Podcast Summary
Empathize with individuals expressing suicidal thoughts: Empathy saves lives by creating a strong therapeutic alliance and helping individuals feel heard and understood
When dealing with individuals expressing suicidal thoughts, it's crucial for mental health professionals to empathize and understand their feelings rather than dismissing or minimizing them. Empathy creates a strong therapeutic alliance and leads to better outcomes. While it may be uncomfortable to acknowledge the depth of someone's despair, doing so can help them feel heard and understood, potentially saving lives. Empathy paves the way for hope and the belief that there are still opportunities for improvement. As mental health professionals, we play a vital role in saving lives, and our empathetic approach is an essential tool in this journey.
Mental health professionals save lives by providing treatments rooted in empathy and therapeutic alliance: Mental health pros help prevent suicide by addressing risk factors like depression, loss, impulsivity, and access to guns, ultimately promoting fulfilling lives
Mental health professionals play a crucial role in saving lives by providing evidence-based treatments rooted in empathy and therapeutic alliance. Suicide is a significant public health issue, ranking as the 10th leading cause of death in adults, and it disproportionately affects individuals between the ages of 15 and 24, who it is the second leading cause of death for. The risk factors for suicide include sex, age, depression, a prior history, ethanol abuse, rational thinking loss, support system loss, organized plan, no significant other, sickness, and access to guns. Males are more likely to complete suicide due to their impulsivity, while females attempt suicide more frequently. Economic factors and geographic location also influence suicide rates. As mental health professionals, it's essential to remember the ultimate goal is not just to help patients recover from depression or suicidal thoughts but to help them build fulfilling lives, filled with meaningful relationships, work, and hobbies.
Factors contributing to suicide risk: Understanding factors like gender, age, mental health conditions, substance abuse, rational thinking loss, and social support system can help identify those at risk and provide effective interventions to prevent suicide.
There are various factors contributing to suicide risk, and gender, age, mental health conditions, substance abuse, rational thinking loss, and social support system play significant roles. Studies indicate that males are more likely to have higher levels of impulsivity, sensation seeking, and substance abuse, which could lead to higher suicide completion rates. Age also plays a role, with the highest risk groups being individuals between 15 to 24 years old and those over 75, especially in males. Depression and other mood disorders increase the risk of suicidality up to 20 times compared to the general population. A prior history of suicide attempts is a major risk factor, with 80% of completed attempts preceded by a nonlethal attempt. Substance abuse, particularly ethanol, decreases inhibitions and increases impulsivity and depression, leading to suicidal thoughts. Social support system issues, such as perceived and actual isolation, are also significant risk factors. An organized plan for suicide is evident in individuals who have made extensive preparations for their attempt. Understanding these factors can help identify those at risk and provide effective interventions to prevent suicide.
Factors increasing suicide risk: Having a clear suicide plan and lack of social support, chronic medical conditions like brain injury, epilepsy, MS, Huntington's, Parkinson's, cancer, and AIDS, access to guns, and psychiatric illnesses like mood disorders and melancholic depression can increase the likelihood of suicide.
The likelihood of completing suicide increases when an individual has a well-planned method and a significant lack of social support. Those who have a clear plan and have put thought into their decision are more likely to follow through. Additionally, chronic medical conditions, particularly traumatic brain injury, epilepsy, MS, Huntington's, Parkinson's, cancer, and AIDS, increase the risk of suicidality. Access to guns, especially in the US, is also a significant factor, as more than half of completed suicides in the country are by firearms. Among psychiatric illnesses, mood disorders, specifically melancholic depression, are the most common, with 90% of suicide completers having a major psychological disorder at the time of suicide. Depression, in particular, increases the risk significantly, with 10-15% of hospitalized depressed individuals committing suicide. The melancholic subtype of depression, characterized by a loss of pleasure in activities, profound despondency, and other symptoms, is more common in inpatient settings and can predict a good response to treatment.
Differentiating Melancholic and Catatonic Depression: Effective treatment for depression depends on recognizing melancholic (lack of pleasure, anxiety, early morning awakenings, weight loss) or catatonic (stupor, mutism, negativism, posturing, agitation) forms. Catatonia, with challenging symptoms, requires multidisciplinary approaches and potential use of ECT or high doses of Ativan.
Depression presents in various forms, and it's essential to differentiate between melancholic and catatonic types for effective treatment. Melancholic depression, characterized by lack of pleasure, early morning awakenings, severe anxiety, and significant weight loss, requires careful observation, especially during hospital discharge. Catatonic depression, on the other hand, is marked by stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, stereotypy, agitation, grimacing, echolalia, and echopraxia. These patients may have increased mortality and risk factors for malnutrition and exhaustion. Catatonia is challenging to diagnose and requires a multidisciplinary approach, often involving Electroconvulsive Therapy (ECT) or high doses of Ativan. Understanding these differences can lead to more accurate diagnoses and better patient outcomes.
Anxiety and depression in the acute setting impact suicide risk: Addressing anxiety and depression promptly in the acute setting can prevent potential malpractice claims, improve treatment effectiveness, and reduce suicide risk. Bipolar patients, especially during manic episodes, have unique suicide risks.
Anxiety and depression, particularly in the acute setting, can significantly impact suicide risk. Anxious distress, a common symptom in depression, is associated with a higher suicide risk and longer illness duration. Addressing anxiety quickly in the acute setting can help prevent potential malpractice claims and improve overall treatment effectiveness. Additionally, bipolar patients, especially during manic episodes, are at a higher risk for suicide attempts. Understanding the different features of depression and bipolar, and their respective risks for suicide, can help healthcare professionals provide the most effective treatment possible. Overall, addressing both anxiety and depression in the acute setting, as well as recognizing the unique risks associated with bipolar, is crucial for suicide prevention.
