Biggest risk factor for suicide?

[LuckiestOne]

A married 78-year-old man is brought to the emergency department after ingesting ten 15-mg temazepam tablets After he is stabilized medically, he undergoes psychiatric evaluation Which of the following is most important in assessing his risk for suicide?

A) Early morning awakening with decreased appetite
B) Family history of suicide
C) Male gender
D) Marital status
E) Patient’s belief that temazepam wouldkill him

I understand the biggest risk factor would be this attempt to kill himself but I am not sure what the answer would be here... Us clueless med students are all over the answers and all sounds right with enough rationalizing!

If you could share some of your expert opinions I would really appreciate it! Thank you very much.

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[hamstergang]

A) Early morning awakening with decreased appetite

Having MDD is a big risk factor for suicide, but having these 2 symptoms isn't really the same thing. In fact, this is completely normal for a 78 year old. Definitely not the answer.

B) Family history of suicide

Certainly a risk factor. Keep it in consideration.

C) Male gender

Certainly a risk factor. Keep it in consideration. Between B and C, which is the bigger risk factor? This isn't something you can rationalize, you would just need to know the stats (I do not).

D) Marital status

Him being married is a protective factor against suicide, so not this.

E) Patient’s belief that temazepam wouldkill him

I understand the biggest risk factor would be this attempt to kill himself but I am not sure what the answer would be here...

I think that possibly E is saying that this was a suicide attempt, so it would be the answer you're looking for of a previous attempt. I'm not confident, but here's where I'm going.

 

[MedSchoolFool]

I'll bite and say E since it indicates significantly lethal intent and blah, blah, blah.

 

[Salpingo]

A married 78-year-old man is brought to the emergency department after ingesting ten 15-mg temazepam tablets After he is stabilized medically, he undergoes psychiatric evaluation Which of the following is most important in assessing his risk for suicide?

A) Early morning awakening with decreased appetite
B) Family history of suicide
C) Male gender
D) Marital status
E) Patient’s belief that temazepam wouldkill him

I understand the biggest risk factor would be this attempt to kill himself but I am not sure what the answer would be here... Us clueless med students are all over the answers and all sounds right with enough rationalizing!

If you could share some of your expert opinions I would really appreciate it! Thank you very much.

While all of the answer choices are protective/risk factors for suicide, the first thing that I would actively be assessing is the perceived lethality of the overdose. Like you said, the biggest risk factor is a previous attempt, so the first thing you have to figure out if this WAS an actual attempt. A doctor who swallows a handful of benzos has a much different flavor than a cognitively dulled/demented one, making it more of a gesture/mistake than a realistic effort to end his life. The knowledgeable benzo ODer got what they wanted when they ended up in the hospital, but the confused/mistaken ODer failed. None of the other risk/protective factors really change the nature of action itself, just the relative risk.

a) Describes melancholic depression, but not sensitive since it doesn't screen out atypical/bipolar/vascular/etc. depression, and not specific since they can be caused by other, non-psychiatric diseases/aging
b) A risk factor, but ?weak since its unclear if the correlation is between suicide attempts or psychiatric illnesses that co-occur with suicide attempts
c) I think this is a stronger relative risk in younger males, but I'm not sure. Either way, I've never seen a patient discharged or admitted based chiefly on gender
d) This is a protective factor, but again, I wouldn't discharge or admit solely based on this factor

Sorry this wasn't as concrete as you were probably hoping for.

 

[LuckiestOne]

Thank you so much for your replies!

 

[FireBurns]

Definitely answer A, at least from a test perspective. They are testing your knowledge about depression and its association with suicide. 2 step reasoning question, first knowing that depression is associated with sleeping problems and appetite changes and second that depression increases suicide risk. At least from a USMLE perspective that is what they are probably looking for.

Standardized Mortality Ratio Relative Risk compared to general population with Major Depression = 20.4-23.3

(Harris EC, Barraclough B. Suicide as an outcome for mental disorders: a meta-analysis. Br J Psychiatry 1997; 170:205-208.)

 

[FireBurns]

Cancel that, completely misread the question....

Definetly E

Patients belief that Temazepam would kill him = previous suicide attempt
This is the biggest risk factor and the USMLE wants you to know that.

Previous post Incorrect.

 

[hamstergang]

Definitely answer A, at least from a test perspective. They are testing your knowledge about depression and its association with suicide. 2 step reasoning question, first knowing that depression is associated with sleeping problems and appetite changes and second that depression increases suicide risk.

Even though you already recognize this as wrong, you should recognize that it wasn't going to be right even without choice E. These 2 symptoms don't make a diagnosis of depression. And, in a 78 year old, these are completely normal and should not lead you to a diagnosis of depression.

 

[Dapplegrey]

Obviously the answer would be "all of the above" to some degree. From a USMLE, PRITE, or Board question it's which is the best answer. In the real world more information would be obtained (e.g. what were the circumstances in which he overdosed, had he previously attempted suicide). Elderly men generally do not f-around with suicide gestures, they use highly lethal means to get the job done without letting anyone know. My guess would be E also. If the guy thought overdosing on Restoril was going to kill him then he intended for it to happen. However, why only 10 pills...unless that's all he had.

 

[hamstergang]

Obviously the answer would be "all of the above" to some degree

Well, definitely not D, as being married is a protective factor.

 

[whopper]

I'd say E...

and I've done psychological autopsies and had to present in front of the American Academy of Forensic Sciences on this issue.

But just that fact that I always screw up on multiple choice exams should make you suspect that I'm wrong. Wait a minute, everyone else is saying E too.

 

[Dapplegrey]

The question states "Which of the following is most important in assessing his risk for suicide?". Answer D is "marital status". Yes--that IS important in "assessing his risk for suicide", whether protective or threatening.

 

[hamstergang]

The question states "Which of the following is most important in assessing his risk for suicide?". Answer D is "marital status". Yes--that IS important in "assessing his risk for suicide", whether protective or threatening.

Ah, that's true, I read the question wrong.