CRPS and Suicide Prevention

Transcription

1 1 CRPS and Suicide Prevention Jill Harkavy Friedman, PhD June 23, 2012 RSDSA Board Meeting 2 What we know about suicidal ideation and behavior Majority of people have thought about suicide at some point in time but did not act on it Most have fleeting thoughts Plans and persistent thoughts are a sign of risk Most people have never made a suicide attempt While 36,909 people died by suicide in the US in 2009* Suicide is relatively rare (12/100,000) It is estimated that at least 6 people are affected by on person who dies by suicide * Most recent statistics available from the Centers for Disease Control 1

2 3 What we know about suicide Complex behavior with multiple risk factors 90% of people who die by suicide have a diagnosable and potentially treatable mental disorder Depression, anxiety, alcohol and other substance use Chronic illness and chronic pain can increase risk for depression And suicide for those who are vulnerable Suicide is not a normal means of coping with prolonged pain Pain medications have major affects on mood and impulse control People with multiple risk factors are more vulnerable to suicide People attempt suicide for relief from unbearable pain 4 Some things we know about people Stigma can prevent people from getting treatment CRPS Depression Stigma can prevent people from offering treatment Medication Inaccurate information can have negative consequences Misdiagnosis Failure to treat Under treatment 2

3 5 How do you know when to worry about someone being at risk for suicide? Observable signs of serious depression: Unrelenting low mood Pessimism Hopelessness Desperation Anxiety, psychic pain and inner tension Withdrawal Sleep problems Increased alcohol and/or other drug use Recent impulsiveness and taking unnecessary risks Threatening suicide or expressing a strong wish to die Making a plan: Giving away prized possessions Sudden or impulsive purchase of a firearm Obtaining other means of killing oneself such as poisons or medications Unexpected rage or anger 6 What should you do if you are worried about someone? Ask Asking about suicide does not make someone think about it Take it seriously, 50 to 75 percent of all suicides give some warning of their intentions to a friend or family member 45+% have seen their primary medical doctor in the month before they died Make no assumptions about a person s private thoughts Be Willing to Listen Start by telling the person you are concerned and give him/her examples of what worries you. If he/she is depressed, don't be afraid to ask whether he/she is considering suicide, or if he/she has a particular plan or method in mind. Ask if they have a therapist and are taking medication. Do not attempt to argue someone out of suicide. Rather, let the person know you care, that he/she is not alone, that suicidal feelings are temporary and that depression can be treated. Avoid the temptation to say, "You have so much to live for," or "Your suicide will hurt your family." 3

4 7 Seek Professional Help Encourage the person to see a physician or mental health professional immediately. Individuals contemplating suicide often don't believe they can be helped, so you may have to do more. Help the person find a knowledgeable mental health professional or a reputable treatment facility, and take them to the treatment American Psychiatric Association select relevant psychiatry association apa@psych.org or call and press 0 American Psychological Association National Association of Social Workers Veterans Affairs SAMHSA Refer them to Life line TALK (8255) for a referral In an Acute Crisis 8 If a friend or loved one is threatening, talking about or making plans for suicide, these are signs of an acute crisis. Do not leave the person alone. Remove from the vicinity any firearms, drugs or sharp objects that could be used for suicide. Take the person to an emergency room or walk-in clinic at a psychiatric hospital. If a psychiatric facility is unavailable, go to your nearest hospital or clinic. If the above options are unavailable, call 911 or the National Suicide Prevention Lifeline at TALK (8255). 4

5 9 Follow-up on Treatment Suicidal individuals are often hesitant to seek help and may need your continuing support to pursue treatment after an initial contact. If medication is prescribed, make sure your friend or loved one is taking it exactly as prescribed. Be aware of possible side effects and notify the physician if the person seems to be getting worse. Frequently the first medication doesn't work. It takes time and persistence to find the right medication(s) and therapist for the individual person. 10 Suicide Risk Screening Alert: a clinical tool that assists clinicians in identifying suicide risk factors Psychiatric Diagnosis Suicidal ideation and plan Prior attempts(s) and deliberate self-harm Anxiety and Depression Hopelessness Substance abuse Recent interpersonal loss Impulsivity and aggression Family history of suicide Recent discharge from a psychiatric hospital History of physical and/or sexual abuse From Simon RI; Screening for suicide risk in a brief medication management appointment. Psychiatric Times, May 2012:

6 11 What a mental health professional can do if you become aware that a patient is at risk Conduct systematic suicide risk assessments Increase frequency and length of visits Review and adjust medication with prescriber Refer patient to intensive outpatient therapy program Refer patient to partial hospitalization program Maintain contact with therapist in split-treatment arrangements Obtain consultation; never worry alone Hospitalize the patient for safety From Simon RI; Screening for suicide risk in a brief medication management appointment. Psychiatric Times, May 2012: Take away message: People with CRPS do not choose the pain just as people with mental disorders such as depression do not choose their illness Pain may be depressing for anyone but not everyone with pain has a mental disorder nor do they kill themselves Suicide is a relatively rare event and does not represent a normal reaction to intense, prolonged pain Mental Health Treatment can help people at risk for suicide We need to know more about the relationship between CRPS and suicide 6

7 13 Thank you Questions, Comments, Discussion American Foundation for Suicide Prevention 120 Wall Street 29 th Floor New York, NY Preventing suicide through education, research and advocacy. 7