Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry Clerkship > Suicide Risk Assessment > Flashcards

Suicide Risk Assessment Flashcards

1
Q

When does a suicide risk assessment need to be done?

A
  1. First psychiatric assessment or admission
  2. Before any inpatient discharge
  3. Any suicidal behavior or ideation
  4. Any noteworthy clinical change
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List the demographic categories of suicide risk factors (6).

A
  1. Gender
  2. Age
  3. Race/Ethnicity
  4. Marital Status
  5. Sexual Orientation
  6. Occupation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

List the clinical categories of suicide risk factors (7).

A
  1. Psychiatric illness and history
  2. Physical illness
  3. Psychiatric symptoms
  4. Psychosocial factors
  5. Family history
  6. Past suicide attempts
  7. Patient safety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Suicide risk factors related to gender? Modulating factors?

A

Male > Female (4:1) - in general + with depression; M=F with bipolar disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Suicide risk factors related to age?

A

Adolescence (10-24) - rates rise sharply
Midlife (25-69) - rate plateaus
Elderly (70+) - rates rise again

Adolescence - 200:1 attempts:suicides vs. Elderly - 4:1 attempts: suicides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Suicide risk factors related to race/ethnicity? Modulating factors?

A

Whites, Native Americans > Hispanics, African Americans and Asians (2:1)

If 65+ - Whites, Hispanics, Asians

If teens/early 20’s - Native Americans, African Americans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Suicide risk factors related to marital status?

A

Single > Married (2:1)

Divorced/Separated/Widowed > Married (4-5:1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Suicide risk factors related to sexual orientation?

A

Apparently increased risk for gay, lesbian, or bisexual (limited studies)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Suicide risk factors related to occupation?

A

Increased risk for physicians, dentists, nurses, artists, social workers, mathematicians, scientists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Suicide risk factors related to psychiatric illness? Modulating factors

A

Overall strongest predictor
Prior suicide attempt is the strongest predictor of psychiatric illnesses

Modulating factors:

  • # of substances used in SUDs increase risk
  • Presence of mood symptoms (schizoaffective > schizophrenia, any mood component of an illness)
  • Alcohol use/heavy drinking
  • # of psychiatric illnesses (more diagnoses, more risk)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Suicide risk factors related to physical illnesses?

A
  • When mood symptoms are present
  • Disorders of the nervous system (MS, Huntington, brain/spinal cord injury, seizure disorder)
  • Cancer, HIV/AIDs, PUD, COPD, chronic renal failure treated with dialysis, SLE
  • Pain syndromes, functional impairment, disfigurement, dependence on others, decreased sight/hearing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Suicide risk factors related to psychiatric symptoms?

A

Hopelessness
Anxiety
Impulsivity/Aggression
Command Hallucinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Suicide risk factors related to psychosocial risk factors?

A 
Lack of social support
Poor relationship with family
Domestic partner violence
Drop in SES
Unemployment
Recent severe, stressful life events in vulnerable individuals (interpersonal loss/conflict, economic problems, legal problems, moving)
Humiliating events (high risk stressor)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Suicide risk factors related to past suicide attempts?

A

High intent:

  • Taking measures to avoid discovery
  • More lethal methods
  • Physical injuries from attempt
  • Suicide note (especially when specific)
  • Expecting to die
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Suicide risk factors related to patient safety?

A

Access to firearms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Suicide risk factors related to other psychiatric history?

A

Sexual and physical abuse
Domestic partner abuse
History of psychiatric hospitalization (risk increased shortly after admission and after discharge)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

List 4 dynamic risk factors.

A

Psychiatric illnesses
Psychiatric symptoms
Psychosocial factors such as lack of social support, domestic partner violence
Patient safety (access to firearms)

18
Q

List 9 protective factors associated with a decreased risk of future suicide.

A
  1. Marriage
  2. Sense of responsibility to family (children in the home, pregnancy, exceptions do exist)
  3. Deterrent religious beliefs
  4. Life satisfaction
  5. Reality testing ability
  6. Positive coping skills
  7. Positive social support
  8. Positive therapeutic relationship
  9. Positive problem solving skills
19
Q

Identify the information to obtain in a patient interview about a past suicide attempt.

A
  1. Level of intent
  2. Method/method availability
  3. Timing
  4. Setting
  5. Preparation
  6. Rehearsal
  7. Consequences
  8. Alcohol involved?
  9. Aborted attempts
  10. Expectation of lethality vs. self-harm
20
Q

What are the components of a specific suicide inquiry about current suicidal ideation?

