Do females or males have the most suicide attempts? Who is more likely to complete the suicides? What is the most commonly used suicide method?
- males complete suicide 4x more than females
- females attempt 3x more often than males
- firearms - most commonly used suicide method - leads to completion, nearly 50%
What is the No. 1 cause of injury related death in the US?
- suicide
- been 28% increase in number of suicides since 2001
What is the 2nd leading COD among the young (15-24) in US?
- 2nd leading cause of death
- on the rise, rates have increased more than 200% from 50s-90s.
Most adolescent suicide attempts are precipitated by what?
- interpersonal conflicts
- intent of behavior appears to be to effect change in behaviors of attitudes of others
- adolescents are very impulsive
Suicide rate among young veteran men (18-29)?
- 56/100,000 (compared to 20/100,000 for non vets in this age range)
85% of elderly suicides involve which pop?
- males - 7x greater than female suicides
elderly white men
Strong correlation b/t chronic pain and?
- suicide, 20-30% of those who die by suicide have issues with chronic illness or pain
Mood disorders make up what % of suicides?
- 49-64%
- major depression - 20x risk of suicide
- approx 90% of those who complete suicide suffer from at least 1 major psychiatric disorder
- 2nd most frequent dx is a substance abuse disorder
Why is the rebound effect so dangerous?
- greatest suicidal risk is during the first 90 days after depression begins to lift
- suicidal thoughts or attempts were 4x more likely during first 10 days of tx than after 3 months
- highest rate of suicide isn’t while a person is in inpt tx, it is the first 30 days after d/c
Warning signs of suicide - IS PATH WARM?
I: ideation - expressed or communicated ideation threatening to hurt or kill hinself, looking for ways to kill himself or by seeking access to firearms, available pills, or other means, and or talking or writing about death, dying or suicide
S: substance abuse - increased alcohol or drug use
P: purposelessness - no reason for living, giving things away, not maintaining hygiene
A: anxiety - agitation, unable to sleep or sleeping all the time, difficulty concentrating
T: trapped - feeling trapped (like there’s no way out and things will never get better)
H: hopelessness: no fute orientation
W: withdrawal - from friends, isolating from family and society
A: anger - rage, uncontrolled anger, seeking revenge, irritable
R: recklessness - acting reckless or engaging in high risk activities, seemingly w/o thinking, impulsive behavior (esp young peeps)
M: mood change - dramatic mood changes, flat affect, depressed mood, acting out of character
situational cues - of suicidal person?
- being fired or being expelled from school
- recent unwanted move
- loss of any major relationship
- death of spouse, child, or best friend, esp if by suicide
- dx of serious or terminal illness
- sudden unexpected loss of freedom/fear of punishment
- anticipated loss of financial security
- loss of cherised therapist, counselour, teacher or pet
- fear of becoming a burden to others
What is the strongest predictor of suicide? what are the big 4?
- strongest predictor: previous attempt
big 4:
- past suicide attempt
- dx of mood disorder (20-30x the risk)
- increasing use/abuse of alcohol or drugs
- hx of self-harm (cutting)
What are suicidality signs specific to adolescents?
- volatile mood swings or sudden change in personality
- indications that they are in unhealthy, destructive, or abusive relationships
- sudden deterioration in hygeine
- self-mutilation
- fixation with death (poems, letters, chat rooms)
- eating disorders, esp combined with dramatic shifts in wt
- gender identity issues
- depression
What are suicidality signs specific to elderly?
- stockpiling meds
- buying a gun
- giving away money or possessions or sense of urgency to settle estate or finalize will.
- taken sudden interest or loss of interest in religion.
- failure to care for themselves in terms of the routine activities of daily living.
- withdrawing from relationships
- experiencing failure to thrive, even after appropriate medical tx
- scheduling a medical appt for vague sxs
- chronic issues of pain management
- undx depression
What health issues should be screened for in elderly b/f being dx with depression?
