Flashcards in Caring for Patients with Suicide Risk: Building a Foundation for Assessment, Screening, and Treatment Deck (52)
Research has shown that most adolescent suicides occur when and where?
after school hours and in the teen’s home
Most adolescent suicide attempts are precipitated by ___________ __________. The intent of the behavior appears to be to effect change in the behaviors or attitudes of others.
Approximately 90% of those who complete suicide suffer from at least one major psychiatric disorder
1. WHat are consistently the most prevalent disorder (49-64%)
2. The 2nd most frequent diagnosis is a what?
1. Mood disorders
2. Substance abuse disorder.
Here’s an Easy-to-Remember Mnemonic for the Warning Signs of Suicide: IS PATH WARM?
Describe each sign.
Expressed or communicated ideation threatening to hurt or kill him/herself, or talking of wanting to hurt or kill him/herself; and/or looking for ways to kill him/herself by seeking access to firearms, available pills, or other means; and/or talking or writing about death, dying or suicide, when these actions are out of the ordinary.
Increased alcohol or drug use
No reason for living; no sense of purpose in life, start giving things away because there’s no purpose in keeping anything, no reason to maintain their hygiene
Anxiety, agitation, unable to sleep or sleeping all the time, difficulty concentrating
Feeling trapped (like there’s no way out and things will never get better)
No future orientation
Withdrawal from friends, isolating from family and society
Rage, uncontrolled anger, seeking revenge, irritable
Acting reckless or engaging in high risk activities, seemingly without thinking, impulsive behavior (especially in younger people)
Dramatic mood changes, flat affect, depressed mood, acting out of character
What does QPR stand for?
QPR: Direct Verbal Clues?
1. “I’ve decided to kill myself.”
2. “I wish I were dead.”
3. “I’m going to commit suicide.”
4. “I’m going to end it all.”
5. “If (such and such) doesn’t happen, I’ll kill myself.”
QPR: Indirect Verbal Clues?
1. “I’m tired of life, I just can’t go on.”
2. “My family would be better off without me.” “Who cares if I’m dead anyway.”
3. “I just want out.”
4. “I won’t be around much longer.”
5. “Pretty soon you won’t have to worry about me.”
QPR: Behavioral Clues?
1. Any previous suicide attempt
2. Acquiring a gun or stockpiling pills
3. Co-occurring depression, moodiness,
4. Putting personal affairs in order
5. Giving away prized possessions
6. Sudden interest or disinterest in religion
7. Drug or alcohol abuse, or relapse after a period
8. Unexplained anger, aggression and irritability
QPR: Situational Clues?
1. Being fired or being expelled from school
2. A recent unwanted move
3. Loss of any major relationship
4. Death of a spouse, child, or best friend, especially if by
5. Diagnosis of a serious or terminal illness
6. Sudden unexpected loss of freedom/fear of punishment
7. Anticipated loss of financial security
8. Loss of a cherished therapist, counselor, teacher, or pet
9. Fear of becoming a burden to others
QPR: Tips for asking the suicide question?
1. If in doubt, don’t wait, ask the question
2. If the person is reluctant, be persistent
3. Talk to the person alone in a private setting
4. Allow the person to talk freely
5. Give yourself plenty of time
6. Have your resources handy; QPR Card, phone
numbers, counselor’s name and any other information that might help
QPR: Less Direct Approach?
1. “Have you been unhappy lately? “
2.“Have you been very unhappy lately?”
3. “Have you been so very unhappy lately that you’ve been thinking about ending your life?”
4. “Do you ever wish you could go to sleep and never wake up?”
QPR: Direct Approach?
1. “You know, when people are as upset as you seem to be, they sometimes wish they were dead. I’m wondering if you’re feeling that way, too?”
2. “You look pretty miserable, I wonder if you’re thinking about suicide?”
3. “Are you thinking about killing yourself?”
1. “Will you go with me to get help?”
2. “Will you let me help you get help?”
3. “Will you promise me not to kill yourself
until we’ve found some help?”
1. Suicidal people often believe they cannot be helped, so
you may have to do more.
2. The best referral involves taking the person directly to someone who can help.
3. The next best referral is getting a commitment from them to accept help, then making the arrangements to get that help.
