Suicide Flashcards
For every suicide, how many attempted suicides are there?
11
What is a crisis?
The point in an individual’s life situation, when urgent intervention is required to avoid precipitous deterioration of his/her condition
What is the most common source of error in the ED with psychiatric concerns?
Overlooking physical conditions as an underlying cause of emotional distress
True or false: psychiatric dx usually stay on a patient’s chart, even after the true etiology is later confirmed
True
What is the usual resulting behavior in a provider, when they are afraid of a patient? What are the consequences of this?
- More restrictive measures than necessary
- Start action to regain autonomy
What is the usual resulting behavior in a provider, when they over identify with the patient? What are the consequences of this?
Relaxing of precautions and lack of appropriate response
What is the usual resulting behavior in a provider, when they are angry at a patient? What are the consequences of this?
- Over-react and control/punish
- Fear in the patient and decreased self closure
What is the usual resulting behavior in a provider, when they are feel any measures they provide for a patient are hopeless? What are the consequences of this?
- passive or slow to intervene
- Lack of appropriate response, pt feels more hopeless
What are the common chronic medical condition that usually cause thoughts of suicide?
- AIDS
- TBI
- CA
- Epilepsy/Huntington’s
- Spinal cord injuries
- Cardiopulmonary disease
What are the three major reasons for suicidal ideation from the internal mental state?
- Feelings of absolute guilt
- Need to escape
- Intolerable emotional states
True or false: psychotic patients are more likely to be violent than non-psychotic patients
True
True or false: psychotic patients are more likely to be victims of violence, than be perpetrators
True
What types of psychotic disorders are more likely to lead to violence?
- Paranoia
- Command hallucinations
What type of hallucinations are more likely to lead to violence?
Command hallucinations
Which two PDs are particularly prone to violence?
Borderline PD
Antisocial PD
What two lobes of the brain that, if injured, lead to violence?
frontal and temporal lobe
Is childhood or adolescent aggression more concerning for future violent behavior?
Childhood
True or false: a h/o having been victimized leads to a lower incidence of violence in the future
False–risk factor for violence
Are males or females a risk factor for violent behavior?
Male
What is the triad of symptoms that predicts violent behavior in kids?
- Firesetting
- Cruelty to animals
- enuresis
Is a younger or older age a risk factor for violent behavior?
Younger
What are the three major questions to ask to assess for violent behavior?
- Thoughts of harming others
- h/o seriously injuring another
- Most violent act ever committed
What are the four major steps to take when talking to a potentially violent patient?
- Multiple communications
- Alert staff
- Watch for physical signs and indicators
- Have all emergency info in place
Should you avoid direct eye contact with violent patients?
Yes
What should be the character of your voice with violent patients?
Remain calm and speak quietly
Where should you be relative to the patient and the door?
Closer to the door, but not blocking it
How far should you stand away from a violent patient?
Leg length
True or false: it is best to hospitalize all “at risk” patients, in terms of suicide potential
False
What is the only reason to psychiatrically hospitalize a patient?
If they’re not safe anywhere else
What is the major issue with suicide contracts?
Takes away an “out” patients feel that they have
What is the single strongest predictor of attempts at suicide?
Prior h/o attempts (even if minor)
True or false: personality disorders increase the risk for suicide
True
What is the risk of suicide for a patient who lost a parent to suicide before the age of 18?
3x
When, relative to the loss of a loved one, are suicides in related patients particularly high?
Anniversary of loss
What is a major risk factor for suicides in the adolescent population?
Suicide of a close friend
What is the major problem with medication and suicide?
Increases energy and drive to kill themselves
Is fantasy/wish to reunite with a deceased loved one a risk factor for suicide?
Yep
What happens to regret levels with increasing attempts at suicide?
Decreases regret
What are the risk factors for multiple attempts at suicide?
- Poorer social problem solving skills
- Comorbid conditions
True or false: patients with multiple attempts at suicide usually stick to the same means
False–often change their method from nonviolent/non lethal to violent/lethal
What are the top three methods of completed suicide?
- Firearms
- Suffocation
- Poison
What is the top means of attempted suicide (but not completed)?
Overdose
Guns in the home = a (__)x increased risk of dying with an attempt of suicide?
5x
What are the three key risk factors for suicide by firearm?
- Social isolation
- Ready access to weapon
- Alcohol/substance abuse
What is the appropriate approach to a suicidal patient?
- Stay positive
- Manage your own emotional reactions
What is the best way to avoid feeling too much empathy towards suicidal patients?
Alternate between suicidal and not
Why is it particularly important to obtain prior treatment records in assessing a suicidal patient?
They may not be honest about their past experiences
What should be documented with suicidal patients? (4)
- Face-to-face assessment-
- Initial and ongoing assessment of suicidal risk
- Mental status exam
- F/u on d/t recommendations
With suicidal patients, you should make the treatment plan consistent with what?
- dx
- dynamics
- suicide risk
- Capacity of pt to comply
What is the best way of protecting yourself against a lawsuit with suicidal patients?
Document thinking
What are the four major steps in the general approach to suicide risk?
- Elicit information for assessment
- Place info in context of patient
- Determine level of intervention
- Plan the nature and frequency of future reassessments
What are the three ways of increasing the protective factors in a patient’s life?
- Pt cooperation around safety concerns
- Alliance and other supportive relationships
- Observation or hospitalization
What are the two best ways to decrease the strength of risk factors in a suicidal patient?
- Access to weapons, drugs etc.
- Triggering /environmental/ relationships
When is hospitalization for a suicidal patient particularly indicated? (4)
- Has no support
- Has a h/o impulsive behavior
- Has a plan and clear intent
- Cannot participate effectively in their own treatment
What is the appropriate level of intensity in the response to a suicidal patient?
Parallel the probability of suicide
What is the major issue with being too involved in the suicidal patient’s life?
Trying to do externally what can only be done internally
