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OSCEs > Suicide risk assessment > Flashcards

Suicide risk assessment Flashcards

1
Q

How should you open a consultation when assessing suicide risk?

A

Intro etc

  • “I’m here to talk about the events that have led you to be admitted to hospital”
  • Explain that some questions will be difficult to answer and reassure that what they tell you will be kept confidential (unless there is risk to patient or another person)
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2
Q

What is the purpose of a suicide risk assessment?

A
  • Establish that patient’s intent
  • Assess the seriousness and perceived seriousness of their attempt
  • Assess how they feel about the attempt at the time of assessment
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3
Q

What questions should you ask about ‘before’ the attempted suicide/episode of self-harm?

A
  1. Was there a precipitant?
    - argument, psychological, physical, or social problems
  2. Was the self-harm planned or impulse?
    - write a suicide note
    - leaving a will
    - terminating contracts
  3. Were are precautions taken against discovery?
    - closing curtains
    - locking doors
    - waiting until they knew no one would be home
    - going somewhere remote
  4. Was alcohol used?
    - ask about the amount and type of alcohol
    - ask about previous alcohol use
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4
Q

What questions should you ask about when attempted suicide/episode of self-harm was taking place (‘during’)?

A
  • What method of self-harm was involved?
  • Was the patient alone?
  • Where were they when they self-harmed?
  • What was going through their mind at the time?
  • Did they think their self-harm would end their life?
  • What did they do straight after the self-harm?
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5
Q

What questions should you ask about ‘after’ the attempted suicide/episode of self-harm?

A
  • Did the patient call anyone? How did they get to A&E? Who were they found by?
  • How did they feel when help arrived?
  • How does the patient feel about the attempt now? Do they regret it?
  • What is the patient’s current mood?
  • Does they patient still feel suicidal?
  • If the patient were to go home today, what would they do?
  • If the patient were to feel like this again, what might they do differently?
  • What does the patient think might prevent them from doing this again in the future?
  • Does the patient feel there is anything to live for?
  • Will the patient accept treatment?
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6
Q

What specific questions do you need to ask if the event involved an overdose?

A
  • What medication(s) did the patient take?
  • Where did the patient get the medication from?
  • How much of the medication did the patient take?
  • What did the patient take the medication with?
  • What did the patient think that amount of medication would do?
  • What made the patient decide to take the medication/how long had they been thinking about taking an overdose for?
  • What did the patient do after taking the medication?
  • How did the patient get to the hospital?
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7
Q

What specific questions do you need to ask if the even involved cutting?

A
  • Where are the cuts?
  • How many cuts are there?
  • How deep are the cuts?
  • How did the patient feel when they were cutting?
  • How did the patient feel when they saw blood?
  • What was the patient hoping the cutting would do?
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8
Q

What mental health disorders do you need to screen for that increase the risk of suicide?

A
  • Depression
  • Psychosis
  • Anorexia
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9
Q

How should you screen for depression?

A
  1. Anhedonia:
    - do you feel that you no longer enjoy activities that you previously used to?
  2. Low mood:
    - how has your mood been recently?
  3. Fatigue:
    - what have your energy levels been like recently?
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10
Q

How should you screen for psychosis?

A
  1. Thought insertion:
    - are the thoughts to harm ever not your own?
  2. Auditory hallucinations:
    - do you ever feel like there are voices that you can hear telling you to harm yourself, that no one else can hear?
    - how do you know these are other peoples’ voices and not your own worries in your head?
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11
Q

How do you screen for anorexia?

A
  • How would you describe your eating habits?
  • Do you feel you’re eating enough at the moment?
  • What is your appetite like at the moment?
  • Have you lost weight recently?
  • Are you satisfied with your current weight?
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12
Q

What questions should you ask about self-harm?

A
  • Has the patient ever carried out self-harm in the past?
  • What methods of self-harm were involved?
  • Did they get any help from their support network or other agencies as a result of their self-harm?
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13
Q

What should you ask the patient about their past psychiatric history?

A
  • Does the patient have nay psychiatric diagnoses?

- Has the patient had any previous admissions to a psychiatric hospital?

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14
Q

What should you ask the patient about their family history?

A
  • Have any of the patient’s family members every attempted or completed suicide?
  • Are there any psychiatric conditions present in close family members?
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15
Q

What is important to ascertain from social history when assessing suicide risk?

A
  1. Living situation
    (support network, children being neglected etc)
  2. Occupation
    (are they coping financially, do they have any debt?)
  3. Alcohol
  4. Recreational drugs
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16
Q

What should be your management in patients you feel are low risk?

A
  • Patients who are low risk may be discharged home without follow-up with
  • If discharging without follow-up, you must formulate a safety plan and signpost to appropriate agencies
17
Q

How do you formulate a safety plan?

A
  1. Encourage patient to seek support from family and friends (ask who they have already told)
  2. Recognise stressors and address them where possible
  3. Avoid harmful alcohol use when stressed
  4. Ask the patient who they could tell if they felt like this again
  5. Suggest that they can seek help from a number of placed:
    - Personal support network
    - GP
    - Local support line (Samaritans)
    - A&E
    - Local mental health services
  6. Signpost to patients to appropriate agencies:
    - GP
    - Housing services
    - Citizen’s advice bureau
    - Alcohol and drugs services
    - Domestic violence services
    - Counselling services
18
Q

What should you advise if the patient requires support from a mental health team?

A
  • Discuss about whether the patient could safely manage at home with the support of intensive home treatment team OR
  • Will they accept voluntary admission to a psychiatric hospital
19
Q

What should you do if a patient is unsafe to send home?

A
  • May be clear that they are high risk of completing suicide or further self-harm and lack insight
  • These patients require assessment under Mental Health Act and most likely require inpatient admission

OSCEs (45 decks)

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