- alzheimers
- thyroid disorders
- MS
- heart attack
- stroke
- parkinson’s disease
- cancer
- diabetes
- hormonal imbalances
- vitamin B12 deficiency
- electrolyte imbalances or dehydration
- some viral infections
What meds may cause sxs of depression in the elderly?
- BP meds
- arthritis meds
- hormones
- steroids - prednisone
What meds are being investigated for their role in possibly causing suicidal ideations?
- anticonvulsants such as depakote, lyrics, neurontin
- chantix
- allergy med: singulair
- acne med: accutane
- SSRIs: in young people
How should you approach a pt that has multiple risk factors for suicide?
- suicide inquiry is qarranted
- pts may not spontaneously report ideations but at least 70% communicate their intentions to sig others.
- ask pts directly if they have ever had thoughts about suicide
- ask specifically about duration, frequency, and intensity of thoughts and feelings
- if suicidal ideation is present - ask if they have a plan - get specifics - higher risk level if they have lethal, detailed or specific plan
- determine extent to which pt expects to carry out the plan - lethal vs. self-injurious
- explore pt’s reasons to die vs. reasons to live
- administer MSE if in doubt about mental status
- ask about access to lethal means
What are protective factors?
- they can mitigate risk in pt with moderate to low suicide risk
- building protective factors should be a part of safety planning with pts
examples:
- effective and appropriate clinical care for mental, physical and substance abuse disorders
- easy access to variety of clinical interventions and supprot for help seeking
- restricted access to highly lethal methods of suicide
- family and community support
- support from ongoing medical, mental health and substance abuse care relationships
- learned skills in problem solving, conflict resolution, and nonviolent handling of disputes
- cultural and religious beliefs that discourage suicide and supprot self-preservation instincts
How can a PCP intervene with a suicidal pt?
- encourage a support network: pre-determined list of supportive individuals
- encourage pt to utilize network even when they are not at critical level
- have them practice coping strategies, and become aware of their own triggers - “how do you feel b/f you first notice you are suicidal?, what do you notice in your thoughts and feelings, or in your body?, what are your triggers?”
- ask them what relaxes them, who do you spend time with that makes you feel good?
- encourage journaling
- have them write up a safety plan with you - recog. warning signs and coping strategies
What is impt about documentation when following up with a pt who is at risk for suicide?
- document risk, management plan, actions that occured and any consultation
- you have to make sure you document when you followed up with pt (even f/u contact with pt reduces their risk of repeat attempts)
Tests to screen for depresison and suicidal risk in a pt?
- PHQ-9: screens for depression severity - 15-19 moderately depressed, and 20-27 is severely depressed
- SAFE-T protocol with C-SSRS screening for suicidal behavior
What are the diff categories for the intensity of ideation on the C-SSRS?
- frequency: how many times do you have these thoughts?
- duration: when you have thoughts - how long do they last?
- controllability: could/can you stop thinking about killing yourself or wanting to die if you want to?
- deterrents: is there anyone or anything that has stopped you from wanting to die or acting on thoughts of committing suicide?
- reasons for ideation: what sort of reasons did you have for thinking about wanting to die or kill yourself? Was it pain or to stop the way you were feeling?
On the C-SSRS what is considered high risk? What is the triage and interventions?
- high risk: suicidal ideation with intent or intent with plan in past month or suicidal behavior w/in past 3 months
- triage: refer to psychologist or psychiatrist for eval for hosp, place on facility high risk list
- poss. interventions: assess medical stability, elopement precautions, pharm tx, psychotherapy, safety plam, telephone f/u after d/c
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Neurobiology28
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Sleep Disorders treatment29
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Behavioral Dynamics38
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Psych meds in pregnancy42
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Eating Disorders32
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Peds depression40
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Substance related disorders108
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Psychosis57
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Depression69
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Bipolar26
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Bipolar meds34
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antidepressant meds55
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postpartum mood disorders24
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Suicide31
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Ped Psychiatry50
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ADHD59
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Munchausen Syndrome18
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Personality Disorders47
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Somatoform disorders28
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Death and Grief36
