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Behavioral Medicine > Suicide > Flashcards

Suicide Flashcards

1
Q

Factors that increase risk of suicide that can be changed: _______ (8)

A
  1. Access to care
  2. Impulsivity
  3. Psychosis
  4. Stress: Unemployment
  5. SI: methods
  6. Social Isolation
  7. SUD
  8. Quality of affect: depressed, anxiety, etc.

( panic, irritation, anger, rage, hopelessness also experienced and changeable)

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2
Q

Factors that increase risk of suicide that cannot be changed: ______ (4).

A
  1. Hx: suicide attempts, family suicide, violence, abuse, psych admission, recent discharge
  2. Male gender
  3. Illness
  4. Alone: widowed or divorced
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3
Q

The protective factors of suicide include ______ (8)

A
  1. Having a family/support system: spouse, chilren, pregnant→responsibility
  2. Culture
  3. Life satisfaction
  4. Problem solving
  5. Fear of the act
  6. Hopefulness
  7. Awareness and willingness to accept help
  8. Access to care
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4
Q

Suicide is the _____ leading cause of death and on the rise.

A

10th

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5
Q

Suicide is the _____ leading cause of death for teens and young adults. ____ attempts per competion.

A
  • 2nd
  • 10-30 attempts
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6
Q

Season for the highest risk of suicide?

Season for the lowest risk of suicide?

A
  • Spring and fall
  • Christmas time
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7
Q

What is the largest risk factor for suicide?

A

Past attempts

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8
Q

Most suicides are completed by ______ (male/female), but most suicides are attempted by _______(male/female).

A
  • males
  • females

(elderly people attempt less but are more successful)

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9
Q

High risk group for suicide include the mentally ill, physicians, elderly, Native American / Alaskan Indian, LGBTQ, ________ (5)

A
  1. Adolescence
  2. Chronic pain patients
  3. Substance use patients
  4. TBI
  5. Veterans
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10
Q

Which psychosocial factors put elderly patients at an increased risk for suicide (6)?

A
  1. Serious relationship Issues
  2. Alone: (living alone, less community involvement)
  3. Financial problems
  4. No Hobbies
  5. Thwarted belongingness and perceived burden
  6. Reluctance to seek healthcare

(lonely, no money, no hobbies, being a burden, won’t go to doc)

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11
Q

Suicide interventions for the elderly

A
  1. Antidepressants
  2. Limiting the size of Overdose drugs (salicylates)
  3. Waiting periods to buy a handgun
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12
Q

Elderly patients who have cancer are at_____ the risk of suicide. Those that have three or more illnesses are at_____ the risk of suicide.

A
  • Cancer (risk X2)
  • 3 + physical illnesses (risk X3)
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13
Q

What puts elderly patients at risk of suicide (6)?

A
  1. Mood disorders
  2. Dementia or cognitive deficits
  3. Illness
  4. Pain
  5. EtOH use
  6. Psychosocial factors
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14
Q

Lifetime riks of suicide in depressed patients

A

15% w/ untreated depression (25x)

(Usually 50% of people who commit suicide had depression)

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15
Q

Panic disorder w/ ______ (co-morbidity) increases risk of suicide even greater than 2xs (which is the stand-alone risk for panic disorder).

A
  • MDD
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16
Q

Anxiety drugs and hypnotics are associated w/ _____ risk of suicide mortality.

A

2x

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17
Q

What are the suicide risk factors for those with mood disorders (3)?

A
  1. Mood congruent delusions
  2. Substance abuse
  3. Antidepressants (lethality)
  4. Stopping Lithium (13x risk)
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18
Q

_______and ______reduce the risk of suicide in bipolar patients by 7xs.

A
  • Lithium
  • clozapine
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19
Q

Which factors involving sleep increase the risk of suicide (3)? Why?

A
  1. Hypersomnia
  2. Insomnia
  3. Nightmares
  • Impaired cognitive fxn → increase hopelessness → less coping
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20
Q

Suicides in children are related to ______.

A

Bullying

(empathy is difficult for people who have not been a victim of bullying)

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21
Q

Females are more likely to ______bully and boys are more likely to ______ bully.

