Suicide risk assessment Flashcards
Risk factors for suicide: epidemiological, psychiatric, past history
Epidemiological:15-24 yo, >65Male, White, Living alone, no children, Stressful life events, Access to firearms
Incarcerated
Low SES
Occupation: farmer, vet, nursing, doctor
Psychiatric: Mood, Anxiety, Schizophrenia, Substance, Eating, Adjustment, Conduct, Borderline personality
Past:Prior attempt, FHx of attempts/completion
SAD PERSONS risk
Sex (male)
Age
Depression
Prior attempt
Ethanol
Rational thinking loss
Suicide in family
Organised plan
No spouse
Serious illness
Clinical presentation
Hopelessness
Anhedonia
Insomnia
Anxiety
++Impaired consciousness
Psychomotor agitation
Panic attacks
Approach to every patient
Have you thought about harming/killing yourself Passive/Active ideation
How would you do it?
Do you have a plan? (intent)
What is stopping you?
Past attempts->lethality, outcomes, medical intervention
What is passive ideation
Would rather not be alive but has no active plan
Assessment of suicidal ideation
Onset and frequency
Control over suicidal ideation
Lethality- do you want to end your life, what do you think would happen if you actually did
Access
Time and place
Provacative factors- what makes you feel worse
Protection- what keeps you alive
Final arrangements
Practiced attempts/aborted attempts
Ambivalence- must be a part of you that wants to live
Assessment of suicide attempt
Setting
Planned
Intoxication
Medical attention
Time lag from attempt to ED
Expectations of lethality, dying
Reaction to survival
Management-GeneralDepressionAlcoholPersonalityPsychosisParasuicidalLong term
Ensure adequate documentations. Thorough history, MSE. Consider hospitalisation for higher risk.
Safety plan for lower risk->agreement to not harm themselves, avoid alcohol, drugs, situations that may trigger suicidal thoughts.
F/U at designated time. Contact HCW, crisis line, go to ED if feel unsafe/suicidal feelings return.
Contingency planning-> anticipate + risk. If…happens, I will…
Depression- hospitalise if severe/psychotic, OP with support/SSRI
Alcohol- abstinence, usually resolves, ATODS
Schizophrenia: hospitalisation
Parasuicide: psychotherapy, crisis intervention
Personality: crisis intervention, ?hospitalise
Long term:Treatment of psychiatric illness, Optimise social functioning, Crisis planning
Self harm
Any act done with the knowledge it is harmful
Key areas to assess in suicide attempts
Suicide risk factors
Suicide intent, seriousness
Risk of self harm
MSE
Current social support
Most appropriate help
What factors suggest +suicide intent
Planning
Precautions taken to avoid discovery/rescue
Dangerous method
No help was sought after the act
How to assess ideation
Feeling like life isn’t worth living
Feeling like you want to end it all
How close are you to going through with your plan
Anything that might stop you from following through
What considerations to make in management
Do they require inpatient psychiatric care to ensure safety. Would they benefit from home treatment. Do they have existing social support. Reduce access to means of harm- tablets, fire arms
Define self harm
Any act done with knowledge it is potentially harmful
Define suicide
Intentionally and successfully ending one’s life
Psychiatric illness as a risk factor
90% who commit suicide have diagnosable mental illness. Those recently d/c from acute centre have ++risk of suicide
15% risk in bipolar
In depression->anhedonia, hopelessness, shame/guilt, anxiety ++risk
Recently commenced on antidepressant-> psychomotor retardation improved, +activity/motivation to complete
Psychiatric illness associations- specific conditions
Unipolar depression- 20X risk, anxiety, insomnia, BPAD- 15X risk
Schizophrenia- 8.5 X risk, young, intellifent, unemployed, good insight, recurrent
Alcohol- lifetime risk 3-4%, males, poor work, social isolation, previous self harm
Personality- BPD ++ 10% will die
Eating disorders- 30 X risk. Strongest association with suicide
Components of MSE
Current mood state
Other psychiatric illness
Current suicidality
Protective factors
Immediate management considerations
Does the patient need in-patient psychiatric care to preserve safety
Would they benefit from in home/crisis care
Any existing social supports that could be called on
Reducing access to means of harming
Must be reveiwed within 24 hours
If medication required-> 1/2 days only
If community managed, person + supports must know how to access help 24 hours/day
Long term management considerations
Management of psychiatric illness
Optimise social functioning
Crisis planning
