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Updated: Dec 27 2021


  • 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
        • 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
    • 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
  • Complications
    • Suicide risk may increase after starting antidepressant therapy
      • energy (to act on suicidal ideation) returns before mood symptoms
  • Prognosis
    • Best predictor of a future suicide attempt is a past attempt
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