4. The third best referral is to give referral information and try to get a good faith commitment not to complete or attempt suicide. Any willingness to accept help at some time, even if in the future, is a good outcome.
The strongest predictor of suicide is a what?
Suicide Risk factors: The Big Four?
1. Past Suicide Attempt
2. Diagnosis of mood disorder
3. Increasing use/abuse of alcohol or drugs
4. History of self-harm (e.g. cutting)
Signs specific to Adolescents
1. Volatile mood swings or sudden change in personality
2. Indications that they are in unhealthy, destructive, or
3. Sudden deterioration in hygiene
Signs specific to Adolescents
1. Fixation with death (poems, letters, chat rooms)
2. Eating disorders, especially combined with dramatic
shifts in weight
3. Gender identity issues
Signs specific to the Elderly
1. Stockpiling medications
2. Buying a gun
3. Giving away money or possessions or sense of urgency to settle estate or finalize will.
4. Taken sudden interest or loss of interest in religion.
5. Failure to care for themselves in terms of the routine activities of daily living.
6. Withdrawing from relationships
7. Experiencing failure to thrive, even after appropriate
8. Scheduling a medical appointment for vague symptoms.
9. Chronic issues of pain management Undiagnosed depression
Depression in the elderly
Before a diagnosis of depression is made, screen for some common health issues that can affect mood, including?
2. Thyroid disorders
3. Multiple Sclerosis
4. Heart attack
6. Parkinson's disease
9. Hormonal imbalances
10. Vitamin B12 deficiency
11. Electrolyte imbalances or dehydration
12. Some Viral Infections
Depression in the Elderly: The following medications may cause symptoms of depression? 4
The following medications may cause symptoms of depression:
1. blood pressure medication
2. arthritis medication
Specific medications that are currently being
investigated for their role in possibly causing
1. Anticonvulsives such as Depakote, Lyrica, and Neurontin.
2. Smoking cessation medication Chantix.
3. Allergy medication Singulair.
4. Acne medication Accutane
5. Antidepressants (SSRI’s) when used with young people.
Suicide Inquiry: Questions?
1. Thoughts of suicide
4. Access to Lethal Means
The SLUMS is a 1.___-point, 2.___ question screening questionnaire that tests what? 4
Dementia and cognitive function
Protective factors that may mitigate suicide attempts?
1. Effective and appropriate CLINICAL CARE*** for mental, physical, and substance abuse disorders (depression is the one of the most treatable of all psychiatric disorders)
2. Easy access to a variety of CLINICAL INTERVENTIONS and support for help seeking
3. RESTRICTED ACCESS to highly lethal methods of suicide
4. Family and community SUPPORT
5. Support from ongoing medical, mental health
and substance abuse CARE RELATIONSHIPS
6. Learned SKILLS in problem solving, conflict
resolution, and nonviolent handling of disputes
7. CULTURAL and RELIGIOUS beliefs that discourage suicide and support self-preservation instincts
1. Utilizing friends and family members that can be contacted in order to distract from suicidal thoughts.
2. Contacting health professionals or agencies, including 911 and the 1-800-273-TALK or going to the emergency room.
3. Reducing the potential for use of lethal means.
4. Encourage a support network
5. Help patient develop a pre-determined list of supportive individuals and their contact information. The network may include friends, family, clergy/minister, co-workers, therapist, suicide lifeline number.
6. Encourage patient to utilize network even when they are not a critical level.
7. Practice Coping Strategies
-Patients who are familiar with their own triggers and cues can utilize coping strategies and may be able to prevent themselves from reaching a point where they feel out of control.
8. Practice Coping Strategies
- Questions to help patient identify triggers
9. SAFETY PLAN
10. Documentation and followup care
11. Developing an office protocol for hospitalization
Office Protocol: Questions to answer in developing your office protocol are?
1) What are the laws in your state regarding involuntary admission?
2) Where will all necessary forms for hospitalizing suicidal patients be kept?
3) What psychiatric units are closest?
4) Is there a mental health provider in your area?
If someone has major depression disorder how much greater risk are they at for suicide?