesn't happen, I'll kill myself."
Types of Indirect Verbal Clues
“I’m tired of life, I just can’t go on.”
“My family would be better off without me.”
“Who cares if I’m dead anyway”
“I just want out”
“I won’t be around much longer”
“Pretty soon you won’t have to worry about me”
Behavioral Clues of Suicidal Patients
Any previous suicide attempt
Acquiring a gun or stockpiling pills
Co-occurring depression, moodiness, hopelessness
Putting personal affairs in order
Giving away prized possessions
Sudden interest or disinterest in religion
Drug or alcohol abuse, or relapse after a period of recover
Unexplained anger, aggression, and irritability
Situational Clues of Suicidal Patients
Being fired or expelled from school
A recent unwanted move
Loss of any major relationship
Death of a spouse, child, or best friend
Diagnosis of a serious or terminal illness
Sudden unexpected loss of freedom/fear of punishment
Anticipated loss of financial security
Loss of a cherished therapist, counselor, teacher, or pet
Fear of becoming a burden to others
Tips for Asking the Suicide Question
If in doubt, don’t wait, ask the question
If the person is reluctant, be persistent
Talk to the person alone in a private setting
Allow the person to talk freely
Give yourself plenty of time
Have your resources handy
Less Direct Approach on Asking the Suicide Question
“Have you been unhappy lately?”
“Have you been very unhappy lately?”
“Have you been so very unhappy lately that you’ve been thinking about ending your life?”
“Do you ever wish you could go to sleep and never wake up?”
Direct Approach to Asking the Suicide Question
“You know, when people are as upset as you seem to be, they sometimes wish they were dead. I’m wondering if you’re feeling that way too?”
“You look pretty miserable, I wonder if you’re thinking about suicide?”
“Are you thinking about killing yourself?”
How to Persuade Someone to Stay Alive
Listen to the problem
Suicide is the problem, it’s the solution
Do not rush to judgement
Offer hope in any way
Top 3 Referral Methods
- Take the person directly to someone who can help
- Getting a commitment from them to accept help, then make arrangements to get that help
- Give referral information & try to get a good faith commitment not attempt or complete suicide
Big Four Risk Factors for Suicide
Past suicide attempt
Diagnosis of mood disorder
Increasing use/abuse of alcohol or drugs
History of self-harm
Suicide Signs Specific to Adolescents
Volatile mood swings Sudden change in personality Indications they are in unhealthy, destructive, or abusive relationships Sudden deterioration in hygiene Self-mutilation Fixation with death Eating disorders Gender identity issues Depression
Suicide Signs Specific to the Elderly
Stockpiling medications
Purchasing a gun
Giving away money or possessions
Sense of urgency to settle estate or finalize will
Taken sudden interest or loss of interest in religion
Failure to care for themselves in terms of ADLs
Withdrawing from relationships
Failure to thrive
Medical appointments for vague symptoms
Chronic issues of pain management
Undiagnosed depression
What medical conditions need to be screened for in the elderly before a diagnosis of depression is made?
Alzheimer's Thyroid disorders MS MI Stroke Parkinson's CA DM Hormonal imbalances Vitamin B12 deficiency Electrolyte imbalances Dehydration Viral infections
Which medications can lead to symptoms of depression in the elderly?
BP medications Arthritis medication Hormones Steroids Depakote, Lyrica, & Neurontin Chantix Singulair Accutane SSRI's
Parts of Suicide Inquiry
Thoughts of suicide
Plan
Intent
Access to lethal means
Important Information for Thoughts of Suicide
Duration
Frequency
Intensity
Important Information for the Patient’s Plan for Suicide
Get specifics
Higher risk level: lethal, detailed, & specific plan
Suicide Inquiry: Intent
Lethal vs. self-injurious
Reasons to die vs. reasons to live
Mental status exam
Suicide Inquiry: Access to Lethal Means
Determine if the patient has access to the means mentioned in their plan or other lethal means
Protective Factors for Suicide
Clinical care for mental, physical, & substance abuse disorders
Clinical interventions & support for help seeking
Restricted accès to lethal means
Family & community support
Support from medical, mental health, & substance abuse relationships
Problem solving, conflict resolution, & non-violent handling of dispute skills
Cultural & religious beliefs
PCP Intervention for Suicidal Patients
Encourage a support network: supportive individuals & contact information
Practice coping strategies: minimize trigger items
Define Suicide Safety Plan
Stepwise plan to help the patient with recognizing the warning signs that a crisis is approaching and identifying coping strategies to soothe their emotions
6 Parts of a Safety Plan
- Warning signs
- Internal coping strategies
- People & social settings that provide distraction
- People to contact
- Professionals or agencies to contact in a crisis
- Making the environment safe
Documenting a visit with a suicidal patient
Suicide risk assessment
Management plan
Actions that occurred
Consultation
Follow-Up with Suicidal Patients
Simple follow up
Assessing for recurrent or increased suicidality
Focus on medication adherence
Document all follow up care
Questions that Should be Part of an Office Protocol
Laws in state regarding involuntary admission
Necessary forms for hospitalizing suicidal patients
Closest psychiatric unit
Mental health provider nearby
Screening Tools for Depression & Suicide Risk
PHQ-9
SAFE-T Protocol with C-SSRS
When do you consider a depressive disorder on the PHQ-9?
At least 4 checks in the shaded areas
When do you consider a diagnosis of major depressive disorder on the PHQ-9?
At least 5 checks in the shaded area
Score of 1-4 on PHQ-9 Indicates
Minimal depression
Score of 5-9 on PHQ-9 Indicates
Mild depression
Score of 10-14 on PHQ-9 Indicates
Moderate depression
Score of 15-19 on PHQ-9 Indicates
Moderately severe depression
Score of 20-27 on PHQ-9 Indicates
Severe depression
What score should you perform suicide assessment?
15+
What do you say to a psychiatrist when you want help immediately?
“I have a person who is an imminent risk of harm to self or others”
Criteria for High Risk via SAFE-T Protocol with C-SSRS
Suicidal ideation with intent or intent with plan in past month
Suicidal behavior within past 3 months
Criteria for Moderate Risk via SAFE-T Protocol with C-SSRS
Suicidal ideation without plan, intent or behavior in past month
Suicidal behavior more than 3 months ago
Multiple risk factors & few protective factors
Possible Interventions for a High Risk Suicide Patient
Assessment of medical stability Observation status Elopement precautions Body/belongings search Pharmacological treatment Family/significant other engagement Psychotherapy Psychoeducation Safety plan Telephone follow-up upon discharge
Possible Interventions for a Moderate Risk Suicide Patient
Pharmacological treatment Psychotherapy Psychoeducataion Family/significant other engagement Safety plan Provide national suicide prevention lifeline card & local emergency contacts
Criteria for Low Risk via SAFE-T Protocol with C-SSRS
Wish to die, no plan, intent or behavior
Suicidal ideation more than 1 month ago without plan, intent, or behavior
Modifiable risk factors and strong protective factors
No reported history of suicidal ideation or behavior
Possible Interventions for a Low Risk Suicidal Patient
Provide information about warning signs
Provide national suicide prevention lifeline care & local emergency contacts
Re-assess at treatment plan review
SAFE-T Protocol with C-SSRS present general guidelines for
Treatment plan for reducing risk level
Suicide risk following discharge from inpatient setting
Community prevention practices
Guidelines for when to document suicide risk assessment
