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Management of mental disorders > Suicide risk assessment > Flashcards

Suicide risk assessment Flashcards

1
Q

Risk factors for suicide: epidemiological, psychiatric, past history

A

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

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2
Q

SAD PERSONS risk

A

Sex (male)

Age

Depression

Prior attempt

Ethanol

Rational thinking loss

Suicide in family

Organised plan

No spouse

Serious illness

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3
Q

Clinical presentation

A

Hopelessness

Anhedonia

Insomnia

Anxiety

++Impaired consciousness

Psychomotor agitation

Panic attacks

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4
Q

Approach to every patient

A

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

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5
Q

What is passive ideation

A

Would rather not be alive but has no active plan

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6
Q

Assessment of suicidal ideation

A

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

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7
Q

Assessment of suicide attempt

A

Setting

Planned

Intoxication

Medical attention

Time lag from attempt to ED

Expectations of lethality, dying

Reaction to survival

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8
Q

Management-GeneralDepressionAlcoholPersonalityPsychosisParasuicidalLong term

A

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

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9
Q

Self harm

A

Any act done with the knowledge it is harmful

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10
Q

Key areas to assess in suicide attempts

A

Suicide risk factors

Suicide intent, seriousness

Risk of self harm

MSE

Current social support

Most appropriate help

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11
Q

What factors suggest +suicide intent

A

Planning

Precautions taken to avoid discovery/rescue

Dangerous method

No help was sought after the act

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12
Q

How to assess ideation

A

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

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13
Q

What considerations to make in management

A

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

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14
Q

Define self harm

A

Any act done with knowledge it is potentially harmful

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15
Q

Define suicide

A

Intentionally and successfully ending one’s life

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16
Q

Psychiatric illness as a risk factor

A

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

17
Q

Psychiatric illness associations- specific conditions

A

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

18
Q

Components of MSE

A

Current mood state

Other psychiatric illness

Current suicidality

Protective factors

19
Q

Immediate management considerations

A

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

20
Q

Long term management considerations

A

Management of psychiatric illness

Optimise social functioning

Crisis planning

Management of mental disorders (3 decks)

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