Suicide (Lauren🌭)

Question 1

Are these all the same thing:

Suicidal Ideation

Suicidal Plan

Suicidal intent

Suicide Attempt

Completed Suicide

Answer 1

No

Suicidal ideation- thinking about suicide. Can range from fleeting thoughts to a detailed plan

Suicidal plan- developing an action plan, getting rid of things, changing your will, etc

Suicidal intent- intention to ACT on the above plan

Suicide attempt- follows through with plan to injure themselves in a way that causes death. Seriousness varies: taking 3 sleeping pills vs gunshot wound

Completed suicide- death by one’s own intended action

Question 2

Why should we not say someone “Commited suicide?”

Answer 2

It implies criminality.

We should say “death by suicide” or “completed suicide” instead

Question 3

Who attempts suicide more often, vs who is more likely to die from suicide: men or women

Answer 3

Women attempt more often

Men are more likely to die from suicide

Question 4

What groups of people have higher rates of suicide?

Answer 4

Native Americans

Alaskan Natives

White people

Veterans

Sexual minority youth

Survivors** (of school shootings, mass trauma, etc)

Question 5

What is the BIGGEST risk factor for suicide?

Answer 5

PREVIOUS SUICIDE ATTEMPT
⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️

This will be on the test

Question 6

What kinds of psychiatric illnesses can increase someone risk for suicide?

Answer 6

Previous suicide attempt

Mood disorder (depressed, bipolar)

Psychotic disorder

Substance use disorder

PTSD

ADHD

TBI

Cluster B personality disorder/traits

Conduct problem

Question 7

What is anhedonia?

Answer 7

No interest/enjoyment in anything

Question 8

What are “command hallucinations”

Answer 8

Auditory hallucinations (“voices”) telling the patient to harm themselves

Question 9

Does family history increase risk of suicide?

Answer 9

Yes.

FH of attempted/completed suicide or psychiatric hospitalization would indicate a certain severity of illness in the family

Question 10

What kind of life stressors can increase the risk of suicide?

Answer 10

Event causing hulmiliation, shame, despair (job loss, bankruptcy, etc)

Chronic pain or acute medical problem

Sexual or physical abuse

Substance intoxication or withdrawal

Pending incarceration or homelessness

Legal problem

Inadequate social support, isolation

Perceived burden on others

Question 11

What kind of changes in someone’s psychiatric treatment can increase their risk of suicide?

Answer 11

RECENT PSYCHIATRIC HOSPITALIZATION

Change in provider

Change in treatment 💊

Hopelessness or dissatisfaction with treatment

Lack of compliance or no treatment at all

Question 12

After someone has had a psychiatric hospitalization, when are they at the highest risk of suicide, and what should you do about it?

Answer 12

Highest risk in first 3 days of leaving a psych hospital.

Get a follow up appointment within 3 days of dischatge

Question 13

What are the WARNING SIGNS that someone may be thinking about suicide?

Answer 13

Feeling like a burden

Being isolated🕴

Increased anxiety

Feeling trapped or in unbearable pain

Increased substance use💉

Looking for a way to access lethal means👀

Increased anger or rage🗣

Extreme mood swings🧟‍♂️

Expressing hopelessness 🤦‍♀️

Sleeping too little or too much🛌

Talking or posting about wanting to die💻

Making plans for suicide 📅

Question 14

What is akathisia?

Answer 14

Restlessness, marching in place, restless legs

Question 15

Why does alcohol intoxication increase suicide risk?

Answer 15

Makes you more likely to do things you wouldn’t normally do

Question 16

What are some Observable HIGH risk things that increase someone’s risk of susicide?

Answer 16

Agitation

Anxiety

Psychomotor activity

Emotional lability (mood swings)

Global insomnia

Appetite disturbance

High level distress

Desperation

Akathisia

Alcohol intoxication

Question 17

What are some Observable LOW risk factors (not ~protective~ against suicide, these are still risk factors, just lower)

Answer 17

Somnolent, sleeping

Calm

Hungry, eating

Self-directed actions (“I want…”)

Future directed actions (talking about things in the future)

Manipulative (“If you don’t….I will kill myself”)

Question 18

What are some PROTECTIVE factors that actually protect against suicide?

