Suicide Risk Assessment

Question 1

suicide as cause of death

Answer 1

4th - 10-65yo
3rd - 15-24 yo
2nd - 25-34

5% are inpatient

Question 2

strongest predictor of suicide

Answer 2

psych illness

Question 3

suicide prediction

Answer 3

foretelling if suicide will/not occur at SOME FUTURE TIME

based on risk factors

Question 4

suicide (risk) assessment

Answer 4

clinical judgement of risk in VERY NEAR FUTURE

based on clinical details/hx

No one specific risk factor or set of risk factors is identified as specifically predictive of suicide

Question 5

suicide risk assessment steps

Answer 5

1. risk factors
2. protective factors
3. do specific suicide inquiry
4. risk level determination & intervention
5. documentation

Question 6

Risk Factors

Answer 6

PRIOR SUICIDE ATTEMPT

Suicidal behavior
Current/past psychiatric disorders
SX (impulsivity, hallucinations, hopelessness, anhedonia)
Family hx - STATIC
Precipitant/Stressors (HUMILIATING events)
Change in TX
Access to firearms

Question 7

Protective Factors

Answer 7

Internal (coping, RELIGIOUS beliefs)

External (marriage, children, pregnancy, pet, social support)

Question 8

Suicide Inquiry

Answer 8

Ideation (frequency, intensity)
Plan
Behavior (past attempts)
Intent)

Question 9

HIGH risk level

Answer 9

Psych dx w/ severe sx + stressors

LETHAL attempt or ideation/rehearsal

Hospitalization + Suicide Precautions

Question 10

MODERATE risk level

Answer 10

Many risk factors
Few protective factors

Suicide ideation with plan. NO intent

?admission pending risk factors

develop crisis/emergency plan

Question 11

LOW risk level

Answer 11

Modifiable risk factor
Strong protective factor

Thoughts of death. NO plan, NO intent

outpatient referral, sx reduction

emergency contacts

Question 12

Documentation

Answer 12

risk level & basis for it

TX plan for reducing risk

+/- firearms

Question 13

suicide rates

Answer 13

male complete more suicide (early 20s and >70s)
elderly - more lethal

female attempt more (early 20s)

Question 14

Demographics

Answer 14

White, Native americans > other races

INC risk: LGBTQ

INC risk: docs/healthcare

Question 15

Bipolar & suicide

Answer 15

bipolar Men and women at equal risk

Question 16

Mood disorders & suicide

Answer 16

+ depression in suicidal pts

Question 17

substances

Answer 17

INC # of substances used, INC risk

Question 18

genetics

Answer 18

suicide is independent, inheritable risk factor

Question 19

chronic illness

Answer 19

INC risk > fatal illness

Question 20

domestic partner abuse

Answer 20

INC risk for victim, abuser, witness/children

Question 21

past hospitalization

Answer 21

INC of suicide risk immediately following discharge and remain high for the following week - month.
need FUP with psych

Question 22

exceptions for protective factors

Answer 22

children in home - women in postpartum with psychotic or mood dx

pregnancy exception - teenager, socioeconomic hardship

Question 23

MODIFIABLE Factors

Answer 23

Patient safety
TX x psych dx
Tx sx - agitation/anxiety
Psychological problems
Social problems

Question 24

NON modifiable factors

Answer 24

Demographics
Past HX
Family HX
Financial difficulties
Unemployment

Question 25

ECT tx

Answer 25

short term reduction

Question 26

Benzodiazepine

Answer 26

Dec risk by tx anxiety

Question 27

Antidepressants

Answer 27

Dec risk x depressive pts

Question 28

Lithium

Answer 28

ANTI-SUICIDE effect

anticonvulsants do not

Question 29

Clozapine (antipsychotic)

Answer 29

DEC risk x schizophrenia & schizoaffective dx