Kk&s Ch.34 Emergency Psychiatry

Front 1

Suicide death rate?
world range?

Back 1

12.5 per 100,000
10 to 25

Front 2

Men commit suicide more than ? times as often as women, a rate that is stable over all ages

Back 2

4

Front 3

Women, , are ? times more likely to attempt suicide than men

Back 3

4

Front 4

Men's higher rate of completed suicide is related to

Back 4

the methods they use: firearms, hanging, or jumping from high places

Front 5

Globally, the most common method of suicide is

Back 5

hanging

Front 6

Suicide rates (increase/decrase) with age and underscore the significance of the midlife crisis. Among men, suicides peak after age ?; among women, the greatest number of completed suicides occurs after age?

Back 6

Suicide rates increase with age and underscore the significance of the midlife crisis. Among men, suicides peak after age 45; among women, the greatest number of completed suicides occurs after age 55

Front 7

Rates of ? per 100,000 population occur in men age 65 and older

Back 7

40

Front 8

Older persons attempt suicide (more or less) often than younger persons,

They are (more or less) often successful.

Back 8

Older persons attempt suicide less often than younger persons, but are more often successful.

Front 9

older persons account for ? percent of suicides

Back 9

25%

Front 10

The rate for those 75 or older is more than ? times the rate among young persons.

Back 10

3

Front 11

The suicide rate, however, is rising most rapidly among

The suicide rate for females in the same age group is increasing more (slowly/faster) than that for males.

Back 11

young persons, particularly males 15 to 24 years of age, and the rate is still rising.

The suicide rate for females in the same age group is increasing more slowly than that for males.

Front 12

Suicide is the ? leading cause of death in those 15 to 24 years of age, after ?

Back 12

3rd

accidents and homicides

Front 13

Most suicides now occur among those aged ?

Back 13

15 to 44

Front 14

? of every three suicides are white males

Back 14

2

Front 15

. Suicide rates among immigrants are (lower or higher) than those in the native-born population.

Back 15

higher

Front 16

Marital status and suicide risk?

Back 16

marriage lessens risk
divorce incrases

Front 17

The higher a person's social status, the (lower or higher) the risk of suicide,

a fall in social status increases the risk

Back 17

igher

Front 18

The weight of current evidence supports the conclusion that both male and female physicians in the United States have elevated rates of suicide, with (males or females) at particularly high ris

Back 18

females

Front 19

Studies show that physicians who commit suicide have a mental disorder, most often ?

Back 19

depressive disorder, substance dependence, or both

Front 20

Among physicians,
which speciality at highest risk of suicide

Back 20

psychiatrists are considered to be at greatest risk, followed by ophthalmologists and anesthesiologists, but all specialties are vulnerable.

Front 21

Suicides increase slightly in (season)

what about during December and holiday periods.

Back 21

No significant seasonal correlation with suicide has been found. Suicides increase slightly in spring and fall but, contrary to popular belief, not during December and holiday periods.

Front 22

About ?of all persons who commit suicide have had medical attention within 6 months of death and a physical illness is estimated to be an important contributing factor in about ? of suicides.

Back 22

33%


50%

Front 23

Factors associated with illness and contributing to both suicides and suicide attempts are

Back 23

oss of mobility, especially when physical activity is important to occupation or recreation; disfigurement, particularly among women; and chronic, intractable pain. Patients on hemodialysis are at high risk. In addition to the direct effects of illness, the secondary effects—for example, disruption of relationships and loss of occupational status—are prognostic factors.

Front 24

Certain drugs can produce depression, which may lead to suicide in some cases. Among these drugs are

Back 24

reserpine (Serpasil), corticosteroids, antihypertensives, and some anticancer agents

Front 25

Almost ? percent of all persons who commit or attempt suicide have a diagnosed mental disorder.

Depressive disorders account for ? percent of this figure, schizophrenia accounts for ? percent, and dementia or delirium for ? percent.

Back 25

95%

80% Depression

10% Sz

5% Dementia & Delirium

Front 26

Persons with ? are at highest risk of suicide.

Back 26

delusional depression

Front 27

Risk factors that increase suicide?

