Updated: 11/30/2019

Suicide

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Topic
Review Topic
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N/A
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Questions
2
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Evidence
6
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Topic
Snapshot
  • A 47-year-old physician with a history of alcohol abuse and depression is transferred to the ER after being found on the floor of his apartment next to an empty bottle of oxycontin and a handle of whiskey.  Prior to this event, he had been giving away large amounts of money and was very thorough in creating a will.
Introduction
  • 8th leading cause of death in US
    • third leading cause ages 15-24 years
  • Risk factors
    • SAD PERSONS
      • Sex - male
        • females attempt more, males succeed more
      • Age - > 45 years
      • Depression or other mental illness
      • Previous suicide attempts
      • Ethanol/substance abuse
      • Rational thoughts/Race
        • whites at higher risk
      • Sickness - chronic illness
      • Organized plan/access to weapons
      • No spouse
        • marriage is protective
        • children of divorced parents at risk
      • Social support lacking Socioeconomic class
        • upperclass professionals at increased risk
Presentation
  • Symptoms
    • complaints of suicide
    • demonstration of suicidal behavior
      • giving away possessions, writing a will, or buying materials for suicide
Evaluation
  • Take a suicide history
    • must ask if patient is having suicidal thoughts or has a plan
    • take all threats seriously
    • detain and hospitalize
    • do not identify with the patient
    • do not leave patient unsupervised
Treatment
  • Hospitalization  
    • "contract of safety"
      • have patient sign on admission
    • regardless if patient refuses
    • also includes self-injurious behavior with suicidal ideation 
      • cutting, burning, intentional harm
  • Nonpharmacologic
    • electroconvulsive therapy - for severe risk of acute self-harm
  • Pharmacologic
    • antidepressants
    • antipsychotic
    • mood stabilizers
Prognosis, Prevention, and Complications
  • Prognosis
    • best predictor of a future suicide attempt is a past attempt 
  • Complications
    • suicide risk may increase after starting antidepressant therapy
      • energy (to act on suicidal ideation) returns before mood symptoms

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Questions (2)
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(M2.PY.15.130) A 17-year-old white female with a history of depression is brought to your office by her parents because they are concerned that she is acting differently. She is quiet and denies any changes in her personality or drug use. After the parents step out so that you can speak alone, she begins crying. She states that school has been very difficult and has been very depressed for the past 2 months. She feels a lot of pressure from her parents and coaches and says she cannot handle it anymore. She says that she has been cutting her wrists for the past week and is planning to commit suicide. She instantly regrets telling you and begs you not to tell her parents. What is the most appropriate course of action? Tested Concept

QID: 105800
1

Prescribe an anti-depressant medication and allow her to return home

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(0/22)

2

Explain to her that she will have to be hospitalized as she is an acute threat to herself

86%

(19/22)

3

Refer her to a psychiatrist

5%

(1/22)

4

Tell her parents about the situation and allow them to handle it as a family

5%

(1/22)

5

Prescribe an anti-psychotic medication

0%

(0/22)

M 7 E

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Evidence (7)
EXPERT COMMENTS (7)
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