PowerPoint Presentation

SUICIDE AND ATTEMPTED SUICIDEMOYA MCLEODWHAT IS SUICIDE?the act or an instance of taking one's own life voluntarily and intentionally (Merriam-Webster, 2015).Attempted suicide is an attempt at taking ones own life voluntarily and intentionally.Parasuicide refers to an act of self-harm without the realistic expectation of deathAs a result, parasuicides or gestures should be taken seriously and deserve the same intensive intervention as unambiguous suicide attempts.2Over 800,000 people die due to suicide every year and there are many more who attempt suicide.Leading cause of death among 15-29 year olds globally in 2012.75% of global suicide occurred in low- and middle-income countries in 2012.Suicide accounted for 1.4% of all deaths worldwide, making it the 15th leading cause of death in 2012

In 2013, the most recent year for which data is available, 494,169 people visited a hospital for injuries due to self-harm behavior, suggesting that approximately 12 people harm themselves (not necessarily intending to take their lives) for every reported death by suicide. Together, those harming themselves made an estimated total of more than 650,000 hospital visits related to injuries sustained in one or more separate incidents of self-harm behavior.4From 1986 to 2000, suicide rates in the U.S. droppedfrom 12.5 to 10.4 suicide deathsper 100,000 people in the population. Over the next 12 years, however, the rate generally increased and by 2013 stood at 12.6 deaths per 100,000About 1% of total deaths are a result of suicideUnsuccessful attempts outnumber completed suicides by a multiple of 16(19.1) was among people 45 to 64 years4 times higher among men than among women U.S. suicide rate (14.2) was among Whites and the second highest rate (11.7) was among American Indians and Alaska NativesMultiple events occur in adolescent or young adultsfirearms were the most common method of death by suicide, accounting for a little more than half (51.4%) of all suicide death5

2000-20066

Percentage of Self-Harm Injuries, by Age Group, Disposition, and Mechanism, United States, 2005-20097METHODS OF SUICIDEIt is estimated that around 30% of global suicides are due to pesticide self-poisoning, most of which occur in rural agricultural areas in low- and middle-income countries.Other common methods of suicide are hanging and firearms.Knowledge of the most commonly used suicide methods is important to devise prevention strategies which have shown to be effective, such as restriction of access to means of suicide.8GROUPS AT RISKELDERLYMALESALDOLSCENTS/ YOUNG ADULTSSERIOUS/TERMINAL ILLNESSMOOD DISORDERS- depression and bipolarSCHIZOPHRENIA- newly diagnosed and those with command hallucinations.SUBSTANCE ABUSESTRESS AND LOSSDo not confuse self-injurious behaviour (cutting) with suicide attempts, although some who repeatedly cut themselves to relieve emotional pain also attempt suicide. May be a form of stress reductionRISK FACTORS FOR SUICIDEMood disorders (depression and bipolar)Substance Abuse (dual diagnosis)Previous suicide attemptLoss-marital partner, partner, close relationship, job, healthExpressed hopelessness or helplessness (does not see a future)

11Impulsivity/AggressivenessFamily suicides, significant other or peer suicideIsolationStressful life eventPrevious or current abuse (emotional/ physical/ sexual)Sexual identity crisis/ conflictAvailable lethal method (eg. Gun)Legal Issues/incarceration

