Suicidal Thoughts

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of suicidal ideation

Intensity of ideation: ‍passive death wish, ‍persistentintermittent

Current plan:

- Mean: ‍ ‍undefined, ‍withwithout access for lethal mean,

- Place: ‍ ‍undefined

- Time: ‍ ‍undefined, ‍withwithout preparations made

Previous suicide attempts: ‍ ‍no

Recent stressors: ‍

Protective factors: ‍none



Associated symptoms: *Try using right-click for negatives*

‍depressed mood

‍hopelessness

‍anxiety

‍worry

‍difficulty concentrating

‍feeling overwhelmed

‍withdrawal from social supports

‍insomnia

‍hypersomnia

‍decreased performance at work/school

‍loss of appetite

‍increased appetite

‍impulsivity

‍risky behavior

‍homicidal ideation

‍substance use

‍hallucinations



Smoking: ‍neversmokerformer smoker, ‍ pack-years

Alcohol: ‍nonesociallyexcessive, ‍ drinks per ‍dayweek

Recreational drugs: ‍none ‍cannabis, ‍IVDU



No history of: ‍mental illness, ‍depression, ‍anxiety, ‍bipolar disorder, ‍schizophrenia, ‍personality disorder

No family history of: ‍suicide, ‍mood disorder

Adherence to treatment: ‍goodpoor





EXAM:

Mental Status:

Appearance: ‍well-dressed, ‍well-groomed, ‍goodpoor eye contact, appears ‍age-appropriate

Behavior: ‍cooperativenon-cooperative

Psychomotor activity: ‍normalretardedagitated

Speech: ‍clear, ‍slowrapid, ‍monotonoustalkative

Mood: ‍euthymicdysthymic, ‍anxious, ‍

Affect: ‍euthymic, ‍reactivenon-reactive, ‍full range, ‍appropriate to situation, ‍congruent with mood

Thought process: ‍organizeddisorganized, ‍coherentincoherent, ‍logicalillogical, ‍

Thought content: ‍normalpreoccupationshopelessness, ‍delusions, ‍suicidal ideations, ‍homicidal ideations

Perception: ‍normal, ‍hallucinations, ‍illusions

Cognition: ‍alert, oriented to ‍3 spheres, disoriented to ‍, attention ‍intactdistractible, memory ‍intactimpaired

Judgment: ‍goodmoderatepoor

Insight: ‍goodmoderatepoor into condition

Reliability: ‍goodmoderatepoor





ASSESSMENT:

‍Suicidal ideation ‍likelysuspectedpossible

DDx: major depressive disorder, bipolar disorder, borderline personality disorder, schizophrenia, post-traumatic stress disorder, substance use disorders, anxiety disorders, adjustment disorder, chronic pain syndromes, chronic illness, neurocognitive disorders, end-of-life issues, grief reaction, psychotic disorders, personality disorders, eating disorders, trauma and stressor-related disorders, medication side effects, substance-induced mood disorder, thyroid disease, anemia, nutritional deficiencies, neurological disorders





PLAN:

Investigations:

- Blood work: ‍CBC, ‍TSH, ‍electrolytes, ‍LFTs, ‍Creatinine

- Urine toxicology screen

- Alcohol level

Treatments:

- Safety plan with patient and family

- Removal of access to means

- Regular check-ins by family or friends

- Safety contacts provided

- Avoidance of alcohol and drugs

- ‍Hospitalization

- ‍Antidepressants

- ‍Antipsychotics

- ‍Mood stabilizers

- ‍Anxiolytics

- ‍Psychotherapy

Further care:

- Psychiatric hold

- Admission to psychiatric unit

- Referral to psychiatrist

- Referral to social worker

- Referral to psychologist

- Referral to crisis team

- Follow-up in ‍ ‍daysweeks

- Return to ER if suicidality worsen or if new symptoms such as psychosis develop