Suicide risk assessment and management Flashcards
if a patients discloses they ‘took some pills’ what specific questions do you want to ask?
- what tablets did you take?
- how many tablets did you take?
- where were you when you took the tablets?
- where did you get the tablets?
what antidepressant class is most likely to cause lethality than the others?
tricyclic antidepressants
perceived vs potential lethality ?
potential and perceived lethality are not always the same. 10 paracetamol tablets = potential high but perceived may be low
question to ask in determining the patients perceived lethality of the act (ie taking pills) ?
what did you think would happen when you took the pills?
questions about concealing actions?
did you do anything not to be found ?
questions to ask regarding final acts ?
- was there anything else you did
- was there anything else you did before taking tablets - for example people make sure they have things in order or completed before
- did you do anything else - did you leave a note
- did you drink any alcohol before taking the tablets ?
- . anything else you did before taking tablets?
what is the relevance of a previous suicidal attempt?
- one or more prior suicide attempts is a risk factor for completed suicide
- 18-38% of suicide completers had previously attempted suicide
information needed to determine ‘seriousness of the suicide’ attempt
- perceived lethality
- degree of pre-planning
- efforts to conceal actions
- potential lethality
- level of medical intervention required
- probability of irreversible damage
- degree of impaired consciousness
how can risk factors for suicide be broadly classified ?
- static/stable risk factors
- dynamic risk factors
what are static risk factors for suicide and what are stable risk factors for suicide ?
- static = fixed historical risk factors (history of previous suicide attempt, serious previous suicide attempt)
- stable = long term risk factors that are likely to endure for many years but are fixed (e.g personality disorder - ameniable to treatment but not in the short term
what is the importance of static/ stable risk factors?
give an indication of propensity for suicide but are not the focus of acute risk management
what is the importance of dynamic risk factors?
- condition or circumstances that elevate risk in the short term
- fluctuate in duration and intensity and inform acute risk management
suicidal ideation is an important .. risk factor
dynamic
define suicidal ideation ?
thinking about or formulating plans for suicide
what are examples of dynamic risk factors for suicide
- hopelessness
- suicidal ideation, communication and intent
- psychosocial stress (e.g financial problems and what happened to lead to them, relationship breakdown)
- substance ie alcohol use
- psychological symptoms (depression, anxiety and psychosis)
psychosocial stressors do … significantly contribute to the risk of suicide on their own. However, they are …. . When combined they can act as …. or …. for suicidal behaviour
not
cumulative
triggers/precipitants
there is a strong association between …. and … . Alcohol has been shown to be associated with … of all suicides . alcohol use at the time of suicidal ideation may increase the possibility of … , …. and …. , increasing the liklihood of a potentially lethal outcome. Alcohol is also a …
- alcohol use and suicidal behaviour
- 1/2
- poor judgment, lack of control and mood changes
- depressant
what psychological symptoms are associated with increased risk of suicide?
- certain symptoms, irrespective of diagnosis are important risk factors for suicide
1. depression
2. anxiety - panic, agitation, anxious ruminations
- akathisia (usually an extrapyramidal side effect of antipsychotic is said to be an anxiety state)
3. psychotic symptoms - especially command auditory hallucinations
- delusions of passivity/ control
association between mental illness and suicide. as many as … out of 10 individuals who die by suicide suffer from a mental disorder at the time of their death. virtually all mental disorder are associated with …. risk of suicide. a history of mental disorder is a …. risk factor for suicide. it suggests a greater propensity for suicide in the future (usually by virtue of illness recurrence or relapse). generally suicide risk is highest at the … of treatment and diminishes thereafter. when the course of illness is … , maximum risk occurs at the beginning of the … phase and in the first … months after in patient discharge
- 9
- increased
- background
- beginning
- episodic
- acute
- 3
with regard to schizophrenia and suicide, between … and … % of individuals with schizophrenia die from suicide. Those at most risk include … (4)
- 10-15%
- male gender
- younger age (initial stages of illness)
- co-morbid mood symptoms
- non-compliance with treatment
with regard to affective disorder and suicide, more than … of clinically depressed patients have suicidal thoughts. the lifetime risk of suicide is significantly elevated in major affective disorders. traditionally a figure of around … % is quoted, but more recent studies indicate much lower rates of … %. No conclusive difference have been drawn between unipolar and bipolar patients with regard to life-time risk of suicide. Those most at risk include … (2)
- half
- 16%
- 6%
- severe depressive symptoms and co-morbidity with substance misuse disorder and personality disorders
with regard to anxiety disorder and suicide, there is a risk of suicide in anxiety disorders although … occuring co-morbidly are probably greater significance. Panic disorder has …. been shown as an independent risk factor. It may however … the risk when occuring co-morbidly with other mental disorders such as substance misue disorders and personality disorders
- anxiety symptoms
- not
3.
with regard to suicide and family history of suicide, suicide is a … for suicide. studies indicate that there is an increased risk of both … and … suicide amongst those with relative who has a history of suicidal behaviour. the majority of patients with a family history of suicide also have a history of … . However, even when controlling for …. there appears to be a familial transmission of suicidality
- risk factor
- attempted
- completed
- affective disorders
- mental disorders
background risk factors for suicide
- gender - higher rates in men compared to womens
- male gender is a significant risk factor - age
- in general suicide rates increase with age but suicide is not the most common cause of death among the elderly. two age groups have been identified with increased suicide risk. (a) 15 to 30 years and (b) over 65 years of age
- risk for suicide after age 60 is associated with retirement, social isolation, declining health and other losses - history of suicide attempts
- seriousness of past suicide attempts
- family history of suicide
- history of mental health disorder
- family history of mental health disorder
- previous hospitalization