A
  • psychologically
  • physically
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22
Q

Warning signs for suicide in adolescence (5)

A
  1. Sadness, withdrawal from others, losing interest
  2. Sleeping or eating troubles
  3. Reckless or harmful activities
  4. Giving away possessions
  5. Talking about death/dying, saying they can’t handle things, goodbye, or that things would be better without them
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23
Q

Self-harming you through highly predictive of _______

A
  1. Future substance misuse
  2. Suicide
  3. Self-injury mortality
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24
Q

How to prevent teenage suicide related to bullying (5)

A
  1. Take that seriously
  2. Remove the means
  3. Engage teams to talk
  4. Reassure that it’s not their fault
  5. Talk to the authorities
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25
Q

Statistics on physician suicide (how many, risk for men v. women, % mentally ill).

A
  1. 300 – 400 physician suicides/year
  2. Male physicians 1.41x general population risk
  3. Female physicians 2.27x general population risk
  4. 85-90% have a mental illness
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26
Q

Risk factors for suicide in Physicians

A
  1. Fear of losing license
  2. Know how to kill
  3. Vulnerable to culture medicine (unforgiving, praised efficient, competitive)
  4. Personality (perfectionism, hypertrophy altruism in self neglect, poor social skills)
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27
Q

Why don’t Physicians seek help?

A
  1. No time
  2. I can get through without help
  3. Shame / embarrassment
  4. Afraid of the medical board finding out
28
Q

Suicide risk assessment (6)

A
  1. Identify predisposing factors
  2. Elucidate potentiating factors
  3. Ask about suicide ideation
  4. Understand the seriousness of the risk
  5. Assess the nature and quality of suicidality (acute vs. chronic, vulnerability to impulsivity)
  6. Determine level of intervention
29
Q

Screening for suicide risk: Screen for _____ (5).

A
  1. Psychiatric illness
  2. Substance use
  3. Family hx of suicide
  4. Stressors
  5. Firearms
30
Q

Suicide Thoughts with a ______ are the highest risk

A

specific method

31
Q

Lethality is the_______.

A

potential for death associated with the means used to attempt suicide

32
Q

Define intent for suicide

A

Desire to die and the expectation that death would result from the action taken to attempt suicide

(even though lethality attempts may be high risk if the intent is strong enough)

33
Q

What are the advantages of involuntary hospitalization?

A
  1. Patients May retrospectively approve
  2. Provider / Hospital risk management
34
Q

Disadvantages of involuntary hospitalization

A
  1. Negative experiences
  2. Lose self-control self-efficacy self-identity
  3. Can be traumatic
  4. Strange Therapeutic Alliance
  5. May result in negative outcome (longer duration of hospitalization, increased likelihood of rehospitalization, less likely to tell someone next time they’re suicidal)
35
Q

Factors that increase the risk of suicide and racial / ethnic minority immigrants (4)

A
  1. Disrupted social network
  2. Devalued identity
  3. Unemployment
  4. Legal uncertainty

(Latino immigrants and Asian immigrants have an increasing risk of suicide with increased time in the United States)

36
Q

Risk factors for acculturation and suicide

A

Erosion of coping strategies and cultural values

37
Q

Suicide protective factors involving acculturation and suicide

A

Improving social integration into the host country

38
Q

Risk factors for suicide in the individual (7)

A
  1. Hx of abuse (physical or sexual)
  2. Family Hx of suicide
  3. Legal/Financial Difficulty
  4. Jail
  5. Rural living
  6. Gun ownership
  7. Public Humiliation
39
Q

Most common illnesses that lead to hospital suicides (6)

A
  1. Psychosis
  2. Cancer
  3. Chronic pain
  4. COPD
  5. HIV
  6. Renal Dialysis

(Suicide watch is all-or-none, MC means: jumping from height)

40
Q

Depression and obesity are interrelated. The rate of completed suicides decreases with increasing _____.

A

BMI

(most suicides after bariatric surgery occurred in the second and third year after surgery; especially those w/pre-surgical mental health hx)

41
Q

Which chronic pain patients are most likely to complete suicide?

A

Back pain and headaches

(regular opioid users are 75% more likely to have suicidal ideation and 2 times more likely to attempt it)

42
Q

Opioid treatment for pain can be replaced with ______ to decrease the risk of suicide (OD).

A

suboxone

(risk of suicide increases w/the daily dosage)

43
Q

Regular opioid users are_____ more likely to have suicidal ideation and 2 times more likely to attempt suicide

A

75%

44
Q

Chronic pain patients are more likely to be suicidal because pain may be perceived as ______ (3).

A
  1. Inescapable
  2. Intolerable
  3. Interminable (endless)
45
Q

Substance use disorder: Intoxication → _____. Social isolation and financial isses → _____.

