Suicide Flashcards

1
Q

What percentage of suicide attempts are due to overdose?

A

70-90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What percentage of overdoses are “successful”?

A

2-11%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the top two causes of death in 15-24 year olds?

A
  1. Accidents

2. Suicide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What precipitates most adolescent suicide attempts?

A

Interpersonal conflicts (relational conflict)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pneumonic for Warning Signs of Suicide

A

IS PATH WARM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does IS PATH WARM stand for?

A
I: ideation
S: substance abuse
P: purposelessness
A: anxiety
T: trapped
H: hopelessness
W: withdrawal
A: anger
R: recklessness
M: mood change
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

QPR in Suicide Prevention

A

Q: question
P: persuade
R: refer
Suicide form of CPR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the intention of QPR?

A

Offer hope through positive action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Types of Direct Verbal Clues

A
"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."
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Types of Indirect Verbal Clues

A

“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”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Behavioral Clues of Suicidal Patients

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Situational Clues of Suicidal Patients

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Tips for Asking the Suicide Question

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Less Direct Approach on Asking the Suicide Question

A

“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?”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Direct Approach to Asking the Suicide Question

A

“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 well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How to Persuade Someone to Stay Alive

A

Listen to the problem
Suicide is the problem, it’s the solution
Do not rush to judgement
Offer hope in any way

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Top 3 Referral Methods

A
  1. Take the person directly to someone who can help
  2. Getting a commitment from them to accept help, then make arrangements to get that help
  3. Give referral information & try to get a good faith commitment not attempt or complete suicide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Big Four Risk Factors for Suicide

A

Past suicide attempt
Diagnosis of mood disorder
Increasing use/abuse of alcohol or drugs
History of self-harm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Suicide Signs Specific to Adolescents

A
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Suicide Signs Specific to the Elderly

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What medical conditions need to be screened for in the elderly before a diagnosis of depression is made?

A
Alzheimer's
Thyroid disorders
MS
MI
Stroke
Parkinson's
CA
DM
Hormonal imbalances
Vitamin B12 deficiency
Electrolyte imbalances
Dehydration
Viral infections
22
Q

Which medications can lead to symptoms of depression in the elderly?

A
BP medications
Arthritis medication
Hormones
Steroids
Depakote, Lyrica, & Neurontin
Chantix
Singulair
Accutane
SSRI's
23
Q

Parts of Suicide Inquiry

A

Thoughts of suicide
Plan
Intent
Access to lethal means

24
Q

Important Information for Thoughts of Suicide

A

Duration
Frequency
Intensity

25
Q

Important Information for the Patient’s Plan for Suicide

A

Get specifics

Higher risk level: lethal, detailed, & specific plan

26
Q

Suicide Inquiry: Intent

A

Lethal vs. self-injurious
Reasons to die vs. reasons to live
Mental status exam

27
Q

Suicide Inquiry: Access to Lethal Means

A

Determine if the patient has access to the means mentioned in their plan or other lethal means

28
Q

Protective Factors for Suicide

A

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

29
Q

PCP Intervention for Suicidal Patients

A

Encourage a support network: supportive individuals & contact information
Practice coping strategies: minimize trigger items

30
Q

Define Suicide Safety Plan

A

Stepwise plan to help the patient with recognizing the warning signs that a crisis is approaching and identifying coping strategies to soothe their emotions

31
Q

6 Parts of a Safety Plan

A
  1. Warning signs
  2. Internal coping strategies
  3. People & social settings that provide distraction
  4. People to contact
  5. Professionals or agencies to contact in a crisis
  6. Making the environment safe
32
Q

Documenting a visit with a suicidal patient

A

Suicide risk assessment
Management plan
Actions that occurred
Consultation

33
Q

Follow-Up with Suicidal Patients

A

Simple follow up
Assessing for recurrent or increased suicidality
Focus on medication adherence
Document all follow up care

34
Q

Questions that Should be Part of an Office Protocol

A

Laws in state regarding involuntary admission
Necessary forms for hospitalizing suicidal patients
Closest psychiatric unit
Mental health provider nearby

35
Q

Screening Tools for Depression & Suicide Risk

A

PHQ-9

SAFE-T Protocol with C-SSRS

36
Q

When do you consider a depressive disorder on the PHQ-9?

A

At least 4 checks in the shaded areas

37
Q

When do you consider a diagnosis of major depressive disorder on the PHQ-9?

A

At least 5 checks in the shaded area

38
Q

Score of 1-4 on PHQ-9 Indicates

A

Minimal depression

39
Q

Score of 5-9 on PHQ-9 Indicates

A

Mild depression

40
Q

Score of 10-14 on PHQ-9 Indicates

A

Moderate depression

41
Q

Score of 15-19 on PHQ-9 Indicates

A

Moderately severe depression

42
Q

Score of 20-27 on PHQ-9 Indicates

A

Severe depression

43
Q

What score should you perform suicide assessment?

A

15+

44
Q

What do you say to a psychiatrist when you want help immediately?

A

“I have a person who is an imminent risk of harm to self or others”

45
Q

Criteria for High Risk via SAFE-T Protocol with C-SSRS

A

Suicidal ideation with intent or intent with plan in past month
Suicidal behavior within past 3 months

46
Q

Criteria for Moderate Risk via SAFE-T Protocol with C-SSRS

A

Suicidal ideation without plan, intent or behavior in past month
Suicidal behavior more than 3 months ago
Multiple risk factors & few protective factors

47
Q

Possible Interventions for a High Risk Suicide Patient

A
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
48
Q

Possible Interventions for a Moderate Risk Suicide Patient

A
Pharmacological treatment
Psychotherapy
Psychoeducataion
Family/significant other engagement
Safety plan
Provide national suicide prevention lifeline card & local emergency contacts
49
Q

Criteria for Low Risk via SAFE-T Protocol with C-SSRS

A

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

50
Q

Possible Interventions for a Low Risk Suicidal Patient

A

Provide information about warning signs
Provide national suicide prevention lifeline care & local emergency contacts
Re-assess at treatment plan review

51
Q

SAFE-T Protocol with C-SSRS present general guidelines for

A

Treatment plan for reducing risk level
Suicide risk following discharge from inpatient setting
Community prevention practices
Guidelines for when to document suicide risk assessment