Suicide overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Suicide is the third leading cause of death among all children and adolescents in the United States. According to the American Society of Suicidology, suicide can be classified based on method employed and psychiatric behavior of person committed into 10 and 8 types. Common risk factors include family history of suicidal behavior, mental disorders such as major depression, substance use disorders, hospitalization or psychotic disorders, history of physical or sexual abuse, previous suicide attempt or exposure to suicide, gay, lesbian, or bisexual orientation, or transgender or gender non-conforming identity, biologic factors, access to firearms, alcohol and drug abuse, social stress, social isolation, adoption, emotional and cognitive factors. Physical examination should be focused towards vital signs, level of consciousness and orientation, manifestations of toxidromes, signs of recent or remote suicide attempts, scars from cutting, bruises from hanging, signs of Physical or sexual abuse, characteristic bruising patterns or genital trauma, signs of substance abuse, track marks from intravenous drug use, nosebleeds or perioral blisters from inhalant use and signs of hyperthyroidism. Psychiatric evaluation is done by the clinicians with specialized training and experience in the psychiatric problems of children and adolescents or general medical emergency department clinicians. Psychiatric evaluation is done once the patient is medically stable. The mnemonic "MALPRACTICE" is used to ensure that all the areas for psychiatric evaluation are being covered. Effective medical management include hospitalization of high risk individuals and stabilizing. Effective psychotherapies for suicide prevention include cognitive behavioral therapy, dialectical behavioral therapy, family therapy and group psychothe. Antidepressants has no proven role in the acute management of the suicidal adolescent or child. The American Society of Suicidology recommends administration of appropriated medications for an underlying psychiatric disorder in pediatric patients hospitalized for suicidal ideation or behavior. There are no effective or concrete strategies in preventing suicides. However, American society of Sucidology brought up certain recommendations in identification of risk factors and warning signs to get aware of an individual at risk. American Society of Sucidology also came up with a mnemonic for warning signs 'IS PATH WARM".
Classification
According to the American Society of Suicidology, suicide can be classified based on method employed and psychiatric behavior of person committed into 10 and 8 types.
Epidemiology and demographics
Suicide is the third leading cause of death among all children and adolescents in the United States. In the United States, the incidence rate of suicide among children aged 5 to 11 years was 1 per 1 million, between 2008 and 2012. Among adolescents, the suicide rate is highest for white males.
Risk factors
Common risk factors include family history of suicidal behavior, mental disorders such as major depression, substance use disorders, hospitalization or psychotic disorders, history of physical or sexual abuse, previous suicide attempt or exposure to suicide, gay, lesbian, or bisexual orientation, or transgender or gender non-conforming identity, biologic factors, access to firearms, alcohol and drug abuse, social stress, social isolation, adoption, emotional and cognitive factors. Mnemonic for identification of risk factors "IS PATH WARM".
Screening
The United States Preventive Services Task Force (USPSTF) have declared that there is insufficient evidence to determine the benefits of screening for suicide risk in the general population of United States adolescents having no prioe history of mental disorders or previous suicide attempts.
Physical examination
Physical examination should be focused towards vital signs, level of consciousness and orientation, manifestations of toxidromes, signs of recent or remote suicide attempts, scars from cutting, bruises from hanging, signs of Physical or sexual abuse, characteristic bruising patterns or genital trauma, signs of substance abuse, track marks from intravenous drug use, nosebleeds or perioral blisters from inhalant use and signs of hyperthyroidism.
Laboratory findings
Commonly performed screening laboratory tests include complete blood count, serum chemistry panels, urinalysis, thyroid stimulating hormone, human chorionic gonadotropin, urine toxicology screen for drugs of abuse, aspirin, and acetaminophen.
Psychiatric evaluation
Psychiatric evaluation is done by the clinicians with specialized training and experience in the psychiatric problems of children and adolescents or general medical emergency department clinicians. Psychiatric evaluation is done once the patient is medically stable. The mnemonic "MALPRACTICE" is used to ensure that all the areas for psychiatric evaluation are being covered.
Treatment
Medical Management
Effective medical management include hospitalization of high risk individuals and stabilizing.
Psychotherapy
Effective psychotherapies for suicide prevention include cognitive behavioral therapy, dialectical behavioral therapy, family therapy and group psychotherapy.
Pharmacotherapy
Antidepressants has no proven role in the acute management of the suicidal adolescent or child. The American Society of Suicidology recommends administration of appropriated medications for an underlying psychiatric disorder in pediatric patients hospitalized for suicidal ideation or behavior.
Prevention
There are no effective or concrete stratagies in preventing suicides. However, American society of Sucidology brought up certain recommendations in identification of risk factors and warning signs to get aware of an individual at risk. American Society of Sucidology also came up with a mnemonic for warning signs 'IS PATH WARM".