Suicide Prevention: Identify and Treat at Risk Patients
Which statement is NOT true regarding tricyclic antidepressants? (a) They are often associated with orthostatic hypotension (b) They are less lethal in overdose when compared to selective serotonin reuptake inhibitors (c) They should be used cautiously or not all in those with cardiac disease (d) They have multiple drug interactions
(b) They are less lethal in overdose when compared to selective serotonin reuptake inhibitors
All of the following are low-risk characteristics for attempting suicide EXCEPT: (a) Female gender (b) Unemployed (c) Married (d) Stable interpersonal relationships
(b) Unemployed
Acute psychosocial crises and chronic psychosocial stressors may include actual or perceived interpersonal losses that may include all of the following EXCEPT. (a) financial difficulties or changes in socioeconomic status (b) level of education (c) domestic violence (d) past or current sexual or physical abuse or neglect
(b) level of education
Suicide rates are highest for men at what age? (a) 15 (b) 25 (c) 45
(c) 45
Suicide rates for women are the highest at what age? (a) 15 (b) 25 (c) 55
(c) 55
Across the world, what is the most common method of suicide? (a) Firearms (b) Poisoning (c) Hanging (d) Jumping from high places
(c) Hanging
Inpatient treatment after a suicide attempt or aborted suicide attempt is recommended in all the following situations EXCEPT: (a) Attempt was violent, near-lethal, or premeditated (b) The patient has limited family and social support (c) Patient can cooperate with recommendations for follow-up (d) The patient is refusing to help
(c) Patient can cooperate with recommendations for follow-up
Subjective expectation and desire for a self-destructive act to end in death IS: (a) Aborted suicide attempt (b) Deliberate self-harm (c) Suicidal intent (d) Suicidal ideation (e) Suicide attempt
(c) Suicidal intent
Symptoms of serotonin syndrome include all of the following EXCEPT: (a) muscle rigidity (b) dilated pupils (c) slowed reflexes (d) agitation
(c) slowed reflexes
Which of the following BEST indicates the number of clients prescribed antidepressants that we can anticipate will have no response to the medication? (a) 2 percent (b) 12 percent (c) 50 percent (d) 38 percent
(d) 38 percent
Major depressive disorder and other depressive disorders account for what percent of suicides? (a) 50% (b) 60% (c) 70% (d) 80%
(d) 80%
Which medication has been associated with prolongation of the QT interval on the electrocardiogram? (a) Citalopram (b) Sertraline (c) Escitalopram (d) A and C
(d) A and C
Ask the person the following about their substance use: (a) how much and how often (b) length of use pattern (c) last time each substance was used (d) All of the above
(d) All of the above
During a structured interview to gather information, clinicians should: (a) Elicit the presence or absence of suicidal ideation (b) Elicit the presence or absence of a suicide plan (c) Assess the degree of suicidality including intent and lethality (d) All of the above
(d) All of the above
In the early phases of treatment, specialists will monitor the patient closely and prescribe specific treatments for symptoms such as: (a) Anxiety (b) Insomnia (c) Hopelessness (d) All of the above
(d) All of the above
Individual strengths and weaknesses include: (a) Coping skills (b) Personality traits (c) Past responses to stress (d) All of the above
(d) All of the above
Inpatient treatment is recommended after a suicide attempt or aborted suicide attempt if: (a) The patient has limited family and social support (b) The patient is psychotic (c) The attempt was violent, near-lethal, or premeditated (d) All of the above
(d) All of the above
Outpatient treatment is recommended after a suicide attempt or in the presence of suicidal ideation/plan when: (a) The plan/method and intent have low lethality. (b) The patient has a stable and supportive living situation. (c) The patient is able to cooperate with recommendations for follow-up. (d) All of the above
(d) All of the above
Thorough and appropriate documentation is essential to prevent malpractice lawsuits. Documentation should always occur: (a) At the first psychiatric assessment or inpatient hospitalization (b) With every occurrence of suicidal behavior or ideation (c) Whenever there is a noteworthy clinical change (d) All of the above
(d) All of the above