A
  1. disinhibition, aggressiveness, and impaired judgement
  2. high risk behaviors

(6x more likely; 63% of suicides had SUD)

46
Q

Risk factors that increase suicide in those with SUD: Family Hx of suicide, older men, depression, ______ (3).

A
  1. Violence
  2. Higher EtOH tolerance
  3. Co-morbid drug use disorder + EtOH use
47
Q

What are the multiple losses of patients with traumatic brain injury that increases their risk of suicide (4)?

A
  1. Employment
  2. Hobbies
  3. Social support
  4. Physical and cognitive functioning

(it may be necessary to screen for psychiatric conditions and suicidal ideation for years after the injury)

48
Q

Traumatic brain injury causes limited problem-solving strategies due to _____ (3).

A
  1. Cognitive deficits
  2. Impulsivity
  3. Poor judgement
49
Q

Behavioral changes in patients with traumatic brain injury: Agitation, anxiety, apathy, ____ (4).

A
  1. Depression
  2. Disinhibition
  3. Irritability
  4. Liability
50
Q

Suicide & TBI: interventions (3)

A
  1. Consistent monitoring and follow-up
  2. Repeat instructions and involve others
  3. Ask about SI

(be patient with them)

51
Q

_____ of suicide victims have had contact w/PCP a month before suicide completion.

A

50%

(usually little contact w/mental health)

52
Q

Link between guns and the very high suicide rates in veterans (3)?

A
  1. Usually owned at least 1 gun
  2. Loaded gun at home
  3. Public carry

(also, they aren’t afraid of guns)

53
Q

Risk factors for suicide, other than guns, in veterans (4)?

A
  1. PTSD & depression
  2. TBI
  3. Substance abuse disorders (esp. opioid)
  4. Low resources

(those who go to the VA have less risk)

54
Q

Trauma survivors at greatest risk of suicide?

A
  1. Sexual or childhood abuse
  2. Combat survivors
  3. Police
  4. EMT
  5. Firefighters

(those who don’t express feelings are at greatest risk)

55
Q

Trauma and suicide: highest risk factors (4)

A
  1. Male
  2. No social support
  3. Family Hx of suicide
  4. Gun ownership
56
Q

Early childhood homelessness and suicide may be accounted for by ____

A

threatened brain development, learning & lifelong health

(2xs the rate of depression)

57
Q

LGBTQ have ____ xs as much SI and _____xs as many attempts compared to the general population. Each episode of harrassmewnt increases the likelihood of suicide.

A
  • 3xs
  • 5xs

(more serious attempts)

58
Q

_____ of Transgender adults have attempted suicide (92% of these before 25-yo).

A

40%

(Rejected family (8.4x risk))

59
Q

When a pt is in danger of committing suicide we commonly miss the most opportune moments before the onset of the issue. Recognition & intervention is key.

Suicide risk assessment: (6)

A
  1. ID predisposing factors
  2. Elucidate potentiating factors
  3. Ask about suicidal ideations
  4. Collateral information helps understand the seriousness
  5. Assess nature and quality of suicidality
  6. Determine level of intervention
60
Q

How do you assess nature and quality of suicidality (3)?

A
  1. Acute vs. chronic
  2. Vulnerability to acting it out
  3. How solid is their therapeutic alliance
61
Q

4 main factors of managing acute suicide risk:

A
  1. Understand the problem: what caused it
  2. Address high-risk environmental factors
  3. Address mood & behavioral facors
  4. Focus on problem-solving
62
Q

What are the high-risk environmental factors to consider in management of acute suicide risk?

A
  1. Reduce isolation
  2. Attempt to stop traumatic events
  3. Counteract suidical behaviors
  4. Limit weapons access
63
Q

What are the mood and behavioral factors to consider in management of acute suicide risk (4)?

A
  1. Observe affect rather than content
  2. Evaluate pt’s ability to tolerate mood
  3. Consider short-term somatic treatments
  4. Identify reasons for living
64
Q

When managing acute suicide risk, what problems can you help to solve (3)?

A
  1. Cognitive distortions
  2. Suggestions of dealing w/situations
  3. Reinforce their adaptive reasoning
65
Q

Before discharging a patient from the office or ER, what factors should you consider (7)?

A
  1. Medical/psychiatric stability
  2. What has changed?
  3. Commitment to not complete suicide
  4. Firearms/means secured
  5. Acute precipitants resolved
  6. Arrange F/U
  7. Social support agrees with d/c plan

Behavioral Medicine (35 decks)

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