Assessing suicide risk

[nectarine]

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Which of these is most impt in assessing risk for suicide?

Early morning awakening/dec appetite/depression sx
family hx
male
marital status
pt's belief that med ingested could kill them

i'm thinking A but male/marital status are also important. thanks for the help.

 

[NCF145]

Which of these is most impt in assessing risk for suicide?

Early morning awakening/dec appetite/depression sx
family hx
male
marital status
pt's belief that med ingested could kill them

i'm thinking A but male/marital status are also important. thanks for the help.

I put the last one.

 

[Depakote]

I put the last one.

I'd agree with this. The intent behind the suicide attempt tells you a lot...

If the patient took the meds believing they would cause their death, that says a lot about the seriousness of the attempt.

This versus a situation where a patient takes 3x the normal dose of benadryl and immediately calls her boyfriend saying she tried to kill herself. This is more likely your "cry for help" scenario.

 

[nectarine]

hmm, i didn't even think of it that way. but it makes sense. thanks guys.

 

[bola]

Hmmm so I came upon this in Kaplan's Behav Science notes (2005 ed) and they say the greatest risk factors are

- Depressed Mood
- EtOh use
- and chronic illness coming in a far third

PS: I'm guessing this is a completely diff concept from COMPLETING suicide in which case MALE sex is the highest risk factor

 

[SeminoleFan3]

If the scenario involves a plan (i.e. the ingested meds) or is assessing a scenario that's already played out (they DID ingest the meds), the fact that they thought the meds could kill them is the best answer.

 

[Argatroban]

Hmmm so I came upon this in Kaplan's Behav Science notes (2005 ed) and they say the greatest risk factors are

- Depressed Mood
- EtOh use
- and chronic illness coming in a far third

PS: I'm guessing this is a completely diff concept from COMPLETING suicide in which case MALE sex is the highest risk factor

I guess that phrase is another way of stating that it was a previous suicide attempt (Thinking that the pills would kill him) instead of obviously stating previous suicide attempt. In this case, it would be the number 1 risk factor.

 

[bola]

ah good point...and Kaplan is referring to just initial risk.

 

[Depakote]

It basically comes down to:

"When you took those pills, did you expect to die?"

if the patient answers yes, that's makes the patient more of a suicide risk than being male/single/depressed/family history of suicide.

 

[sebsvenmdc]

So, the top criteria for suicide are:

1) MSII
2) Previous attempt
3) MSI
4) Male

 

[doogoshly]

wrd on putting the last one. previous attempt seemed most impt to me too.

 

[DocHolliday1]

from what i remember when I saw this question there was no suggestion of a previous attempt, just b/c the patient believed meds could kill someone

they first choice listed early awakening, decr appetite and a few other signs without directly stating depression

I thought what the question was going for was to recognize the signs of Major Depression (first choice) and then correlate major depression with an incr risk of suicide

I thought the last choice was the distractor, I mean I believe enough Tylenol could kill me, but I'm not suicidal

was I off base?
was this an NBME Q? where did I see this?

 

[nectarine]

it was on NBME 6

 

[silas2642]

So, the top criteria for suicide are:

1) MSII
2) Previous attempt
3) MSI
4) Male

I don't know, I hear MS III is pretty bad, particularly if you're on OB.

 

[silas2642]

Which of these is most impt in assessing risk for suicide?

Early morning awakening/dec appetite/depression sx
family hx
male
marital status
pt's belief that med ingested could kill them

i'm thinking A but male/marital status are also important. thanks for the help.

Yeah, one of the first things you want to know when the dude wakes up is whether or not he actually thought he was going to die when he took the pills. Believing that he was using a lethal means to kill himself is a much better predictor than any of the other ones (especially being a single male-- most of the single men I know are probably happier than the married men I know).

 

[Mortal_Lessons]

from what i remember when I saw this question there was no suggestion of a previous attempt, just b/c the patient believed meds could kill someone

they first choice listed early awakening, decr appetite and a few other signs without directly stating depression

I thought what the question was going for was to recognize the signs of Major Depression (first choice) and then correlate major depression with an incr risk of suicide

I thought the last choice was the distractor, I mean I believe enough Tylenol could kill me, but I'm not suicidal

was I off base?
was this an NBME Q? where did I see this?

It's one thing to assess someone who wasn't admitted for suicide (they're in for angina or whatever) for their risk of a future suicide event. Like taking anyone off the street and assessing their suicide risk. There's a table/chart in HY Behavioral with the top 5 risk factors. It's a whole other thing to assess someone who's been admitted for an attempted suicide for a future suicide event. Then things like intentionality, lethality, etc become very important. Just because someone off the street says "I know taking a lot of Tyelonol can kill me" doesn't mean their risk of suicide is higher. However, if you ask someone who was admitted for an attempted suicide if they think the pills they took would kill them and they say "yes" then that's certainly pertinent information regarding a future suicide event.

 

[nectarine]

Yeah, one of the first things you want to know when the dude wakes up is whether or not he actually thought he was going to die when he took the pills. Believing that he was using a lethal means to kill himself is a much better predictor than any of the other ones (especially being a single male-- most of the single men I know are probably happier than the married men I know).

well, in the question the patient was elderly (i believe). i think losing your spouse especially in the elderly (or really anyone) could be important. i think it's in FA that marital status is used to assess risk. they have like 10 things and there's some dumb mnemonic.