suicide & DSH
Wednesday, December 03, 2003
Back to MRCPsych revision
Suicide & DSH
1. The risk of complete suicide is high in over 45s presenting with DSH T
2. History of previous DSH increases the risk of complete suicide T
3. The risk of complete suicide high in women presenting with DSH F
4. The risk of complete suicide high in a medical practitioner presenting with DSH T
5. The risk of complete suicide high in an alcoholic man presenting with DSH T
6. Factors predicting suicide after DSH include female sex F
7. Factors predicting suicide after DSH include evidence of serious intent T
8. Factors predicting suicide after DSH include unemployment T
9. Factors predicting suicide after DSH include anxiety disorders F
10. Factors predicting suicide after DSH include depression T
11. The epidemiology of suicide reveals that analgesic over dose is the commonest method of poisoning T
12. The epidemiology of suicide reveals that Cross-national studies show a co-variation with unemployment T
13. The epidemiology of suicide reveals a general increase in rate after the age 18 T
14. The epidemiology of suicide reveals that death by poisoning is increasing F
15. The epidemiology of suicide reveals a variation in rate between patients taking different types of antidepressants T
16. The presence of Akathisia increases the risk of suicide in a schizophrenic patient T
17. Unemployment increases the risk of suicide in a schizophrenic patient T
18. High premorbid educational achievement increases the risk of suicide in a schizophrenic patient T
19. Fear of mental deterioration increases the risk of suicide in a schizophrenic patient T
20. Thought echo increases the risk of suicide in a schizophrenic patient F
21. Asking about suicidal intend increases the risk F
22. A truly suicidal patient will not reveal these thoughts F
23. Fluctuating severity of thought indicates a higher risk category F
24. Aggressive patients have lower risk F
25. In patients with borderline PD expressing of suicidal intend can be assumed to be manipulative
Over 90% have psychiatric disorder & about ½ will have admitted to somebody before the act that they are contemplating suicide .It is commoner in men over the age of 45. Seasonal effect of spring is well known. Access to certain materials (guns, drugs) makes some methods more likely than others. I.e. shooting is common in USA not in the UK.
Social triggers: unemployment, divorce, lack of religious affiliation, living in cities with lack of social support, some professions (doctors, vets, publicans) life events such as bereavement & job loss.
Psychological factors: ½ suffer from depression (10-15 % of those with depression commit suicide). Alcoholism 15% of alcoholics die by suicide, schizophrenia (10% die by suicide & relatively fewer discuss the idea before hand) often-young males with good premorbid adjustment early in the illness. Other psychiatric causes include PD, BPAD, and PTSD. OCD decreases the risk of suicide several folds. Physical illness: increase the risk especially chronic & painful illnesses. Genetic factors: MZ > DZ twins
Neuro chemical: Low CSF 5HIAA is related to impulsivity & suicide, low blood cholesterol
26. Heavy drinking increases the risk of suicide after DSH T
27. Patients with dissocial PD are at risk of complete suicide after an episode of DSH T
DSH is commoner than suicide but still dangerous because ½ suicides previously had DSH. Demographics suggest typical patient to be a female under the age of 35. Other factors such as living in urban areas, social isolation, and unemployment low social class are the same as for complete suicide. But DSH is far more likely to be impulsive in reaction to an acutely stressful life event. Psychiatric co morbidity is the same as for suicide except schizophrenia .A further attempt is more likely in those who take precautions against being found or write suicide note. Painful & violent methods are said to indicate a more serious attempt
28. suicide is commoner in divorced compared with never married T
29. suicide rates fall in spring time F
30. 10-15% depressed patients die by suicide usually early in the illness
31. suicide is associated with decreased religious affiliation in the community T
32. Suicide is associated with high IQ F
33. Suicide is associated with social class T
34. Suicide is associated with suicidal ideas T
35. Suicide is associated with alcoholism T
36. Suicide is associated with OCD F
37. Suicidal intends do not vary in severity F
38. DSH using paracetamol has shown a recent increase in the UK F
39. In the year after an episode of DSH the risk of suicide is 100 times that of the general population T
40. The risk of suicide is significantly increased in a person with epilepsy T
41. Young widowers & elderly widows are at highest risk of suicide following bereavement F young widows & elderly widowers are at highest risk.
42. DSH is more prevalent in the lower social class T
43. The rate of suicide is increased in patients with Somatisation disorder F
44. The risk of suicide in cancer patients is increased in the later stages of the disease F
45. People with depression & panic disorder are at a great risk of committing suicide than people with depression alone T
46. The rates of DSH are rising F
47. Peak age of DSH in men is lower than that for women F
48. Suicide rates are increased in pregnancy F
49. A none dangerous method of DSH predicts a low risk of subsequent suicide F
50. The single most common reason among women for admission to medical wards in the UK is DSH T in men it is the 2nd most common after IHD
51. The density of 5HT receptors in the brain is decreased in patients dying by suicide F increased
52. People who indulge in DSH rarely commit suicide F
53. Suicide rates are higher in winter F
54. The risk of suicide is lower in people who call the Samaritans F it is increased in subsequent years
55. Patients recovering from a severe depressive episode are at increased risk of suicide T
