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Suicide - Assessment, Management and Treatment

Algorithm

1. Persistent suicidal ideation or thoughts are an indicator for which classification of “risk of suicide attempt”?

A. High Acute Risk

B. Intermediate Acute Risk

C. Low Acute Risk

D. None of the above


2. Which of the following is a modifier that increases the level of risk for suicide of any defined level?

A. Acute state of substance use.

B. Access to means.

C. Existence of multiple risk factors or warning signs.

D. All of the above.


Module A

3. The objective of risk assessment is to stratify individuals into levels of risk.

A. True

B. False


Module A: A

4. Which of the following conditions is considered to be a risk factor for suicide and is characterized by a high rate of suicidal ideation?

A. Chronic pain

B. Depression

C. Insomnia

D. All of the above


5. During clinical assessment, the therapeutic interventions that follow depend on the psychiatric diagnosis.

A. True

B. False


Module A: B

6. Which of the following is not one of the ultimate goals of suicide risk assessment?

A. Identify patients who are in need of immediate intervention to prevent a suicidal act.

B. Determine the appropriate treatment setting to optimize safety.

C. Immediately put patients on antidepressant and anti-anxiety medications.

D. Formulate a treatment plan that reduces the risk for future suicidal thoughts or behaviors.


7. A suicide risk assessment must include the evaluation of the patient’s internal experience, thoughts, beliefs, and attitudes; their external world of relationships and stressors; as well as the myriad of factors that increase the likelihood of suicide and those that prevent them from action.

A. True

B. False


8. Which of the following is not one of the three direct warning signs for the highest likelihood of suicidal behaviors occurring in the near future?

A. Writing or talking about suicide.

B. Maxing out credit cards.

C. Updating wills or making financial arrangements for paying bills.

D. Seeking access of lethal means.


9. The first priority in determining the care setting is safety.

A. True

B. False


Module A: C

10. Patients should not be directly asked if they have thoughts of suicide as this may cause further suicidal ideation.

A. True

B. False


11. When assessing for current intent and the degree of intent for suicide, it is important to understand the extent to which the patient:

A. Wishes to die.

B. Means to kill him/herself.

C. Understands the probable consequences of his/her actions or potential actions.

D. All of the above.


12. Which of the following is one of the strongest and most reliable predictors of future suicidal behavior?

A. History of a past suicide attempt.

B. Suicide of a parent or caregiver.

C. Substance abuse disorders.

D. Mental illness.


13. Once the decision to die by suicide is made, the suicidal person may be less agitated and appear more stable, leading clinicians to underestimate the suicide risk, but this behavior should be considered a warning sign.

A. True

B. False


Module A: D

14. Patients ages _____ who are prescribed an antidepressant are at increased risk for suicidal ideation and warrant an increase in the frequency of monitoring of these patients for such behavior.

A. 15 to 21

B. 18 to 25

C. 15 to 25

D. 15 to 32


15. The suicide of someone famous can be a psychological risk factor for suicide.

A. True

B. False


16. Assessment of the risk for suicide should focus on:

A. The distinct component of the suicidal act itself.

B. Impulsivity as a trait of the individual.

C. Both (A) and (B).

D. Each patient is different and therefore focus cannot be narrowed down.


17. While commonly held perceptions of suicide include the notion that most involve following a plan and thus are potentially foreseeable, current research demonstrates that most suicides are actually impulsively committed.

A. True

B. False


18. Which of the following is not one of the critical factors involved in suicides?

A. Public humiliation.

B. A sense of perceiving oneself as burdensome to others.

C. A lack of belongingness.

D. A learned capability for self-injury based upon experiencing activities that “foster fearlessness of and competence for suicide.”


19. Research has demonstrated that impulsive traits can be predictive of suicide attempt impulsivity.

A. True

B. False


20. Clinicians should not be overly focused on an individual’s level of impulsivity, but instead spend more time determining whether the individual’s level of impulsivity has in fact led to a lifestyle fraught with painful and provocative experiences.

