A 21-year-old man presents with a recent suicide attempt. You are asked to assess him in the emergency room.
Which one of the following statements concerning the suicide assessment of this patient is true?
Correct Answer C:
Previous attempts: 50% to 80% of those who commit suicide have previously attempted it.
Depression: This symptom combined with problems sleeping and eating increases the risk approximately 500 times. People are more likely to be at risk when they are coming out of a depression rather than when they are profoundly depressed.
The presence of psychotic thinking: Often severely disturbed people believe death to be a temporary rather than permanent state. They fully expect to return tomorrow after committing suicide today. Confusion and disorientation also adds significantly to the risk factors.
Regarding suicide, all of the following are associated with increased risk of a successful attempt, except:
Men commit suicide far more frequently than women. However, women make far more attempts than men. Risk factors for suicide include: history of suicide attempts, severe hopelessness and depression, alcohol/substance abuse, loss/separations, severe medical illness.
A previously-healthy 70-year-old man made a nearly successful attempt at suicide by hanging. His depression has been effectively treated with a tricyclic antidepressant. On examination, he has an impairment of short and long-term memory. He is well-nourished, and routine hematologic and biochemical tests are normal.
The most likely cause of his memory deficit is:
Correct Answer D:
Hanging or strangulation account for 15% of all suicides yearly with hanging being the most common method of suicide amongst inmates. The male to female ratio is 4:1. Death is caused by cerebral anoxia caused by compression of the nerves and vessels in the neck. Occlusion of the upper airway by constriction of the neck is thought to be rare, however closure of the airway is caused by upward displacement of the tongue and epiglottis. Cardiac arrest may ensue from pressure on the vagus nerve or carotid sinus.
Most survivors of the initial trauma later die of pulmonary edema, aspiration pneumonia, or ARDS. Delayed airway obstruction has been observed secondary to hemorrhage or edema formation or to fracture of the hyoid bone. Survivors often exhibit memory loss, restlessness, and confusion.
Which one of the following populations has the highest rate of death by suicide?
Correct Answer A:
Men ≥ 75 years have the highest rate of death by suicide. Among all age groups, male deaths by suicide outnumber female deaths by 4:1. About 3 females attempt suicide for every male that makes an attempt.
Risk factors and warning signs for a potential completed suicide include: male sex, age > 65 years, previous suicide attempt, making detailed suicide plans, taking steps to implement plan (obtaining gun, pills), taking precautions against being discovered, personally significant anniversaries, family history of suicide or of affective disorder, unemployment or financial difficulties, particularly if causing a drastic fall in economic status, recent separation, divorce, or widowhood and social isolation with real or imagined unsympathetic attitude of relatives or friends.
When is a depressed patient most likely to commit suicide?
Experts believe there’s an association between early recovery and increased likelihood of suicide. As depression begins to lift, a person's energy and planning capabilities may return before the suicidal thoughts disappear, increasing the chances of a suicide attempt. Studies show that the period six to twelve months after hospitalization is when patients are most likely to consider, or reconsider, suicide.
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