Suicide

Question 1

For every suicide, how many attempted suicides are there?

Answer 1

11

Question 2

What is a crisis?

Answer 2

The point in an individual’s life situation, when urgent intervention is required to avoid precipitous deterioration of his/her condition

Question 3

What is the most common source of error in the ED with psychiatric concerns?

Answer 3

Overlooking physical conditions as an underlying cause of emotional distress

Question 4

True or false: psychiatric dx usually stay on a patient’s chart, even after the true etiology is later confirmed

Answer 4

True

Question 5

What is the usual resulting behavior in a provider, when they are afraid of a patient? What are the consequences of this?

Answer 5

• More restrictive measures than necessary

- Start action to regain autonomy

Question 6

What is the usual resulting behavior in a provider, when they over identify with the patient? What are the consequences of this?

Answer 6

Relaxing of precautions and lack of appropriate response

Question 7

What is the usual resulting behavior in a provider, when they are angry at a patient? What are the consequences of this?

Answer 7

• Over-react and control/punish

- Fear in the patient and decreased self closure

Question 8

What is the usual resulting behavior in a provider, when they are feel any measures they provide for a patient are hopeless? What are the consequences of this?

Answer 8

• passive or slow to intervene

- Lack of appropriate response, pt feels more hopeless

Question 9

What are the common chronic medical condition that usually cause thoughts of suicide?

Answer 9

• AIDS
• TBI
• CA
• Epilepsy/Huntington’s
• Spinal cord injuries
• Cardiopulmonary disease

Question 10

What are the three major reasons for suicidal ideation from the internal mental state?

Answer 10

• Feelings of absolute guilt
• Need to escape
• Intolerable emotional states

Question 11

True or false: psychotic patients are more likely to be violent than non-psychotic patients

Answer 11

True

Question 12

True or false: psychotic patients are more likely to be victims of violence, than be perpetrators

Answer 12

True

Question 13

What types of psychotic disorders are more likely to lead to violence?

Answer 13

• Paranoia

- Command hallucinations

Question 14

What type of hallucinations are more likely to lead to violence?

Answer 14

Command hallucinations

Question 15

Which two PDs are particularly prone to violence?

Answer 15

Borderline PD

Antisocial PD

Question 16

What two lobes of the brain that, if injured, lead to violence?

Answer 16

frontal and temporal lobe

Question 17

Is childhood or adolescent aggression more concerning for future violent behavior?

Answer 17

Childhood

Question 18

True or false: a h/o having been victimized leads to a lower incidence of violence in the future

Answer 18

False–risk factor for violence

Question 19

Are males or females a risk factor for violent behavior?

Answer 19

Male

Question 20

What is the triad of symptoms that predicts violent behavior in kids?

Answer 20

• Firesetting
• Cruelty to animals
• enuresis

Question 21

Is a younger or older age a risk factor for violent behavior?

Answer 21

Younger

Question 22

What are the three major questions to ask to assess for violent behavior?

Answer 22

• Thoughts of harming others
• h/o seriously injuring another
• Most violent act ever committed

Question 23

What are the four major steps to take when talking to a potentially violent patient?

Answer 23

1. Multiple communications
2. Alert staff
3. Watch for physical signs and indicators
4. Have all emergency info in place

Question 24

Should you avoid direct eye contact with violent patients?

Answer 24

Yes

Question 25

What should be the character of your voice with violent patients?

Answer 25

Remain calm and speak quietly

Question 26

Where should you be relative to the patient and the door?

Answer 26

Closer to the door, but not blocking it

Question 27

How far should you stand away from a violent patient?

Answer 27

Leg length

Question 28

True or false: it is best to hospitalize all "at risk" patients, in terms of suicide potential

Answer 28

False

Question 29

What is the only reason to psychiatrically hospitalize a patient?

Answer 29

If they're not safe anywhere else

Question 30

What is the major issue with suicide contracts?

Answer 30

Takes away an "out" patients feel that they have

Question 31

What is the single strongest predictor of attempts at suicide?

Answer 31

Prior h/o attempts (even if minor)

Question 32

True or false: personality disorders increase the risk for suicide

Answer 32

True

Question 33

What is the risk of suicide for a patient who lost a parent to suicide before the age of 18?

Answer 33

3x

Question 34

When, relative to the loss of a loved one, are suicides in related patients particularly high?

Answer 34

Anniversary of loss

Question 35

What is a major risk factor for suicides in the adolescent population?

Answer 35

Suicide of a close friend

Question 36

What is the major problem with medication and suicide?

Answer 36

Increases energy and drive to kill themselves

Question 37

Is fantasy/wish to reunite with a deceased loved one a risk factor for suicide?

Answer 37

Yep

Question 38

What happens to regret levels with increasing attempts at suicide?

Answer 38

Decreases regret

Question 39

What are the risk factors for multiple attempts at suicide?

Answer 39

- Poorer social problem solving skills | - Comorbid conditions

Question 40

True or false: patients with multiple attempts at suicide usually stick to the same means

Answer 40

False--often change their method from nonviolent/non lethal to violent/lethal

Question 41

What are the top three methods of completed suicide?

Answer 41

1. Firearms 2. Suffocation 3. Poison

Question 42

What is the top means of attempted suicide (but not completed)?

Answer 42

Overdose

Question 43

Guns in the home = a (__)x increased risk of dying with an attempt of suicide?

Answer 43

5x

Question 44

What are the three key risk factors for suicide by firearm?

Answer 44

- Social isolation - Ready access to weapon - Alcohol/substance abuse

Question 45

What is the appropriate approach to a suicidal patient?

Answer 45

- Stay positive | - Manage your own emotional reactions

Question 46

What is the best way to avoid feeling too much empathy towards suicidal patients?

Answer 46

Alternate between suicidal and not

Question 47

Why is it particularly important to obtain prior treatment records in assessing a suicidal patient?

Answer 47

They may not be honest about their past experiences

Question 48

What should be documented with suicidal patients? (4)

Answer 48

- Face-to-face assessment- - Initial and ongoing assessment of suicidal risk - Mental status exam - F/u on d/t recommendations

Question 49

With suicidal patients, you should make the treatment plan consistent with what?

Answer 49

- dx - dynamics - suicide risk - Capacity of pt to comply

Question 50

What is the best way of protecting yourself against a lawsuit with suicidal patients?

Answer 50

Document thinking

Question 51

What are the four major steps in the general approach to suicide risk?

Answer 51

- Elicit information for assessment - Place info in context of patient - Determine level of intervention - Plan the nature and frequency of future reassessments

Question 52

What are the three ways of increasing the protective factors in a patient's life?

Answer 52

- Pt cooperation around safety concerns - Alliance and other supportive relationships - Observation or hospitalization

Question 53

What are the two best ways to decrease the strength of risk factors in a suicidal patient?

Answer 53

- Access to weapons, drugs etc. | - Triggering /environmental/ relationships

Question 54

When is hospitalization for a suicidal patient particularly indicated? (4)

Answer 54

- Has no support - Has a h/o impulsive behavior - Has a plan and clear intent - Cannot participate effectively in their own treatment

Question 55

What is the appropriate level of intensity in the response to a suicidal patient?

Answer 55

Parallel the probability of suicide

Question 56

What is the major issue with being too involved in the suicidal patient's life?

Answer 56

Trying to do externally what can only be done internally