RISK REDUCING FACTORSWillingness to accept helpFuture-oriented goals and plansHopefulnessGood Social SupportAbsence of suicidal intentionStable moodLower severity of mental illness symptomsReligious prohibitionsMoral objections to suicideHandling an emergencySUICIDEA 45 year old man comes to the ER after attempting to cut his wrists six months after his 7 year old daughter was in a motor vehicle collision. The patient is upset and restless and wrings his hands frequently. He cannot sleep at night, has lost his appetite, cries easily and frequently. He is preoccupied with thoughts of his daughter. He sees her sometimes in his living room and wishes he was hit by the car instead.AFTER STABILIZATIONIDENTIFY A SUICIDE ATTEMPTA patient being evaluated in the ER should not be allowed to leave prior to a full evaluationIntoxication and delirium should be ruled out. The patient must be sober before the formal suicide evaluation can take place.Physician should be coignizant of patients and physicisians safetyAn attendant should accompany the patient to all procedures and tests.16INTERVENTIONAssess- What caused the crisis and what are the individuals reaction to it?Plan- Evaluate the persons strengths and weaknesses, support systems, coping skillsIntervention- establish relationship, help understand event and explore feelings and alternative coping strategiesEvaluation- Evaluate outcomes/ plan for future/ need for follow up (Aguilera, 1998)Rapid focused assessmentMental status exam: normally with psychiatristRisk assessment: violence, suicideNeurological exam as neededRecords and familyLab workDiagnosisAccurate, timely documentationThe patient should be placed on suicide precautions.Patients presenting with overdose need aggressive initial treatment and close monitoring for the first 12 to 24 hours. The patient may withhold, underestimate, or be physically unable to give accurate estimates of type or quantity of pills ingested. 18INTERVIEWING TECHNIQUESBehavioural Incident- eg. How many pills did you take?Shame Attenuation- Do other people pick fights with you?Gentle Assumption-what other ways have you thought of killing yourself?Symptom Amplification- how many fights have you been in 20, 30?Denial of the Specific- have you ever thought about?KEEP communication open in a non-judgemental way; do not minimize or offer advice in this situation.Patient-physician relationship is very important especially in preventing future suicide attempts19AssessHopelessness- a key element; unable to see future (seen in depression)Speaks of suicide- ask if there are thoughts of suicidePlan- Patient has exact method for suicideGiving away possessionsAuditory Hallucinations- commanding to kill oneselfLack of supportSubstance abusePrevious suicide attempt in family or with selfPrecipitating eventMedia- suicide of famous personality

Ask family and friends to step out of the room, requesting to talk with them laterIt is important to remain calm, nonjudgmental, and nonthreatening.Medical history should include review of current medications, past and recent substance use, history of seizures or head injuries, and HIV risk factors. Information should be gathered about prior suicide attempts and psychiatric illnesses because both are associated with an increased risk of suicide

20

HIPPA regulations and basic medical ethics prohibit the clinician from divulging patient health informationHealth Insurance Portability and Accountability Act (HIPPA)21INTERVENTIONEffective assessment and knowledge of risk factorsObservation and safe environmentIdentification of triggers- identify triggers to patient to seek help earlySubstance abuse treatment/ supportPsyhotherapy/ cognitive behavioural therapy/ electroconvulsive therapyTreatment of medical disorders- thyroid/ cancer

Info from involved parties to get timeleine22Increased activity- if ableSupport network/ family involvementInvolvement in outside activities- avoid isolationClient and family educationPsychopharmacology, especially SSRIs- closely monitor children, adolescents and young adultsKnowledge of the patient's attitudes and feelings about their illness may be very relevant.Have frequent consultations after an attempt

Knowledge of the patient's current and past prescription medications and access to drugs, alcohol, and firearms is vital. This information will be helpful in establishing an understanding of the environment that the patient may be returning to upon discharge

The individual must not be left alone Anything that the patient may use to hurt or kill himself or herself must be removed The suicidal patient should be treated initially in a secure, safe, and highly supervised place; inpatient care at a hospital offers one of the best settings After the initial intervention, which usually includes hospitalization, it is critical that there be in place an ongoing management treatment 23

THANK YOUREFERENCEShttp://www.psychiatrictimes.com/all/editorial/psychiatrictimes/pdfs/psych-survival2.pdfhttp://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdfhttp://medind.nic.in/maa/t04/i1/maat04i1p59.pdfhttp://home.apu.edu/~ksetterlund/2012-2013/Articles/Newhill%20-%20Psychiatric%20Emergencies-%20Overview%20of%20Clinical%20Principles%20(2).pdfhttp://www.who.int/mental_health/prevention/suicide/suicideprevent/en/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC419387/