A. True

B. False


21. Which of the following are considered risk management options?

A. Admitting the patient for inpatient hospital care.

B. Making a referral for residential care.

C. Detoxification.

D. All of the above.


22. Which of the following is the most common method of attempted suicide?

A. A firearm

B. Intentional overdose

C. Hanging

D. None of the above


23. All patients at acute risk for suicide who are under the influence (intoxicated by drugs or alcohol) should be evaluated in an urgent care setting and be kept under observation until they are sober.

A. True

B. False


24. Detoxification alone may be sufficient when suicidal thoughts or behaviors are present.

A. True

B. False


25. A telltale risk factor for unintentional overdose, compared to a suicide attempt, is a recent loss of tolerance, as seen by those during incarceration or detoxification.

A. True

B. False


Module A: E

26. The assessment should comprise a physical and psychiatric examination including a comprehensive history.

A. True

B. False


27. Which of the following should be considered by the provider when choosing a setting for the initial evaluation to ensure the safety of the patient and the clinical staff so that potentially life-threatening conditions can be managed effectively?

A. Secure all belongings to prevent access to lethal means and elopement from the facility.

B. Monitor the patient in a visible area, away from exits, with limited access to equipment that may be used to harm oneself or others.

C. Request Behavioral Health Consultation to conduct a thorough suicide risk assessment and recommend a treatment plan.

D. All of the above.


Module B: F

28. Which of the following is not a care setting?

A. Primary care clinics.

B. Emergency departments.

C. Jail or prison.

D. Inpatient hospital wards.


29. The inpatient psychiatric hospital setting is particularly suitable for the treatment of chronic risk for suicide rather than acute risk.

A. True

B. False


30. A patient may be discharged to a less restrictive level of care from an acute setting after a behavioral health clinician evaluated the patient or was consulted, and which of the following conditions have been met?

A. Clinician assessment that the patient has no current suicidal intent.

B. The patient’s active psychiatric symptoms are assessed to be stable enough to allow for reduction of level of care.

C. The patient has the capacity and willingness to follow the personalized safety plan.

D. All of the above must be met.


31. Inpatient treatment is the standard of care because it has been found to be the most successful in clinical trials.

A. True

B. False


32. Which of the following is not true with regard to hospitalization?

A. The surrender of freedom and independence can result in regression and hurt the therapeutic alliance, especially when involuntary.

B. The hospitalized patients are no longer at a high risk for suicidal behaviors.

C. Increases to costs of health care, potentially impacting employment.

D. Hospitalization for a mental disorder may result in a lifetime of stigma and loss of civil rights.


33. The highest risk period for suicide attempts occurs within the first week of hospitalization and immediately upon discharge from the hospital through the subsequent _____ weeks.

A. 4

B. 8

C. 12

D. 16


Module B: G

34. Family engagement should include family sessions and education about:

A. Warning signs.

B. Adherence to the recommended treatment plan.

C. Emergency procedures.

D. All of the above.


35. There is expert consensus that “no harm” contracts are insufficient for mitigating suicide risk.

A. True

B. False


Module C: I

36. For the prevention of suicide, the primary goal of cognitive-behavioral therapy is to teach suicidal patients that death is not the only option.

A. True

B. False


37. Which of the following emphasizes the emotional and maladaptive ways that individuals react to stressful conditions when facing significant problems?

A. Problem Solving Therapy (PST)

B. Cognitive-Behavioral Therapies (CBT)

C. Dialectical Behavior Therapy (DBT)

D. Interpersonal Therapy (IPT)


Module C: K

38. Intervention strategies in patients whom suicide risk is associated with using substances should emphasize:

A. Safety

B. Relapse prevention

C. Addressing the substance use

D. All of the above


Module C: M

39. Lithium should be avoided or used in caution in patients with which of the following?

A. Liver failure

B. Impaired renal function

C. Cancer

D. HIV / AIDS


40. Benzodiazepines can occasionally disinhibit aggressive and dangerous behaviors and enhance impulsivity.

A. True

B. False


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