Back 27

A history of
impulsive behavior or violent acts increases the risk of suicide as does

previous psychiatric hospitalization for any reason

Front 28

Diagnoses of ? and ? occurred most often among suicides in persons less than 30 years of age,

and diagnoses of ? disorders and ? disorders most often among suicides in those age 30 and above

Back 28

Diagnoses of substance abuse and antisocial personality disorder occurred most often among suicides in persons less than 30 years of age, and diagnoses of mood disorders and cognitive disorders most often among suicides in those age 30 and above

Front 29

Stressors associated with suicide in those under 30 were

over 30?

Back 29

<30
separation,
rejection,
unemployment, and
legal troubles

>30 illness

Front 30

Psychiatric patients' risk for suicide is ? times that of nonpatients.

Back 30

3 to 12

Front 31

inpatients have ?higher suicide risks, respectively, than their counterparts in the general population.

psychiatric outpatients?

Back 31

5 to 10X

3 to 4X

Front 32

The psychiatric diagnosis with greatest risk of suicide in both sexes is

Back 32

a mood disorder.

Front 33

suicide risk is highest in the ? week of the psychiatric admission; after ?weeks, inpatients have the same risk as the general population.

Back 33

suicide risk is highest in the first week of the psychiatric admission;
after 3 to 5 weeks, inpatients have the same risk as the general population.

Front 34

Times of staff rotation, particularly of the psychiatric residents, are periods associated with inpatient suicides

True or False?

Back 34

True

Front 35

Epidemics of inpatient suicides tend to be associated with

Back 35

periods of ideological change on the ward, staff disorganization, and staff demoralization.

Front 36

Studies show that ? of depressed patients who commit suicide do so within 6 months of leaving a hospital; presumably they have relapsed.

Back 36

33% or more

Front 37

A follow-up study of 5,000 patients discharged from an Iowa psychiatric hospital showed that in the first 3 months after discharge, the rate of suicide for female patients was ? times that of all Iowa women; the rate of suicide for male patients was ? times that of all Iowa men

Back 37

275 X

70X

Front 38

The main suicide risk groups are patients with

Back 38

depressive disorders, schizophrenia, and substance abuse, and

patients who make repeated visits to the emergency room.

Front 39

Patiente who frequent emergency services have an increased suicide risk

True or False?

Back 39

True
especially those with panic disorder

Front 40

Nevertheless, the age-adjusted suicide rates for patients with mood disorders have been estimated to be ? per 100,000 for male patients and ? per 100,000 for female patients.

Back 40

400 male

180 female

Front 41

People with MDD commit suicide
more early in illness or later?

Back 41

early

Front 42

Patients with depressive disorder in the community who commit suicide tend to be ?age group

Back 42

middle-aged or older.

Front 43

is social isolation a risk for suicide?

Back 43

Yes
> risk if single, sep, divor, widowed, bereaved, isoalted

Front 44

Suicide among depressed patients is likely at
onset, middle, end of
depressive episode?

Back 44

at the onset or the end of a depressive episod

Front 45

Are less than adequate treatment
not being in therapy but having a history of therapy risk factors for suicide

Back 45

Regarding outpatient treatment, most depressed suicidal patients had a history of therapy; however, less than half were receiving psychiatric treatment at the time of suicide. Of those who were in treatment, studies have shown that treatment was less than adequate. For example, most patients who received antidepressants were prescribed subtherapeutic doses of the medication.

Front 46

The suicide risk is high among patients with schizophrenia: Up to ? percent die by committing suicide

Back 46

10%

Front 47

The onset of schizophrenia is typically in adolescence or early adulthood, and

most
of these patients who commit suicide do so during (early, late, in middle of illness course)

Back 47

the first few years of their illness; therefore, those patients with schizophrenia who commit suicide are young.

Front 48

the risk factors for suicide among patients with schizophrenia are

Back 48

young age,
male gender,
single marital status,
a previous suicide attempt,
a vulnerability to depressive symptoms, and
a recent discharge from a hospital

Front 49

? percent of suicides among patients with schizophrenia occur during the first few weeks and months after discharge from a hospital;

% ? commit suicide while inpatients

Back 49

Up to 50 percent of suicides among patients with schizophrenia occur during the first few weeks and months after discharge from a hospital;

only a minority commit suicide while inpatients.