A
  1. Ideation (intensity, frequency, duration - past 48 hours + worst ever)
  2. Plans (timing, location, lethality, availability, preparation)
  3. Behaviors (past attempts, aborted attempts, rehearsals)
  4. Intent (extent patient expects to carry out plan, believes plan to be lethal vs. self-injurious, ambivalence
  5. Suicide note?
21
Q

What are the steps of a suicide risk assessment?

A
  1. Identify risk factors (especially dynamic ones) for suicide
  2. Identify protective factors against suicide.
  3. Do a specific suicide inquiry.
  4. Risk level determination and intervention
  5. Documentation
22
Q

Define low suicide risk and possible interventions.

A

Modifiable risk factors, strong protective factors, thoughts of death but no plan, intent, or behavior

Intervention: outpatient referral, symptom reduction, give emergency/crisis number

23
Q

Define moderate suicide risk and possible interventions.

A

Multiple risk factors, few protective factors, suicidal ideation with plan, but no intent or behavior

Intervention: admission may be needed; depends on risk factors. Develop crisis plan, give emergency/crisis number.

24
Q

Define high suicide risk and possible interventions.

A

Psychiatric diagnosis with severe symptoms or acute precipitating event, protective factors not relevant, potentially lethal attempt or persistent ideation with strong intent or suicide rehearsal

Intervention: admission generally indicated unless a significant change reduces risk, suicide precautions

25
Q

General steps in treatment/intervention of suicide risk?

A

Reduce risk
Attend to patient safety
Address modifiable risk factors
Provide education to family
Monitor psychiatric status and response to treatment
Psychotherapy with a positive and sustaining therapeutic relationship (target issues, manage high risk symptoms, etc.)

26
Q

Possible somatic treatments for suicide risk?

A 
ECT - evidence for short-term reduction
Benzodiazepines - Rx anxiety
Antidepressants - Rx depression
Lithium - anti-suicide effect
Clozipine - decreases suicidality in schizophrenia or schizoaffective disorders
27
Q

deaths by suicide annually in the US? # inpatient suicides?

A

35,000+

5-6% (1,800)

28
Q

Rates of suicide (incidence), ideation, and attempts in the population?

A

Ideation: 5.6% population/year (lifetime prevalence = 13.5%)
Attempts: 0.7% population/year
Incidence: 10.7/100,000 (0.0107%)

29
Q

Suicide is the ___ (#) leading cause of death among people ages 10-65.

A

4th

30
Q

___% of people who die by suicide have a diagnosable illness at the time of their death.

A

90

31
Q

___ of patients who die by suicide have seen a physician within a month of their death.

A

2/3

32
Q

Up to ___ of people have suicidal thoughts at some point in their lives.

A

1/3

33
Q

True or false - there is no accurate way to prospectively predict suicide or suicide attempts.

A

True

34
Q

List # risk factors for homicide/violence.

A
  1. Verbal or physical threats/menacing
  2. Past/recent history of violence (personal or property)
  3. Carrying/obtaining weapons or potential weapons
  4. Progressive psychomotor agitation
  5. Paranoi or command auditory hallucinations
  6. Excessive alcohol use
  7. Frontal lobe/other brain injury
35
Q

Define “duty to protect.”

A

When a patient presents a serious danger of violence toward others, the provider incurs an obligation to use reasonable care to protect the intended victim. This may result in a need to warn the intended victims, to warn others who can warn the intended victims, to notify police, and to do whatever steps are reasonably necessary under the circumstances.

36
Q

How should “danger to others” be assessed?

A

Consider:

  1. Threat (clear or vague)
  2. Danger (serious or marginal)
  3. Victim (identifiable?0)
  4. Timing (imminent?)
37
Q

What is parens patriae?

A

State has a parental responsibility for its citizens

38
Q

What is police power?

A

State has a responsibility for its citizens

39
Q

What are reasons for involuntary psychiatric hospitalization?

A
  1. Danger to self
  2. Danger to others
  3. Unable to care for self
  4. Lack of insight due to the illness, patient expected to deteriorate to the point of engaging in dangerous conduct
40
Q

Describe the process the state of IL uses for initial and continuing involuntary psychiatric hospitalization?

A
  1. Petition (done by anyone except whoever does the certificate)
  2. First certificate (done by a physician, clinical psychologist, or other qualified examiner)
  3. Second certificate (done by psychiatrist with at least 3 years of training)
  4. Court hearing (done or set up within 5 days of the first certificate)

Psychiatry Clerkship (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions