SUICIDE &SUICIDE &MOOD DISORDERMOOD DISORDER

NOOR HAFIZAH BINTI HASSAN2007287236

REFERENCES

1. Suicide risk in mood disorders, Zoltan Riehmer, Curr Opin Psychiatry. 2007;20(1):17-22.

2. Principle of suicide risk assessmentHow to interview depressed patient and tailor treatmentRichard L. Frierson, Margaret Melikian, Peggy C. WadmanPostgrad Med 2002;112(3):65-71

DEFINITION

• SUICIDE: self-inflicted death with evidence that the person intended to die

• SUICIDE ATTEMPT: self-injurious behavior with nonfatal outcome with intention of dying

• SUICIDAL IDEATION: thoughts of wanting to die; seriousness varies

Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry 5th edition

WHY BOTHER ?

90% of suicide victims & attempters 1 current axis 1 major mental disorder (mainly untreated)o Major Depressive Episode (MDE) : 56-87 %o Substance Use Disorder : 26-55 %o Schizophrenia : 6-13 %

“state-dependent” phenomenon:o During MDE: 78-89 %o Dysphoric Mania: 11-20 %o Euphoric Mania / Euthymia: 0-7 %

PREDICTING RISK FACTORSSAD PERSONS (Patterson and colleagues)

SCORE

APPROACHING SUICIDAL PATIENT

• What was the precipitant for the event?• Was it planned?• What was the method of self harm?• Did you leave a suicidal note?• Was you alone at the time of event?• Was you intoxicated?• Did you seek any precautions against discovery?• Did you seek help after the attempt?• How did you feel when you was found?

HISTORY OF PRESENT ILLNESS

EXTENT OF SUICIDAL IDEATION• When did you begin to have suicidal thoughts?• Did any event precipitate the suicidal thoughts?• How often do you think about suicide?• How much control do you have over your suicidal ideas?• Do you regard yourself as a burden, or that your life isn’t

worth living?• What makes you feel better : contact with family

member/use of substance• What makes you feel worse?• Do you have a plan to end your life?• What stops you from killing yourself?

PLANS FOR FURTHERANCE AND LETHALITY

• Do you own a gun or access to firearms?• Do you have access to potentially harmful

medications / drugs?• Have your imagined your funeral / how people will

react to your death?• Have you practiced your suicide; put gun to head / held

meds in hands• Have you change your will / life insurance policy / give

away your possessions?

ASSESS CURRENT SITUATION• If you are to going to the same situation again, has

anything change?• Outlook on the future