Suicide

Question 1

Definitions;

1. Suicide risk management
2. 5 components of suicide
3. Suicidal ideation
4. Suicidal intent
5. Suicide plan
6. Suicide attempt
7. Self-harm

Answer 1

1. Identification, assessment and treatment of person exhibiting suicidal behaviour.
2. ideation, intent, plan, access to lethal means, history of past suicide attempts
3. Thoughts and fantasies about, or ruminations and preoccupations with death, in general, and self-inflicted death, in particular.
4. commitment to and expectation of death by suicide. strength of intent reflected in belief in lethality of method rather than actual lethality.
5. specific ideas person has about impending suicide attempt.
6. purposeful action that is related with implicit/explicit intent to die, regardless of objective lethality of method.
7. Self-inflicted injury X associated with implicit/explicit intent to die.

Question 2

Epidemiology

Answer 2

1. for ppl aged 15-44, 4th leading cause of death worldwide, 6th leading cause of ill health and disability
2. Male more common
3. Midlife and older people in developed countries. <30y in developing countries.

Question 3

Risk f:

Answer 3

1. Strong:
   - Male(probably due to more lethal means)
   - Correctional setting: more so if male, young(20-25), unmarried, first-time offender arrested for a minor
   - FHx
   - Childhood physical and sexual abuse
   - Suicidal plan
   - Previous attempt(16x increase if ≥2 attempts
   - Hx of mental disorder: most prevalent are major depressive disorder and substance abuse
   - availability of lethal means: firearms highest case-fatality
2. Weak:
   - FHx of psych illness
   - Psychosocial stressors
   - Employment status: medical/dental profession, unemployed
   - Marital status: divorced, single, widowed
   - Physical illness: esp CNS and physical impairment

Question 4

MANAGEMENT:

a) Immediate management
b) Long-term management

Answer 4

a) - does patient need in-patient psychiatric care? detention under MHA or voluntary basis?
- would patient benefit from input of home, outreach or crisis teams?
- existing social supports?
- reducing access to means of self-harm ie weekly dispensing of medication

b) - Tx of psychiatric illness
- optimising social functioning
- crisis planning ie access to emergency psychiatric services, telephone counselling

Question 5

RISK F.

a) Epidemiological
b) Clinical

Answer 5

a) - Male/younger females
- LGBT
- Prisoners(esp remand)
- marital status: single, divorced, widowed
- unemployment
- certain occupations: doctor, vet, nurse, farmer
- Low socioeconomic status
- isolation

b) - psychiatric illness(anorexia nervosa has strongest association)/personality disorder
- previous self-harm
- alcohol dependence
- physical illness
- FHx(depression, alcohol dependence, suicide)
- recent adverse life-events