Thoughts of self-harm and suicide can be elicited by asking: (a) Do you have guns or other weapons available to you? (b) Have you made any particular preparations (e.g., purchasing specific items, writing a note or a will, making financial arrangements, taking steps to avoid discovery, rehearsing the plan)? (c) Have you ever started to harm (or kill) yourself but stopped before doing something? (d) All of the above
(d) All of the above
All of the following medications can lead to depression, EXCEPT: (a) Beta-blockers (b) Sedatives (c) Chemotherapy agents (d) Desvenlafaxine
(d) Desvenlafaxine
Which medication is least likely to lead to depression? (a) Sedatives (b) Corticosteroids (c) Calcium channel blockers (d) Diuretics
(d) Diuretics
In general, employment serves as a protective factor against suicide; however, certain occupations increase a person's risk. High-risk occupations include all of the following EXCEPT: (a) Healthcare provider (b) Lawyer (c) Artist (d) Engineer
(d) Engineer
The veteran population is at an increased risk for suicide because they possess many risk factors, which include all of the following EXCEPT: (a) Increased rates of major depressive disorder (b) Greater access to lethal means such as firearms (c) Previous combat exposure (d) Higher levels of optimism and social support
(d) Higher levels of optimism and social support
Common side effects of selective serotonin reuptake inhibitors (SSRIs) include all of the following EXCEPT: (a) Sexual Disfunction (b) Nausea (c) Headache (d) Hypertension
(d) Hypertension
Suicide is almost always the result of what? (a) Physical illness (b) Veteran status (c) Old age (d) Mental illness
(d) Mental illness
Individuals who self-harm through the superficial cutting of their skin usually have a personality disorder, and they display all of the following characteristics EXCEPT: (a) Introversion (b) Neurosis (c) Hostility (d) Optimism
(d) Optimism
Physical illness is a significant contributing factor in about half of all suicide. Physical factors that contribute to suicide include all of the following EXCEPT: (a) Loss of mobility (b) Disfigurement (c) Chronic pain (d) Root canal
(d) Root canal
Which of the following antipsychotic medications is an antidepressant available in a transdermal patch? (a) Tranylcypromine (b) Quazepam (c) Phenelzine (d) Selegiline
(d) Selegiline
All of the following are high-risk characteristics for attempting suicide EXCEPT: (a) Male gender (b) Divorced or widowed (c) Unemployed (d) Stable family background
(d) Stable family background
Documentation should include: (a) Risk assessments (b) Decision-making processes (c) Changes in treatment (d) Records of prescribed medication (e) All of the above
(e) All of the above
Self-injurious behavior with a nonfatal outcome accompanied by explicit or implicit evidence that the person intended to die is: (a) Aborted suicide attempt (b) Deliberate self-harm (c) Suicidal intent (d) Suicidal ideation (e) Suicide attempt
(e) Suicide attempt
Self-injurious behavior with a nonfatal outcome accompanied by explicit or implicit evidence that the person intended to die: (a) Aborted suicide attempt (b) Deliberate self-harm (c) Suicidal intent (d) Suicidal ideation (e) Suicide attempt
(e) Suicide attempt
Which antidepressant is most likely to cause weight gain? (a) Mirtazapine (Remeron ®) (b) Sertraline (Zoloft ®) (c) Venlafaxine (Effexor ®) (d) Bupropion (Wellbutrin ®)
(a) Mirtazapine (Remeron ®)
Drugs that can cause depression include all of the following expect: (a) Beta-blockers (b) Glucagon (c) Calcium channel blockers (d) Corticosteroids
(b) Glucagon
Of the following countries, which has the highest suicide rate? (a) United States (b) South Korea (c) Portugal (d) Australia
(b) South Korea
Which class of antidepressant medication must NOT be taken with foods high in tyramine? (a) Selective Serotonin Reuptake Inhibitors (b) Monoamine Oxidase Inhibitors (c) Selective Norepinephrine Reuptake Inhibitors (d) Tricyclic Antidepressants
(b) Monoamine Oxidase Inhibitors
Which group of people is at the highest risk for completed suicide? (a) Teenage boys (b) Older adult males (c) Teenaged girls (d) Older adult females
(b) Older adult males
Inpatient treatment might be recommended in the presence of suicidal ideation with all the following situations EXCEPT: (a) Past attempts (b) Plan/method and intent have low lethality (c) Lack of response to or inability to cooperate with a partial hospital or outpatient treatment (d) Lack of access to timely outpatient follow-up
(b) Plan/method and intent have low lethality
The term antidepressant is BEST described by which of the following? (a) Pharmacologic agents that affect brain chemistry in such a way as to lift the mood or diminish the symptoms of depression (b) Prescription medications that trigger the brain reward system (c) Neuropharmaceuticals which elevate and enhance the metabolic process (d) Psychiatric medications that promote brain plasticity and restructure the cognitive processes