Front 50

Up to ? percent of all alcohol-dependent persons commit suicide

Back 50

15%

Front 51

The suicide rate for those who are alcoholic is estimated to be about ? per 100,000 annually

Back 51

270

Front 52

About ? percent of all alcohol-dependent suicide victims are male

Back 52

80%

Front 53

As many as ? percent of all alcohol-dependent suicide victims have experienced the loss of a close, affectionate relationship during the previous year.

Back 53

50%

Front 54

The suicide rate for persons who are heroin dependent is about ? times the rate for the general population

Back 54

20X

Front 55

An estimated ? percent of patients with antisocial personality disorder commit suicide

Back 55

5%

Front 56

Suicide is ? times more common among prisoners than among the general population.

Back 56

3X

Front 57

Uncompleted suicide attempts are made by almost 20 percent of patients with

Back 57

a panic disorder and social phobia

If depression is an associated feature, however, the risk of completed suicide rises.

Front 58

Best indicator of increased risk of suicide?

Back 58

A past suicide attempt is perhaps the best indicator that a patient is at increased risk of suicid

Front 59

Studies show that about ? percent of depressed patients who commit suicide have made a previous attempt.

Back 59

40%

Front 60

The risk of a second suicide attempt is highest within? months of the first attempt.

Back 60

3

Front 61

The clinical feature most often associated with the seriousness of the intent to die is

Back 61

a diagnosis of a depressive disorde

Front 62

19th century by the French sociologist Emile Durkheim. In an attempt to explain statistical patterns, Durkheim divided suicides into three social categories: egoistic, altruistic, and anomic.

Explain each

Back 62

Egoistic suicide applies to those who are not strongly integrated into any social group


Altruistic suicide applies to those susceptible to suicide stemming from their excessive integration into a group, with suicide being the outgrowth of the integration—for example, a Japanese soldier who sacrifices his life in battle.

Anomic suicide applies to persons whose integration into society is disturbed so that they cannot follow customary norms of behavior.
nomie also refers to social instability, and a general breakdown of society's standards and values.

Front 63

Freud stated his belief that suicide represents

Back 63

aggression turned inward against an introjected, ambivalently cathected love object. Freud doubted that there would be a suicide without an earlier repressed desire to kill someone else.

Front 64

A study by Aaron Beck showed that ? was one of the most accurate indicators of long-term suicidal risk

Back 64

hopelessness

Front 65

Is low or high CSF 5-HIAA associated with suicide attempts?

Back 65

LOW
5-HIAA is a serotonin metabolite
(reflecting low serotonin

Front 66

Low concentrations of 5-HIAA in CSF predicts future suicidal behavior.

True or False?

Back 66

True

Front 67

Strongest evidence of suicide being genetic?

Back 67

The strongest evidence suggesting the presence of genetic factors in suicide comes from adoption studies carried out in Denmark.

Searches of the causes of death revealed that 12 of the 269 biological relatives of these 57 adopted suicide victims had themselves committed suicide, compared with only 2 of the 269 biological relatives of the 57 adopted controls

Front 68

Tryptophan hydroxylase (TPH) is an enzyme involved in the biosynthesis of serotonin. A polymorphism in the human TPH gene has been identified, with two alleles—U and L.

Which one of these is more associated with risk of suicide attempts?

Back 68

L allele
(UL or LL = > risk)
UU = least risk

Front 69

The presence of one TPH*L allele may indicate a reduced capacity to

Back 69

hydroxylate tryptophan to 5-hydroxytryptophan in the synthesis of serotonin, producing low central serotonin turnover and, thus, a low concentration of 5-HIAA in CSF.

Front 70

Parasuicide is a term introduced to describe patients who injure themselves by self-mutilation (e.g., cutting the skin), but who usually do not wish to die. Studies show that about ? percent of all patients in psychiatric hospitals have cut themselves; the female-to-male ratio is almost 3 to 1.

Back 70

4%

3 F: 1Male

Front 71

The incidence of self-injury in psychiatric patients is estimated to be more than ? times that in the general population.

Back 71

50X

Front 72

Self-injury is found in about ? percent of all abusers of oral substances and ? percent of all intravenous users admitted to substance-treatment units.

Back 72

30 % oral substances
10% IV

Front 73

The wrists, arms, thighs, and legs are most commonly cut; the ??? are cut infrequently.

