is your patient at risk of suicide? by orman
TRANSCRIPT
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Is my patient suicidal?
Rob Orman, MD
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What to say
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What to ask
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Knowledge Gap
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Knowledge Absence
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Good
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Bad
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Rare
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Complete suicide
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3% high risk
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60% low risk
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Lie
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LieSelf
Reported
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The Suicide Thromboelastograph
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Friends and
Family
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Friends and
FamilyKnow
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What is suicidal ideation?
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Mindset and
Intent
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Suicide attempt
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Suicide attempt
Stress relief
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Suicide attempt
Stress reliefattention
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What and Why
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Mindset and
Intent
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Injury is secondary
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Why did it happen?
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What
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WhatWhen
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WhatWhen
Why
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What
Why
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Mindset and
Intent
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Is this suicidal ideation?
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What
Why
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What
WhyStressedRelieves Tension
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Is this suicidal ideation?
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What
Why
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What
WhyHopelessDepressedNo way out
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Is this suicidal ideation?
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Behavior
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Behavior
Motivation
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Behavior
Motivation
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What
Why
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What
Why
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Takes away the pain
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Do you feel suicidal?
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Do you feel suicidal?
Always!
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What
Chronic ideation
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What
WhyGet the story
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What
WhyRisk Assess
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How to assess suicide risk?
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Gestalt
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Gestalt
Decis
ion tools
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Gestalt
Decis
ion tools
Spontaneous questions
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Organized
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Organized
Systematic
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Columbia Suicide Severity Rating
Scale
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What questions to ask
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How to ask
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Structure interview
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6 questions
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Doesn't Have
to be the patient
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6 questions
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Is there ideation?
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Have you ever wished you were dead or
wished you could go to sleep and not wake
up?
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Have you ever had thoughts of killing
yourself?
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No?
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Have you ever wished you were dead or
wished you could go to sleep and not wake
up?
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Have you ever had thoughts of killing
yourself?
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No?
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No ideation
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Have you ever done anything, started to do anything, or prepared to do anything to end
your life?
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Yes ideation
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Define it
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Vague thoughts
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Vague thoughts
Specific Plan
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Define the
ideation
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Is there INTENT
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Have you been thinking about how you might
kill yourself?
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Have you had these thoughts and had some intention of acting on
them?
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Is there INTENT
with a plan
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Have you started to work out the details
of how to kill yourself? Do you
intend to carry out the plan?
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Have you ever done anything, started to do anything, or prepared to do anything to end
your life?
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Obvious
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What did you think would happen when
y0u did X?
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How do you feel now that you’re not dead?
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Explore the
ideation
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Incessant or
fleeting
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Previous attempts
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What’s stopping
you?
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Protective Factors
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Did you want to kill
yourself?
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Did part of you want to kill yourself?
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ideation
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ideationintent
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ideationintentplanning
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inform
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inform
suicide risk
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Organized Systematic
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What
Why
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Mindset and
Intent
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Impulsive Act
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Short Lived
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![Page 116: Is Your Patient at Risk of Suicide? By Orman](https://reader034.vdocuments.site/reader034/viewer/2022052606/58ee27df1a28abdc578b4583/html5/thumbnails/116.jpg)
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hopelessness
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hopelessnesstrapped
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hopelessnesstrapped
previous
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hopelessnesstrapped
previousideation
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![Page 122: Is Your Patient at Risk of Suicide? By Orman](https://reader034.vdocuments.site/reader034/viewer/2022052606/58ee27df1a28abdc578b4583/html5/thumbnails/122.jpg)
Remove the
Means
![Page 123: Is Your Patient at Risk of Suicide? By Orman](https://reader034.vdocuments.site/reader034/viewer/2022052606/58ee27df1a28abdc578b4583/html5/thumbnails/123.jpg)
![Page 124: Is Your Patient at Risk of Suicide? By Orman](https://reader034.vdocuments.site/reader034/viewer/2022052606/58ee27df1a28abdc578b4583/html5/thumbnails/124.jpg)
1-2%
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1-2%
61%
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1-2%
61%
82%
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Remove the
Means
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Chance of Dying
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Lower
![Page 130: Is Your Patient at Risk of Suicide? By Orman](https://reader034.vdocuments.site/reader034/viewer/2022052606/58ee27df1a28abdc578b4583/html5/thumbnails/130.jpg)
![Page 131: Is Your Patient at Risk of Suicide? By Orman](https://reader034.vdocuments.site/reader034/viewer/2022052606/58ee27df1a28abdc578b4583/html5/thumbnails/131.jpg)
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40%
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Remove the
Means
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Chance of Dying
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Lower
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ASK
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What
WhyGet the story
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What
Why
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Mindset and
Intent
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Risk Assessment
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Is there ideation?
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Explore the
ideation
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Gestalt
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Gestalt
Decis
ion tools
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Gestalt
Decis
ion tools
Spontaneous questions
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The what
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Thinking about OD
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The why
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Breakup
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BreakupLost Job
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BreakupLost JobDepressed
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20yo
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20yothinking
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20yothinking
OD
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20yothinking
OD
mult triggers
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What
Why
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What
Why
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Is there ideation?
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Have you ever wished you were dead or
wished you could go to sleep and not wake
up?
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Yes
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Have you ever had thoughts of killing
yourself?
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Tonight
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Yes ideation
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Is there INTENT
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Have you been thinking about how you might
kill yourself?
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OD
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Have you had these thoughts and had some intention of acting on
them?
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Yes
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Have you started to work out the details
of how to kill yourself? Do you
intend to carry out the plan?
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Lock self in bathroom
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Lock self in bathroom
family asleep
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Have you ever done anything, started to do anything, or prepared to do anything to end
your life?
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Not before tonight
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Explore the
ideation
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Incessant or
fleeting
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Previous attempts
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What did you think would happen when
y0u did X?
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How do you feel now that you’re not dead?
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What’s stopping
you?
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Fear
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Trivial
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TrivialLife threat
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Never Perfect
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Never PerfectAlways Excellent