Answer 18

Children at home

Sense of responsibility to family or pets

Pregnancy

Religious

Life satisfaction

Positive social support

Effective clinical care

Easy access to interventions/support

Support form ongoing providers

Skills in problem solving

Question 19

If someone has protective factors, can we be sure they will never consider suicide?>

Answer 19

No, they can not always counteract an acute suicide risk

Question 20

What’s is SAFE-T?

Answer 20

Its an app that gives you a 5 step way to evaluate someone’s suicide risk and triage them

Question 21

When do you need to assess someone’s suicide risk?

Answer 21

Emergency department or crisis evaluation

Initial patient evaluation (with a psychiatric complaint)

Abrupt change in clinical presentation

Worsening/lack of improvement despite treatment

Significant loss or Social stressor (death in family, job loss)

New illness, especially if life threatening, disfiguring, or with severe pain

Routinely in the treatment of psychiatric illness, in ANY setting (inpatient or outpatient)

In some hospitals and PCPs, it is done routinely on everyone

Question 22

Will asking a patient about suicide put the idea in their heads?

Answer 22

No you should not be afraid to ask

Question 23

How should you ask about suicide in a psychotic patient?

Answer 23

“Do the voices ever tell you to do specific things? Do you obey them? Why are you compelled to obey them?”

“Do they ever try to get you to hurt or kill yourself?”

Question 24

When you are assessing someone’s suicide risk, is it OK to get the bare minimum of info from them?

Answer 24

GET AS MUCH INFO AS POSSIBLE

(Idk she put that in capital letters and big font)

Specify suicidal ideation, plan and intent

OLD CARTS (onset, duration, aggravating, alleviating factors etc)

Ask them about steps taken toward enacting plans

Determine the patients belief about the lethality of the method

Determine if they have the means (gun, supply of meds etc)

Conditions under which the patient would act

Question 25

The Columbia-Suicide Severity Rating Scale is used all the times and has 6 questions. What are those questions?

Answer 25

1. ) Have you wished you were dead or wished you could go to sleep and not wake up?
2. ) have you had any actual thoughts of killing your self?

(If YES to 2, ask questions 3-6. If NO to 2, go directly to question 6.)

3. ) Have you been thinking about how you might do this?
4. ) Have you had thee thoughts and had some intention of acting on them?
5. ) Have you started to work out the details of how to kill yourself? Do you intend to carry out this plan?
6. ) Have you ever done anything, started to do anything, or prepared to do anything to end your life? (Ex: collected pills, obtained a gun, gave away valuables, wrote a will/suicide note, held a gun but changed your mind, went to the roof but didnt jump, etc

If YES, ask: Was this within the past 3 months?

Question 26

What are countertransference issues?

Answer 26

It is when YOUR feelings about the patient change how you assess them.

Ex: you like/trust the patient and believe them when they say it was an accident

Question 27

What should you do if a suicidal patient is intoxicated/

Answer 27

Wait until they’re sober to assess them (but keep them safe in the meantime)

Question 28

What should you do if a suicidal patient is threatening?

Answer 28

Call security/police lol

Question 29

What should you do if a suicidal patient disagrees with your recommendation?

Answer 29

Consider the need for involuntary treatment

Question 30

How do you manage a suicidal patient?

Answer 30

Stabilize medical conditions

Safely contain them (physical/chemical restraint, 1:1 sitter, remove dangerous objects)

Repeated observation/assessment

Remove/treat modifiable risk factors

Question 31

Suicide is often attributed to mental health conditions, but approximately ______% had no known diagnosis at the time of death and a single factor is rarely the cause

Answer 31

50%

Ex: Anthony Bourdain

Question 32

If someone lacks a risk factor, is that a Protective factor?

Answer 32

No.

Example: no substance abuse= yay, but it’s not protective against suicide

Question 33

If you are assessing a minor for suicide risk and you determine she needs inpatient psychiatric treatment, but her parents refuse, what can you do?

Answer 33

Call DCS and they will take temporary custody to get her the treatment she needs

Question 34

I had no idea how to make cards for this lecture that was full of common sense stuff

Answer 34

It might be a good idea just to read through the slides again because i can not say for sure that these cards are a good summary of the entire lecture