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Risk in
psychiatry (Types (Non-compliance (Epidemiology
Common, Types
…
Risk in
psychiatry
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Types
Risk to self
Suicide
Epidemiology
15th leading cause of death globally (2nd in 15-30y)
M>F
Young adults/middle age, elderly
Varies by profession
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Definition
Act of killing self deliberately, performed by the person
concerned, in full knowledge of the outcome
Risk factors
Male
Young or elderly
Previous attempts/DSH
Past psychiatric history
Current mental state (hopeless, unexplained
symptom improvement, gain insight, psychosis)
PMH (chronic disease e.g. pain)
Substance misuse
Finaicial problems
Relationship problems
Adverse life events
Social isolation
LGBT
Assessment
Suicidal ideation
'Have you ever thought that life isn't worth living?'
Have you ever thought about ending your life?'
'Do you think that you would act on these thoughts?'
Post suicide
attempt
Before
Triggers
Planning (planned or spontaneous)
Intention (cry for help, end life)
Method chosen
Suicide note?
During
Did they attempt to get help
How they were found (alert someone, by chance)
After
How they feel about it (?regret)
Symptoms of mental illness
Protective factors (hope, beliefs, family/friends)
Other
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Self-harm
Cutting, burns, etc.
Risk to others
Adults
Epidemiology
Homicides often by those with known mental illness
e.g. psychosis and/or drug/alcohol abuse history
NHS staff commonly subject to physical/verbal abuse
Risk factors
Previous violence
Past psychiatric history
Current mental state
Substance misuse
Childhood trauma
Poor social support
Negative life events
Unemployment
Inpatients
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Management
Restraint
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Pharmacological
Rapid tranquilisation
E.g. olanzepine, haloperidol, aripiprazole,
quetiapine, chlorpromazine, lorazepam, diazepam
Route: PO/IM
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Child safety
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Support services
universal, additional or
complex/significant needs