Suicidal ideation history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]

History and Symptoms

Talking about having no reason to live Forming a plan for the suicide attempt Wanting to be left alone Violent or rebellious behaviors Running away Difficulty concentrating Hopelessness Depression Despair Paranoia Delusions Psychosis No hope for the future The belief that nothing will get better Changes in eating or sleeping patterns Seeking out lethal means to end their life Preoccupation with death or dying Getting affairs in order – making a will, giving away treasured possessions Saying goodbye to loved ones Acting recklessly Previous suicide attempts Psychomotor agitation Insomnia Dramatic mood swings Anger Anxiety Sudden change to extreme happiness Talking about wanting to die Anhedonia Hallucinations Vague somatic physical symptoms Decline in work or scholastic performance Withdrawing from once-pleasurable feelings Sudden and extreme personality changes Sudden sense of calm Increased usage of alcohol or drugs Worsening of emotional health Neglecting personal appearance Panic attacks Angst Extreme remorse

Alteration in sleeping or eating habits

• Residual scars from previous attempts or injuries

Evaluation of a patient with suicidal ideation

Evaluation of the Patient with Suicidal Ideation New patients Ask about a history of psychiatric illness and substance abuse; if present, ask about a history of suicidal ideas and attempts. Using the CAGE questionnaire, screen for alcohol abuse. Perform a mental status examination, with emphasis on mood, affect and judgment. New and established patients with evidence of major depression, substance abuse, anxiety disorder or a recent stressor Ask about suicidal ideation and furtherance of plans (including access to lethal means). Identify symptoms associated with suicide Review risk factors associated with suicide Interview family or significant other, if indicated. Synthesize and formulate a treatment plan. Questions to ask to patients with suicidal ideation Delineate extent of suicidal ideation When did you begin to have suicidal thoughts? How often do you think about suicide? Do you feel as if you're a burden? Or that life isn't worth living? Did any event (stressor) precipitate the suicidal thoughts? Do you have any stressors What makes you feel better What makes you feel worse Do you have a plan to end your life? What stops you from killing yourself (e.g., family, religious beliefs)? Do you have access to fire arms Have you changed your will or life insurance policy or given away your possessions? References References