Suicide Risk Assessment Self-Test

Transcription

1 Suicide Risk Assessment Self-Test The 30 item true or false self-test is designed to enhance clinician suicide risk assessment by incorporating evidence-based risk and protective factors. This self-test is a teaching instrument. Scoring is by and for the test-taker. The questions are selected from data evidencebased sources referenced on the answer sheet. Robert I. Simon, M.D. Clinical Professor of Psychiatry Director, Program in Psychiatry and Law Georgetown University School of Medicine Washington, DC Robert I. Simon, M.D., 2009 Page 1

2 Questions 1. The purpose of suicide risk assessment is to inform patient treatment and management, not the prediction of suicide. 2. Eating disorders have the highest Standard Mortality Ratio (SMR)* for suicide. 3. The relative risk of suicide in bipolar disorder is 25 times the general population. 4. Comorbidity significantly increases suicide risk. 5. Most evidence-based suicide risk and protective factors are derived from communitybased psychological autopsy studies. * SMR: a measure of the relative risk of suicide for a particular psychiatric disorder compared to the expected rate in the general population Robert I. Simon, M.D., 2009 Page 2

3 6. After purchase of a handgun, the suicide rate is 57 times the general population during the first week. 7. Documented, competent suicide risk assessments are a rarity. 8. There are a number of acceptable methods for conducting suicide risk assessments. 9. Suicide prevention contracts are important in the management of the borderline patient at risk for suicide. 10. Religious affiliation is a protective factor against suicide. 11. The legal standard of care requires that suicide risk assessments be reasonable. Robert I. Simon, M.D., 2009 Page 3

4 12. Lithium and clozapine reduce suicide attempts in bipolar and schizophrenic patients respectively. 13. A high educational level is a protective factor against suicide. 14. The Standard Mortality Ratio (SMR) is elevated for all psychiatric disorders including mental retardation. 15. Approximately 15% of suicidal patients do not admit to suicidal ideation but do tell their families % of unplanned and 60% of planned suicide attempts occur within 1 year of suicide ideation onset. Robert I. Simon, M.D., 2009 Page 4

5 17. Living with a child under the age of 18 is a protective factor against suicide. 18. Short-term suicide risk factors are useful in assessing the likelihood of a suicide attempt within hours. 19. The risk of suicide is highest during the first year following a suicide attempt % of patients who have made a suicide attempt eventually complete suicide. 21. Prior suicide attempts and hopelessness are powerful clinical predictors of completed suicide. 22. In adolescents, there is considerable evidence that contagion effects can lead to suicidal behaviors following personal contact with a suicide. Robert I. Simon, M.D., 2009 Page 5

6 23. In the Copenhagen Adoption Study, adoptees who completed suicide had a tenfold increase in suicide in biological relatives than biological relatives of matched adoptees who did not complete suicide. 24. Melancholic depression is associated with increased suicide risk as compared with depression without melancholic features. 25. Patients with psychotic disorders are at 5 times the risk of suicide compared with nonpsychotic patients. 26. Evidence-based suicide risk factors are derived from systematic reviews, cohort and case-control studies. 27. The suicide rate in the general population between increased to 18 per 100,000. Robert I. Simon, M.D., 2009 Page 6

7 28. The preferred study designs for determining suicide risk are cohort and case-control studies. 29. Following inpatient discharge, the risk of suicide is highest during the first week. 30. If the absolute risk of suicide in bipolar patients is 193 per 100,000, then 99,807 bipolar patients will not commit suicide. Robert I. Simon, M.D., 2009 Page 7

8 Suicide Risk Assessment Self-Test Answers 1. True 2. True 3. False: correct answer is -18 times 4. True 5. False: correct answer is - also cohort and case-control studies 6. True 7. True 8. True 9. False: correct answer is - no evidence that suicide prevention contracts prevent suicide 10. True 11. True 12. True 13. False: correct answer is - no evidence to support statement 14. False: correct answer is - no elevated suicide risk in mental retardation 15. True 16. True 17. True 18. False: correct answer is - there are no short-term suicide risk factors 19. True 20. False: 10-15% Robert I. Simon, M.D., 2009 Page 8

9 21. True 22. True 23. False: correct answer is - 6 fold 24. True 25. False: correct answer is - 2 times 26. True 27. False: correct answer is - remained steady at 11% per 100, True 29. True 30. True Sources 1. Textbook of Suicide Assessment and Management (Simon RI, Hales RE, eds.) American Psychiatric Publishing, Inc., Arlington, VA, Simon RI: Assessing and Managing Suicide Risk: Guidelines for Clinically Based Risk Management, American Psychiatric Publishing, Inc., Arlington, VA, American Psychiatric Association: Assessment and treatment of patients with suicidal behaviors. Am J Psychiatry 160 (suppl): 1-60, 2003 Robert I. Simon, M.D., 2009 Page 9