risk assessment and management in psychiatry

Question 1

what kind of risk factors exist? (3)

Answer 1

1. static - historical
2. stable - long term but not fixed
3. dynamic - changing over time - more manageable

Question 2

what is at risk in mental disorder?

Answer 2

1. self
2. others
3. to own mental health

Question 3

why is risk assessment important?

Answer 3

1. identify adverse outcomes
2. rank outcomes in likelihood
3. differentiate what we can change and what we can’t
4. risk management

Question 4

deaths from suicide annually?

Answer 4

1 million

Question 5

suicide vs homicide in UK?

Answer 5

10x

Question 6

gender ireland suicide?

Answer 6

m>f when young

but female rates in young have doubles in last 10yrs

Question 7

year of suicide decriminalised?

Answer 7

1993

1995 - task force, prevention measures

Question 8

how many people commit suicide in ireland per year

Answer 8

600

Question 9

people who commit suicide - rate of mental prob, previous attempts?

Answer 9

60%

36% previous attempt

Question 10

what is parasuicide?

Answer 10

self harming action that is non habitual and has a non fatal outcome

BASICALLY DSH

NB risk factor for completed suicide - risk in year after 30-50x

Question 11

what’s the national registry of self harm?

Answer 11

collects data on people presenting to ED with DSH - covers all general and paeds EDs in ireland

Question 12

most common methods DSH?

Answer 12

drug OD

1. tranquilisers
2. paracetamol
3. antidepressants/mood stabilisers

second most common is cutting - more in younger

Question 13

alcohol and DSH?

Answer 13

in 40% of DSH presentations

Question 14

repetition of DSH?

Answer 14

higher risk with cutting

high risk repetition

Question 15

what is anomic suicide?

Answer 15

happens when attachment between the person and society are strained

Question 16

media and suicide

Answer 16

reporting of suicide - increased rates- there are guidelines for responsible reporting

Question 17

economics and suicide?

Answer 17

lower rates in war

higher in economic prosperity and decline

Question 18

occupations with high rates suicide?

Answer 18

doctors - poor help-seeking, stigma
vets
armed and police forces

Question 19

risk factors for suicide?

Answer 19

1. male
2. social class 1 + 4
3. single
4. unemployed
5. elderly
6. chronic pain/ill
7. previous attempts
8. ideation
9. mental illness
10. substances
11. fhx
12. recent hosp d/c

Question 20

is DSH a risk for suicide?

Answer 20

yes

Question 21

rational suicide

Answer 21

without a mental illness
still often change mind
still should try to prevent

Question 22

rate of death in 1st attempt of suicide?

Answer 22

55%

most who die by suicide never referred to psych

Question 23

if someone says they attempted suicide what do you want to ask about?

Answer 23

1. before: plan/events/final acts/note/knowledge of method used - perceved lethality
2. during: what, where, how avoided discovery, did they contact anyone
3. after: how were they discovered, regret, future plans?

Question 24

parasuicide questions?

Answer 24

1. post discharge accommodation
2. substance abuse
3. intention to repeat
4. has it changed anything
5. will they engage with MHS?

Question 25

what is SADPERSONS?

Answer 25

assesses RFs in patients after an episode of self harm

Question 26

outline SADPERSONS

Answer 26

1. sex 2. age 3. depression hx 4. previous attempt 5. ethanol 6. reality break - psychosis/delirium 7. social support 8. organised plan 9. no spouse 10. sickness

Question 27

people with mental health are likely to ________ crime

Answer 27

be the victims of

Question 28

mental health problems ______ violence

Answer 28

have a small association with

Question 29

homicide by the mentally ill is _______

Answer 29

not increasing

Question 30

homicides by the mentally ill are mostly due to _______

Answer 30

system failures

Question 31

RFs for violence

Answer 31

1. personal - previous violence 2. illness related - psychotic, substance abuse 3. mental state - planning, threats, anger, command hallucinations 4. situational - access to weapons

Question 32

what is an SPJ?

Answer 32

structured professional judgement- combination of clinical and actuarial risk assessment - ex. is the HCR 20

Question 33

purely clinical risk assessment efficacy -

Answer 33

not great

Question 34

MHA and risk?

Answer 34

can involuntary treatment if risk to self or others or a risk to their mental health