Transcript Singin` the Blues!: Overview of Depressive Disorders

An American Epidemic:
Practical and Clinical
Considerations of Suicide
A word of caution…
• I consider this topic to be the most
important of the semester. That being
said, it can be a sensitive topic and you
should not feel obligated to remain in
class if you are uncomfortable.
Activity Time!
• Take out a piece of paper and answer “True” or
•
•
•
•
•
•
“False” for the following statements
1. Suicide is less common than murder.
2. We should be gentle or tentative when
approaching someone we think may be suicidal.
3. Once someone is intent on committing suicide,
there is no way to stop them.
4. Psychologists and psychiatrists are the only
people who can help someone who is suicidal.
5. Suicidal people are only seeking attention.
6. Depression causes all suicides.
Stats and Facts
1. 7th or 8th leading cause of death overall in the
2.
3.
4.
5.
6.
7.
last decade
2nd or 3rd leading cause of death for adolescents
and young adults
Most prevalent in adolescents and older adults
Twice as common in college students than noncollege counterparts
Accounts for about 30-33,000 deaths annually
Women more likely to attempt, men more likely
to complete
Suicidal thoughts and attempts difficult to count
What would you do?
• Fred is a loved one who has made
references to death and disappearing of
late. You also notice he exhibits signs of
depression.
• 1. How would you handle this situation?
• 2. What if he had a plan?
Risk Factors/Causes
•
•
•
•
•
•
•
•
1. Mood disorder
2. Gender
3. Negative Life Event
4. Neuroticism
5. Low self-esteem
6. Low social support
7. Personality Disorder
**Most likely completed when mood is
improving
Warning signs
1. Talking about dying
2. Recent loss
3. Depressive symptoms
4. Talking about loss of control/harming self or
others
5. Withdrawal from relationships
6. Hopelessness
7. Previous attempt**
8. “Finalizing behavior” (e.g., Giving things away,
tying up relationships, making out wills)
What can you do?
•
•
•
•
•
1. Educate yourself on warning signs
2. Be direct
3. NEVER leave the person alone
4. Assess immediacy of threat – plan and means?
Remove if needed
5. GET HELP!!!
– University Counseling Center
• 348-3863
– University Psychological Clinic
• 348-5000
– 1-800-273-TALK
– UAPD
• 348-5454
– DIAL 911
So, we’ve reviewed the practical
issues concerning suicide…
• Let’s chat about the controversies…
Thomas Szasz and the
(Im)morality of suicide
• Argues that suicide
•
•
•
•
prevention is:
Immoral
Impractical
Can treat underlying
conditions
What do you think?
Physician-Assisted Suicide
• Jack Kevorkian assisted
•
in roughly 100 assisted
suicides
Created machine to
induce unconsciousness
and deliver a lethal
dose of potassium
chloride
The Death and Dignity Act
• Oregon was the first state
to make assisted suicide
legal in 1994
• Act requires 2 physicians
•
•
to clear:
A. less then 6 months to
live
B. not suffering from
mental illness
Medical stance on
assisted suicide
• AMA is against
assisted suicide.
• However, BMA
surveys show
interesting results!
Let’s debate!
• What are the pros and cons of assisted
suicide?
Suicide from the clinician’s
perspective
• Basic Terms:
• 1. Deliberate self-harm without intent
• 2. Suicide attempt
• 3. Risk and protective factors
• 4. Self injurious behavior
• 5. Suicidal ideation
– Active vs. passive
Steps in a typical suicide risk
assessment
• Question: Imminent risk of death vs. non-fatal
•
•
•
•
•
attempts?
1. Allow person to discuss their problem for 5-10
minutes
2. Assess negative psychological effects of
problem (e.g., hopeless, depressed)
3. Assess thoughts of suicide uninterrupted 
thoughts at the moment
4. Assess thoughts of death- active or passive?
5. Ask about carrying out plan/taking other with
them
Considerations in risk assessment
• Validate feelings, but convey options
• Risk and protective factors approach
– See handout
• Low, Medium, High Risk
– No clear cut off
– Clinical judgment
Activity Time: Forming a Risk
Prediction and Action Plan
• Dr. Phil is out of the office
•
•
•
•
because he was arrested for
stupidity
Help him out by pairing up and
using the risk and protective
factors sheet to:
A. Make a suicide risk
judgment about the following
case
B. Based on your judgment,
propose ideas for immediate
treatment
We’ll discuss!
Poor Bucky…
• Bucky is a 22 year-old male graduate student who came
•
•
to see you complaining of active suicidal thoughts,
depression, excessive alcohol use, and talking of using
his father’s rifle. He has never attempted suicide, but
has a long history of suicidal thoughts and psychiatric
treatment. A comprehensive evaluation of his
background showed he recently lost his best friend in a
car accident, has an uncle who committed suicide, and
he suffered physical abuse as a child. Bucky noted
feeling guilty because suicide goes against his strong
family ties and devout religiosity. Bucky noted having 5
or 6 close friends, but has withdrawn from them. He
has discussed plans for the upcoming week in which he
will take part in a university concert. Bucky ends the
session by telling you he wants to feel better, but does
not know what to do.
Assign Bucky a risk level
Generate some ideas for treatment
Immediate treatment
options/considerations
• Involving family/friends
– Confidentiality considerations
– Support system
• Medication evaluation
• Inpatient or outpatient therapy
• Crisis Response Plan vs. “No suicide contract”
• Hospitalization
– Duty to protect