Mental Health Conditions and Suicidal Risk: Bipolar disorder, schizophrenia, and OCD increase suicidal thoughts and actions. Risk factors include male gender, young age, unemployment, chronic disease, prior depression, substance abuse, recent hospital discharge, and akathisia.
Individuals with mental health conditions, such as bipolar disorder, schizophrenia, and obsessive-compulsive disorder (OCD), are at an increased risk for suicidal thoughts and actions. Bipolar disorder, specifically, has two types, 1 and 2, with type 1 having a higher risk for suicide attempts and completion, particularly for those with the rapid cycling subtype. Schizophrenia has an even higher risk, with up to 50% attempting suicide and 10% completing it. Risk factors for suicide in schizophrenia include being male, young age, unemployment, chronic disease, prior depression, substance abuse, and recent hospital discharge. Akathisia, a side effect of antipsychotic medication, can also increase suicidality. A meta-analysis from 2018 found that individuals with OCD have a higher risk for suicidal ideation and behavior, especially during periods of severe symptoms. It's crucial for healthcare professionals to monitor patients for these conditions and potential suicidal thoughts, and to address any akathisia or other side effects promptly to minimize risk.
Higher Suicide Risk in OCD, Schizophrenia, BPD, and Psychopathy: People with OCD, Schizophrenia, BPD, and high psychopathy have a higher risk of suicide. Developing a strong therapeutic alliance is crucial. Clomipramine is best for OCD, start with a low dose. Self-mutilation in BPD is a risk factor. Primary psychopathy increases suicide risk, especially under 30 with high PCLR scores.
Individuals with Obsessive-Compulsive Disorder (OCD) and Schizophrenia have a higher risk of suicide despite being less likely to seek early treatment. The mean rate of lifetime suicide attempts for these individuals is close to 14.25%, and suicide ideation is close to 44%. Developing a strong therapeutic alliance is crucial for these individuals to follow through with treatment. For OCD, Clomipramine is considered the best antidepressant with a lower number needed to treat compared to Prozac. Starting with a low dose and going slow is essential to avoid making patients more anxious. Self-mutilating behavior, which occurs in about 50-80% of cases of Borderline Personality Disorder (BPD), is a risk factor for suicide, with a suicide rate between 5-10%. The relationship between self-mutilation and suicide risk is contentious, but most authors consider it a risk factor. Primary psychopathy, especially in individuals under 30, increases the risk of suicide, and there is a statistically significant moderate increased risk for those with high psychopathy checklist revised (PCLR) scores. The odds ratio for this subset of PCLR scores is 2.12.
Mental health conditions and substance use increase suicide risk: Antisocial personality disorder and substance use disorder significantly increase suicide risk, with attempt rates around 11% and 33.3% respectively, and completion rates close to 5% and 7 times the general population.
Certain conditions, such as antisocial personality disorder and substance use disorder, significantly increase the risk of suicide. For antisocial personality disorder, individuals are more likely than the general population to die by violent means, including both homicide and suicide. The suicide attempt rate is around 11%, and the completion rate is close to 5%. For substance use disorder, the risk is even higher, especially for women. A study using Veterans Health Administration data found that the suicide rate among substance users was about 7 times greater than the general population. The Quebec study found that up to 33.3% of individuals entering treatment for addiction had suicidal ideation, and close to 6% had attempted suicide within the past 30 days. The highest risk group was found to be those combining alcohol with any other drug. It's crucial to recognize the increased risk during the acute phase of treatment and prioritize helping individuals get off substances while also addressing any underlying mental health conditions. Additionally, fentanyl has been a major contributor to accidental overdoses in this population and its use has been increasing rapidly.
Substance abuse increases suicide risk, especially for women and specific drugs: Women using opiates, sedative hypnotics, anxiolytics, or cannabis have a higher suicide risk. Presence of antipsychotics, Benzodiazepines, or barbiturates in toxicology tests is common among suicide victims, but not always indicative of overdose. Burnout and depression do not always lead to suicide.
Substance abuse significantly increases the risk of suicide, particularly for women. The risk is even higher for women using opiates, sedative hypnotics or anxiolytics, and cannabis. In the case of physicians, the presence of certain substances, such as antipsychotics, Benzodiazepines, or barbiturates, in toxicology testing is more common among suicide victims than in the general population. However, it's important to note that the reasons for these substances being present are not always clear, and it may not necessarily indicate a toxic overdose. Contrary to popular belief, medical residents actually have a lower suicide rate compared to the general population, despite high rates of burnout and depression. It's crucial to distinguish between burnout and suicidality, as they are often conflated in media reports.
Discussing the prevalence and risk factors of doctor burnout: Approximately 1 in 3 doctors experience burnout, but it's unclear if this is clinically significant or a result of their demanding work. Risk factors include mood disorders, substance use, and personality traits.
According to the Maslach Burnout Inventory, approximately 33% of doctors are considered burned out based on their scores. However, it's important to consider if this is clinically relevant or if it's simply a result of the demanding nature of their work. We've discussed the epidemiology and risk factors of burnout, including mood disorders, substance use, and personality disorders. In future episodes, we will dive deeper into the genetics of suicide, lessons from autopsies, and ways to decrease suicide. Stay tuned for more information and resources on this topic. Remember, if you have any questions or thoughts, please reach out to us on social media. We value your engagement and feedback. And, as always, your reviews on iTunes or Stitcher are greatly appreciated.
