Week 8: Mental health 2 (suicide, self harm and MMSE) Flashcards
Commonest cause of suicide is depression. However not all those suffering will have a mental illness. Can result from a range of factors inc:x
Commonest cause of suicide is depression. However not all those suffering will have a mental illness. Can result from a range of factors inc:
- Psychiatric disorders
- Negative life events
- Psychological factors
- Alcohol and drug misuse
- Family history
- Physical illness
- Access to methods of self-harm
Risk factors for committing suicide
- History of depression
- Previous suicide attempt
- Severe depression
- Anxiety
- Feelings of hopelessness
- Personality disorder
- Alcohol/ drug abuse
- Male gender
- Family history of suicide
- Exposure to suicidal behaviour
- Recent discharge from psychiatric care
protective factors for suicide rsik
- Social support
- Religious belief
- Being responsible for children (esp younger children)
Questions to ask
- Are they feeling hopeless, or that life is not worth living?
- Have they made plans to end their life?
- Have they told anyone about it?
- Have they carried out any acts in anticipation of death (e.g. putting their affairs in order)?
- Do they have the means for a suicidal act (do they have access to pills, insecticide, firearms…)?
- Is there any available support (family, friends, carers…)?
- Where practical, and with consent, it is generally a good idea to inform and involve family members and close friends or carers. This is particularly important where risk is thought to be high.
- When a patient is at risk of suicide this information should be recorded in the patient’s notes. Where the clinician is working as part of a team it is important to share awareness of risk with other team members.
- Regular and pro-active follow-up is highly recommended.
Asking about suicidal ideas
Some patients will introduce the topic
without prompting, while others may be too embarrassed to admit they may have been having thoughts of suicide. However the topic is raised, careful and sensitive questioning
is essential.
- It should be possible to broach suicidal thoughts in the context of other questions about mood symptoms or link this into exploration of negative thoughts (e.g. “It must be difficult to feel that way – is there ever a time when it feels so difficult that you’ve thought about death or even that you might be better off dead?”).
- Another approach is to reflect back to the patient your observations of their non-verbal communication (e.g.
“You seem very down to me”. “Sometimes when people are very low in mood they have thoughts that life is not worth living: have you been troubled by thoughts like this?”).
The interview setting should be
- A quiet room
- Meet patient alone
- Open questioning
- Sometime can be done on telephone but hard to assess none verbal communication
involvement of others
- Recommended that clinicians inform and involve family, friends
- Can help protect against suicide
- Can help reduce access to lethal means
- If patient is not competent to give consent, clinician should act in patients best interest- involve family and friends
managing risk: involvement of others
- Record in patients notes share awareness of risk with other team members
- Arrange a follow up
- Pt should be informed how to best contact you / out of hours in between appointments should an emergency arise i.e. let them know if they feel worse or have increased urges
managing riskL other steps
- Assess whether patients have potential means for a suicide
- Only prescribe limited supplies of medication that might be taken in overdose
- Tricyclic antidepressants e.g. dosulepin
- Paracetamol
- Opiates
- Ask family to dispose of stockpiled medication
- Active treatment of underlying depressive illness is KEY
- If suicide risk is high, particularly when depression is complicated by other mental health problems referral to secondary psychiatric services
- Many clinicians will make informal agreements with patient about what they should do if they feel unsafe or things deteriorate
suicide risk assessment
most significant diff between suicide and self-harm is
intent
Suicide vs self-harm
- Suicide usually comes from a place of despair, hopelessness and worthlessness
- Self harm is used as a way to cope with their feelings and stressors
- Can reassure person that they are still alive when they are experiencing emotional numbness or disconnection
- Physical act of cutting or burning induces pain receptors in the body that triggers the brain to feel an adrenaline rush which can be easily become addictive
- Have some similar risk factors e.g. trauma, abuse, chronic stress, feelings of isolation, depression or anxiety
screening for suicide risk
TASR-AM
Self-harm
when someone takes action to hurt or harm themselves, is still commonly called “deliberate self-harm”. However, it is not an illness but an expression of personal distress, and self-harm for the individual concerned is no more deliberate than blushing would be for many people when in an embarrassing situation.
why self harm
- When someone self-harms, they are usually feeling very emotional and distressed.
- Many describe their self-harm as a way to release overwhelming emotions.
- Can give sense of control
- Some people plan it in advance, others act on the spur of the moment.
- Though some people self-harm only once or twice, others do it regularly – and it can become hard to stop.
MMSE
minim mental state examination
- Ask which hand they right with
- Ask permission to do the test
- I’m going to ask you some questions and give you some problems to solve answer them as best as you can
interpretation of the MMSE
patient exam for GPCOG
informer interview for for GPCOG
