Suicide ✅

Related Subjects: |Psychiatric Emergencies |Depression |Mania |Schizophrenia |Suicide |Acute Psychosis |Delusions |General Anxiety Disorder |Obsessive-Compulsive disorder |Wernicke Korsakoff Syndrome |Medically Unexplained symptoms |Postpartum/Postnatal Depression |Postpartum / Postnatal Psychosis |Eating disorders in Children

⚠️ Any patient presenting with an overdose or suicide attempt should undergo a psychiatric assessment before discharge. In primary care, assess for self-harm risk in anyone with low mood, depression, or other psychiatric illness. Always follow local safeguarding and crisis pathways (e.g., liaison psychiatry, crisis teams).

🩺 Initial Suicide Risk Assessment

• Direct Inquiry: Ask clearly and sensitively (“Have you thought about harming yourself?”).
• Plans & Means: Ask if they have a plan and access to means (medications, firearms, ligatures).
• Risk Severity: Look for:
  • Specific plan with intent
  • Access to lethal means
  • Past suicide attempts
  • Severe mental illness (e.g., depression, psychosis)
  • Lack of social supports
• Silent Risk: Some patients may conceal intent - monitor closely if suspicion remains high.

📊 Suicide Risk & Psychiatric Disorders

🔑 Key Suicide Risk Factors

• Previous suicide attempt (strongest predictor)
• Major psychiatric illness (esp. depression, psychosis, personality disorders)
• Substance misuse
• Chronic illness or pain
• Recent significant loss (bereavement, divorce, redundancy)
• Family history of suicide
• Social isolation / lack of support

🚑 Immediate Management

• Low Risk: Supportive care, follow-up, consider counselling/CBT.
• Moderate Risk: Safety plan, closer follow-up, involve family with consent, refer to mental health services.
• High Risk: Urgent referral to liaison psychiatry/crisis team. Remove access to lethal means. Consider MHA admission if patient refuses but risk is imminent.

📅 Long-Term Management

• Psychotherapy: CBT, DBT (especially for BPD), problem-solving therapy.
• Medication: Antidepressants, mood stabilisers, or antipsychotics depending on diagnosis.
• Social Support: Housing, financial support, community resources.
• Follow-Up: Frequent, structured reviews. Reassess risk at every contact.

👩‍⚕️ Specialist Referral

• All high-risk patients → urgent psychiatric evaluation.
• Engage crisis/home treatment teams for acute support.
• Consider inpatient admission if persistent suicidal ideation, especially with intent and means.

📝 Documentation

✅ Always document suicide risk assessment, protective factors, discussions with patient/family, safety plan, and your clinical reasoning. Good documentation protects patients and clinicians.

Cases - Suicide

• Case 1 - Young adult with depression 😔: A 21-year-old university student presents after an overdose of paracetamol following weeks of low mood, insomnia, and social withdrawal. He expresses regret at surviving but admits persistent suicidal thoughts. Diagnosis: major depressive episode with high suicide risk. Managed with urgent medical stabilisation, psychiatric admission, and initiation of antidepressant + psychotherapy.
• Case 2 - Middle-aged man with alcohol misuse 🍺: A 47-year-old unemployed man with long-standing alcohol dependence is brought by police after being found on a bridge. He reports hopelessness, financial debt, and no protective factors. Past history: two previous suicide attempts. Diagnosis: recurrent suicidal behaviour in the context of alcohol misuse. Managed with crisis team input, alcohol services referral, and close community psychiatric follow-up.
• Case 3 - Elderly woman with physical illness 🏥: A 72-year-old woman with chronic pain from osteoarthritis and recent bereavement presents after expressing intent to hang herself. She has given away personal belongings and written a note. Exam: severe depressive features, psychomotor retardation. Diagnosis: late-life depression with suicide intent. Managed with urgent psychiatric admission, risk management, and antidepressant initiation.

Teaching Point 🩺: Suicide risk must always be assessed in context of psychiatric illness, substance misuse, and social stressors. Red flags: previous attempts, detailed plans, hopelessness, giving away possessions. Management = ensure safety, involve crisis/psychiatric services, treat underlying illness, and strengthen social supports.