Back 73

face, breasts, and abdomen

Front 74

Most persons who cut themselves claim to experience no pain and give reasons, such as

Back 74

anger at themselves or others,
relief of tension,
and the wish to die

Front 75

parasuicidal behaviour associated with what traits?

Back 75

Most are classified as having personality disorders and are significantly more
introverted,
neurotic, and
hostile than controls

Front 76

Most "cutters" have attempted suicide
true or false?

Back 76

True

Front 77

Psychodynamic view of self-mutilation?

Back 77

Self-mutilation has been viewed as localized self-destruction, with mishandling of aggressive impulses caused by a person's unconscious wish to punish himself or herself or an introjected object.

Front 78

Are the following risk factors for suicide?
Homosexual Gender Identity
Early loss or separation from parents
Hypochondriasis
Protestant or non-religious status
Employment
Recent childbirth
Secondary gain
Female Sex
Repression

Back 78

Unemployment and male sex > risk factors
All others true

Front 79

Suicide Risk: provide high/low risk data for
1. Age
2. Sex
3. Marital Status
4. Employment
5. Interpersonal relationships
6. Family background

Back 79

1. Age: > 45; Low <45
2. Sex: Male; L female
3. Marital Status: divorced or widowed vs married
4. Employment: unemployed = high risk
5. Interpersonal relationships: conflictual vs stable
6. Family background: conflictual vs stable

Front 80

Mental health factors associated with suicide

Back 80

severe depression,
psychosis
severe PD
substance abuse
hopelessness

Front 81

Suicide ideation factors:

Back 81

frequent
intense
prolonged

Front 82

high risk factors related to suicide attempts?

Back 82

multiple
planned
unlikely rescue
Wish to die
Communication Internalized : self-blame > risk than externalized
Lethal methods available

Front 83

Most suicides among psychiatric patients are
not preventable
preventable

Back 83

preventable
because evidence indicates that inadequate assessment or treatment is often associated with suicide

Front 84

Factors strongly suggestive of hospitalization

Back 84

But the absence of a strong social support system,
a history of impulsive behavior,
and a suicidal plan of action are indications for hospitalization

Front 85

If the patient refuses hospitalization, the family must take the responsibility to ?.

Back 85

be with the patient 24 hours a day

Front 86

Patients recovering from a suicidal depression are at particular risk
Why?

Back 86

Increased energy to act on suicidal plans

As the depression lifts, patients become energized and, thus, are able to put their suicidal plans into action (paradoxical suicide). A further complication is the activating effect of serotonergic drugs, such as fluoxetine, which are effective antidepressants, especially with suicidally depressed patients. Such agents may improve psychomotor withdrawal, thus permitting the patient to act on preexisting suicidal impulses because they have more energy.

Front 87

Outpatient treatment may be more beneficial than hospitalization: lesser risk of suicide

Describe situation

Back 87

Patient has chronic suicidal ideation and/or self-injury without prior medically serious attempts, if a safe and supportive living situation is available and outpatient psychiatric care is ongoing

Front 88

Admission for sure or maybe?
1. Current impulsive behavior, severe agitation, poor judgment, or refusal of help is evident
2. Patient is male, >45 years of age, especially with new onset of psychiatric illness or suicidal thinking
3. patient regrets surviving
4. Patient has limited family and/or social support, including lack of stable living situation
5. Patient is psychotic

Back 88

All for sure's except
Patient has limited family and/or social support, including lack of stable living situation ... can also be a maybe facto
& Psychosis

Front 89

What goals might help reduce suicide?

Back 89

Educate
Reduce access to lethal means
Train for recognition of suicide risk factors
Increase Tx access
Research
Increase surveillance

1. Promote awareness that suicide is a public health problem that is preventable
2. Develop broad-based support for suicide prevention
3. Develop and implement strategies to reduce the stigma associated with being a consumer of mental health, substance abuse, and suicide prevention services
4. Develop and implement suicide prevention programs
5. Promote efforts to reduce access to lethal means and methods of self-harm
6. Implement training for recognition of at-risk behavior and delivery of effective treatment
7. Develop and promote effective clinical and professional practices
8. Improve access to, and community linkages with, mental health and substance abuse services
9. Improve reporting and portrayals of suicidal behavior, mental illness, and substance abuse in the entertainment and news media
10. Promote and support research on suicide and suicide prevention
11. Improve and expand surveillance systems