(a) Pharmacologic agents that affect brain chemistry in such a way as to lift the mood or diminish the symptoms of depression
A common first-line drug for depression associated with few side effects is: (a) Sertraline (Zoloft ®) (b) Amitriptyline (Elavil ®) (c) Phenelzine (Nardil ®) (d) Serzone (Trazodone ®)
(a) Sertraline (Zoloft ®)
Jason is a 34-year-old white male who presents to the emergency room with fever, seizures, and diaphoresis. His only medical condition is depression, and he is treated with sertraline. He was seen in the emergency room one week ago for a sprained knee and was prescribed tramadol. Which of the following condition is Jason most likely suffering from? (a) Psychotic depression (b) Serotonin syndrome (c) Bipolar disease (d) Dysthymia
(b) Serotonin syndrome
The criteria for involuntary commitment includes: (a) The person presents as a danger to self, other, or property, or the person is gravely disabled such that they cannot provide for their basic needs or health (b) The person can cooperate with recommendations for follow-up, and the plan/method and intent have low lethality (c) All of the above
(a) The person presents as a danger to self, other, or property, or the person is gravely disabled such that they cannot provide for their basic needs or health
A good opening question for a suicide assessment is, "Have you ever felt that life was not worth living?" (a) True (b) False
(a) True
An interview to gather information during a suicide assessment must be done in a private setting. (a) True (b) False
(a) True
Ask the person what benefits they obtain from their substance of choice is very helpful information. (a) True (b) False
(a) True
Asking first about socially acceptable substances such as caffeine or tobacco products helps to establish a level of comfort for the rest of the interview. (a) True (b) False
(a) True
Asking the person what negative consequences have arisen from their substance use is important. (a) True (b) False
(a) True
Caucasian men and women are three times more likely to commit suicide than African American men and women. (a) True (b) False
(a) True
Common medical illnesses that are seen in combination with depression include heart disease, cancer, stroke, Parkinson's disease, dementia, and diabetes. (a) True (b) False
(a) True
Cultural or religious beliefs about death or suicide are part of the psychosocial situation. (a) True (b) False
(a) True
Depression is associated with higher rates of substance abuse. (a) True (b) False
(a) True
Depression often co-exists with other mental health conditions. (a) True (b) False
(a) True
In order to prevent malpractice lawsuits, clinicians should document suicide risk assessments with every occurrence of suicidal behavior and with any evidence of noteworthy clinical change. (a) True (b) False
(a) True
In states with more stringent gun control laws, suicide by firearms has decreased. (a) True (b) False
(a) True
Inpatient treatment may be needed if a person with suicidal ideation does not respond or is unable to cooperate with partial hospitalization or outpatient treatment. (a) True (b) False
(a) True
Lethality is distinct from and may not always coincide with an individual's expectation of what is medically dangerous. (a) True (b) False
(a) True
Lethality of suicidal behavior is the objective danger to one's life associated with a suicide method or action. (a) True (b) False
(a) True
MAOI food interactions tend to affect the level of catecholamine neurotransmitters in the body. (a) True (b) False
(a) True
Married individuals with children are much less likely to commit suicide than single persons. (a) True (b) False
(a) True
Men are four times more likely to commit suicide compared with women, regardless of age, race, religion, or marital status. (a) True (b) False
(a) True
Military women commit suicide three times more often than non-veteran women of the same age. (a) True (b) False
(a) True
Monoamine oxidase is an enzyme that breaks down neurochemicals such as serotonin, dopamine, and norepinephrine. (a) True (b) False
(a) True
Nearly 95 percent of those who commit or attempt suicide have a diagnosed mental health disorder. (a) True (b) False
(a) True
One of the most serious complications of depression is suicide. (a) True (b) False
(a) True
Over 30 percent of people who commit suicide have seen a healthcare professional within the previous six months. (a) True (b) False
