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Suicide & mood disorder


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Suicide & mood disorder

  2. 2. REFERENCES <ul><li>Suicide risk in mood disorders, Zoltan Riehmer, </li></ul><ul><li>Curr Opin Psychiatry. 2007;20(1):17-22 . </li></ul><ul><li>2. Principle of suicide risk assessment </li></ul><ul><li>How to interview depressed patient and tailor treatment </li></ul><ul><li>Richard L. Frierson, Margaret Melikian, Peggy C. Wadman </li></ul><ul><li>Postgrad Med 2002;112(3):65-71 </li></ul>
  3. 3. DEFINITION <ul><li>SUICIDE: self-inflicted death with evidence that the person intended to die </li></ul><ul><li>SUICIDE ATTEMPT: self-injurious behavior with nonfatal outcome with intention of dying </li></ul><ul><li>SUICIDAL IDEATION: thoughts of wanting to die; seriousness varies </li></ul>Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry 5 th edition
  4. 4. WHY BOTHER ? <ul><li>90% of suicide victims & attempters  1 current axis 1 major mental disorder (mainly untreated) </li></ul><ul><ul><li>Major Depressive Episode (MDE) : 56-87 % </li></ul></ul><ul><ul><li>Substance Use Disorder : 26-55 % </li></ul></ul><ul><ul><li>Schizophrenia : 6-13 % </li></ul></ul><ul><li>“ state-dependent” phenomenon: </li></ul><ul><ul><li>During MDE: 78-89 % </li></ul></ul><ul><ul><li>Dysphoric Mania: 11-20 % </li></ul></ul><ul><ul><li>Euphoric Mania / Euthymia: 0-7 % </li></ul></ul>
  5. 6. PREDICTING RISK FACTORS <ul><li>SAD PERSONS (Patterson and colleagues) </li></ul>
  6. 7. SCORE
  7. 9. APPROACHING SUICIDAL PATIENT <ul><li>What was the precipitant for the event? </li></ul><ul><li>Was it planned? </li></ul><ul><li>What was the method of self harm? </li></ul><ul><li>Did you leave a suicidal note? </li></ul><ul><li>Was you alone at the time of event? </li></ul><ul><li>Was you intoxicated? </li></ul><ul><li>Did you seek any precautions against discovery? </li></ul><ul><li>Did you seek help after the attempt? </li></ul><ul><li>How did you feel when you was found? </li></ul>HISTORY OF PRESENT ILLNESS
  8. 10. EXTENT OF SUICIDAL IDEATION <ul><li>When did you begin to have suicidal thoughts? </li></ul><ul><li>Did any event precipitate the suicidal thoughts? </li></ul><ul><li>How often do you think about suicide? </li></ul><ul><li>How much control do you have over your suicidal ideas? </li></ul><ul><li>Do you regard yourself as a burden, or that your life isn’t worth living? </li></ul><ul><li>What makes you feel better : contact with family member/use of substance </li></ul><ul><li>What makes you feel worse? </li></ul><ul><li>Do you have a plan to end your life? </li></ul><ul><li>What stops you from killing yourself? </li></ul>
  9. 11. PLANS FOR FURTHERANCE AND LETHALITY <ul><li>Do you own a gun or access to firearms? </li></ul><ul><li>Do you have access to potentially harmful medications / drugs? </li></ul><ul><li>Have your imagined your funeral / how people will react to your death? </li></ul><ul><li>Have you practiced your suicide; put gun to head / held meds in hands </li></ul><ul><li>Have you change your will / life insurance policy / give away your possessions? </li></ul>
  10. 12. ASSESS CURRENT SITUATION <ul><li>If you are to going to the same situation again, has anything change? </li></ul><ul><li>Outlook on the future </li></ul>