Suicide and risk assessment Flashcards
What is a risk assessment in a psychiatric context?
assessing the risk of self-harm, suicide and/or risk to others
What are 12 examples of protective factors against suicide?
- children at home
- pregnancy
- strong religious beliefs or spiritual belief that suicide is immoral
- strong social support
- positive coping skills
- positive therapeutic relationship
- supportive living arrangements
- life satisfaction
- fear of physical act of suicide
- fear of disapproval by society
- responsibility for others
- hope for the future
What are 13 risk factors for suicide?
- history of DSH or attempted suicide
- psychiatric illness - depression, schizophrenia, substance misuse, alcohol abuse, personality disorder
- childhood abuse - sexual/physical
- family history - suicide/suicide attempt in 1st deg
- medical illness - disabling, painful or terminal
- male gender
- age 40-44 in men
- unemployed/low socioeconomic status
- occupation: vets, doctors, nurses, farmers
- access to lethal means: firearms, hanging, strangling, suffocation
- low social support/live alone/institutionalised e.g. prisons/soldiers
- single/ widowed/ separated/ divorced
- recent life crisis e.g. bereavement, family breakdown
What are 6 common clinical features of individuals who are suicidal?
- preoccupation with death - thoughts, fantasies, ruminations
- sense of isolation and withdrawal from society
- emotional distance from others
- distraction and lack of pleasure - in own world, anhedonia
- focus on the past - dwell on past losses and defeats, anticipate no future
- feelings of hopelessness and helplessness
What is the mnemonic to remember risk factors for suicide following attempted suicide?
Note: Planned Attempts Are Very Frightening!
- Note left behind
- Planned attempt of suicide
- Attempts to avoid discovery
- Afterwards help was not sought
- Violent method
- Finals acts: sorting out finances, writing a will
What are 3 investigations useful for a patient who is suicidal/ attempted suicide?
- Medical investigations according to the method e.g. drug levels
- Questionnaires: Tool for Assessment of Suicide Risk (TASR), Beck Suicide Intent Scale
- Suicide can be confirmed by post-mortem
What are 2 examples of questionnaires to assess suicide risk?
- Tool for Assessment of Suicide Risk (TASR)
- Beck Suicide Intent Scale
What are 5 differences between suicide and self-harm?
- Suicide more common in males, SH in females
- Risk of suicide increases with age but SH more common in young people
- Suicide may be planned meticulously, SH impulsive
- Suicide act is more violent but SH in form of overdose or cutting
- Physical and psychiatric illness common with suicide, less common with SH
What are 7 aspects of the risk assessment for suicide?
- Exploring suicidal ideation
- Exploring suicidal intent
- Exploring risk factors
- Perform mental state examination
- Explore protective factors
- Explore risk to others (including children) and risk from others
- Formulate management plan
What are 3 questions to ask to explore suicidal ideation?
- How do you feel about your future?
- Do you feel that life is worth living?
- Have you ever thought about taking your own life?
What are 11 questions to consider for exploring suicide intent?
- What precipitated the attempt? Was it planned?
- What method did you use?
- Was a suicide note left? Any other preparations before acting e.g. will?
- Were you intoxicated with drugs or alcohol?
- Were you alone?
- Were there precautions taken to avoid discovery?
- Did you think you were certain to die even if received medical attention?
- What was the degree of premeditation? How long had they been contemplating suicide for? What plans before acting?
- Did you seek help after attempt, or were they found and brought in by someone else?
- How do you feel about it now - regret or wish they had succeeded?
- How do you feel about being found? Relieved or angry?
What are 5 questions to ask to help explore risk factors for suicide?
- anything in particular making you feel this way? can you tell me about it?
- have oyu ever tried anything like this before?
- are you aware if you are suffering from any mental health illness?
- do you have any health problems bothering you at the moment?
- is there any family history of suicide, attempted suicide or self-harm?
What are 5 key aspects of the mental state examination to perform?
- APPEARANCE
- dishevelled, unkempt/unclean, evidence of suicidal behaviour e.g. wrist lacerations
- BEHAVIOUR
- MOOD
- low mood, flat affect
- THOUGHTS
- delusions about benefits of suicide e.g. family will be better off, obsession with taking own life
- PERCEPTION
- may have second person auditory command halluciantions telling to kill oneself in pscyhotic depression/schizophrenia
What are 53 questions to ask to explore the risk to others?
- do you ever have thoughts of harming others?
- do you have close contact with any children?
- document name, DOB, place of residence, enquire nature of relationship
- do you ever feel threatened or at risk from others?
How can you approach formulating a management plan following a risk assessment?
determine whether patient low, medium or high risk and formulate management plan accordingly, depending on degree of planning, severity of attempt and ongoing concerns about risk
