🏥 Stations

🧠 Qbank

📖 Book

😃 More

💳 Pricing

🔒 Dashboard

📖 OSCE Learning

🔒 OSCE Stations

🔒 Qbank

🔐 Membership
Share your insights

Help us by sharing what content you've recieved in your exams


Suicidal thoughts

Specialties > Child health

Differential Diagnosis Schema 🧠

Primary Psychiatric Disorders

  • Major depressive disorder: Characterized by persistent low mood, anhedonia, feelings of hopelessness, and recurrent thoughts of death or suicide.
  • Bipolar disorder: Suicidal thoughts may occur during depressive episodes or in mixed states, where depressive and manic symptoms coexist.
  • Schizophrenia: Suicidal ideation may occur due to distress from psychotic symptoms, particularly in response to command hallucinations or feelings of hopelessness.
  • Borderline personality disorder: Characterized by chronic feelings of emptiness, impulsivity, and recurrent suicidal behaviour or threats.
  • Anxiety disorders: Severe anxiety, panic disorder, or post-traumatic stress disorder (PTSD) can lead to suicidal ideation, particularly in the context of overwhelming distress.

Secondary Causes

  • Substance misuse: Intoxication with or withdrawal from substances such as alcohol, opioids, or stimulants can trigger or exacerbate suicidal thoughts.
  • Chronic pain: Persistent pain conditions, especially those resistant to treatment, are associated with increased risk of suicide.
  • Neurodegenerative diseases: Conditions like Parkinson’s disease, Huntington’s disease, or multiple sclerosis can lead to depression and suicidal ideation.
  • Traumatic brain injury (TBI): Individuals with a history of TBI may experience increased impulsivity, depression, and suicidal thoughts.
  • Serious physical illness: Diagnosis of conditions such as cancer or HIV/AIDS can lead to existential crisis and suicidal ideation, particularly in the context of poor prognosis or uncontrolled symptoms.

Situational Factors

  • Recent loss or trauma: Bereavement, relationship breakdown, or other significant life stressors can precipitate suicidal thoughts.
  • Social isolation: Lack of social support or feelings of loneliness can contribute to hopelessness and suicidal ideation.
  • Financial difficulties: Debt, unemployment, or other financial crises can lead to feelings of despair and suicidal thoughts.
  • Exposure to suicide: Knowing someone who has died by suicide can increase the risk, particularly in vulnerable individuals.
  • Bullying or abuse: Ongoing or past experiences of bullying, abuse, or domestic violence can lead to feelings of entrapment and suicidal ideation.

Key Points in History 🥼

Suicidal Ideation

  • Nature of thoughts: Ask about the frequency, duration, and intensity of suicidal thoughts.
  • Plan and intent: Enquire about specific plans for suicide, the means to carry it out, and the intention to act on these thoughts.
  • Previous attempts: History of previous suicide attempts, self-harm, and methods used, as this increases the risk of future attempts.
  • Protective factors: Assess for factors that might reduce the risk, such as responsibilities, religious beliefs, or social support.
  • Triggers: Identify any recent events or stressors that have exacerbated suicidal thoughts.
  • Access to means: Determine whether the patient has access to firearms, medications, or other means of carrying out suicide.

Background

  • Mental health history: Previous diagnoses, hospitalizations, and treatment for psychiatric conditions, particularly depression, anxiety, and psychosis.
  • Substance use: Current or past use of alcohol, illicit drugs, or prescription medications that may influence mood or judgement.
  • Family history: History of suicide, mental illness, or substance misuse in first-degree relatives, which may indicate a higher risk.
  • Medical history: Chronic pain, debilitating conditions, or terminal illness that could contribute to suicidal ideation.
  • Social history: Relationships, occupation, financial status, and living situation, as well as any recent changes or stressors in these areas.
  • Support network: Availability of family, friends, or community support, and their awareness of the patient’s struggles.

Possible Investigations 🌡️

Psychiatric Assessment

  • Mental state examination: Assess appearance, behaviour, speech, mood, affect, thought process, thought content (including delusions and hallucinations), cognition, insight, and judgement.
  • Risk assessment tools: Use standardized tools like the SAD PERSONS scale or the Columbia-Suicide Severity Rating Scale (C-SSRS) to quantify risk.
  • Cognitive assessment: Screen for cognitive impairment using tools like the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA).
  • Psychosocial assessment: Evaluate the patient’s social circumstances, including relationships, housing, employment, and financial status.
  • Substance use assessment: Use tools like the AUDIT-C for alcohol use or DAST for drug use to assess substance-related risks.

Laboratory and Imaging Tests

  • Full blood count (FBC): To rule out anaemia or infection, which could contribute to fatigue or low mood.
  • Thyroid function tests: To exclude hypothyroidism, which can present with depressive symptoms.
  • Electrolytes and renal function: To assess for any metabolic imbalances, particularly in the context of malnutrition or dehydration.
  • Liver function tests: Especially relevant in patients with a history of alcohol misuse or those on psychotropic medications.
  • Drug screening: Urine or blood tests to detect substances that could influence mental state or contribute to suicidal ideation.
  • CT/MRI brain: If there is suspicion of an organic brain condition, such as a tumour or stroke, contributing to suicidal thoughts.

No comments yet 😉

Leave a Reply

Child health