(a) True
Over one-quarter of those who commit suicide are dependent on alcohol at the time. (a) True (b) False
(a) True
Psychotherapy is more effective than a placebo, and the total number of sessions is not associated with the degree of clinical benefit. (a) True (b) False
(a) True
Psychotherapy is most effective in moderate-to-severe depression after a medication has stabilized the disease. (a) True (b) False
(a) True
Questions about intent to harm others are important in a suicide assessment. (a) True (b) False
(a) True
Risk assessment should be documented in a suicide assessment. (a) True (b) False
(a) True
Selective serotonin reuptake inhibitors (SSRIs) can, in effect, increase the amount of available serotonin within the brain. (a) True (b) False
(a) True
Self-inflicted death with explicit or implicit evidence that the person intended to die is suicide. (a) True (b) False
(a) True
Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. (a) True (b) False
(a) True
Serotonin syndrome most often occurs when two drugs that affect the body's level of serotonin are taken together. (a) True (b) False
(a) True
Serotonin-norepinephrine reuptake inhibitors (SNRIs) also tend to have a weak dopamine reuptake effect. (a) True (b) False
(a) True
Suicidal assessment scales have limited value, and they are no substitute for clinical expertise. (a) True (b) False
(a) True
The best predictor of a suicide attempt is a previous suicide attempt. (a) True (b) False
(a) True
The person should be involuntarily committed if there is a diagnosable mental disorder where a mental disorder is defined as any organic, mental, or emotional impairment that has substantial adverse effects upon an individual's cognitive or volitional behavior. (a) True (b) False
(a) True
The rate of suicide increases as a person ages. (a) True (b) False
(a) True
To attempt suicide, men more commonly use firearms, hanging, or jumping from high places, whereas women more often use poison or medication overdose. (a) True (b) False
(a) True
Women experience suicidal thoughts and attempt suicide three times as often as men. (a) True (b) False
(a) True
In the United States, which states have the highest rate of women committing suicide? (a) Montana and Wyoming (b) Alaska and Idaho (c) New Jersey and New York (d) Indiana and Ohio
(b) Alaska and Idaho
Which of the following medications has a chemical structure similar to amphetamines and can increase dopamine levels? (a) Escitalopram (b) Bupropion (c) Fluvoxamine (d) Sertraline
(b) Bupropion
Willful self-inflicting of painful, destructive, or injurious acts without the intent to die: (a) Aborted suicide attempt (b) Deliberate self-harm (c) Suicidal intent (d) Suicidal ideation (e) Suicide attempt
(b) Deliberate self-harm
A suicide assessment is an abbreviated, focused evaluation. A thorough psychiatric evaluation is not indicated. (a) True (b) False
(b) False
Asking the person about over the counter substances, including diet aids, cough, and cold preparations, herbal supplements is not part of a substance abuse assessment. (a) True (b) False
(b) False
Documentation of a suicide assessment cannot include whether the patient has access to firearms because this is a violation of the second amendment. (a) True (b) False
(b) False
During a suicide assessment, previous or current medical diagnoses and treatments, surgeries or hospitalizations are deferred until discharge planning. (a) True (b) False
(b) False
Previous suicide attempts should not be discussed during a suicide assessment. (a) True (b) False
(b) False
Psychiatric specialists cannot cooperate with the primary care physician in the case of a suicide attempt because of HIPAA. (a) True (b) False
(b) False
The American Psychiatric Association suggests using a suicidal assessment scale because the scales have been validated as very valuable. (a) True (b) False
(b) False
The rate of suicide is higher in civilians than in the veteran population. (a) True (b) False
(b) False
The route of administration of abused substances has no clinical importance. (a) True (b) False
(b) False
Suicide claims how many lives per year in the United States? (a) 47,000 (b) 20,000 (c) 105,000 (d) 3,500
(a) 47,000
Potentially self-injurious behavior with explicit or implicit evidence that the person intended to die but stopped the attempt before physical damage could occur is: (a) Aborted suicide attempt (b) Deliberate self-harm (c) Suicidal intent (d) Suicidal ideation (e) Suicide attempt
(a) Aborted suicide attempt
Outpatient treatment is recommended after a suicide attempt or in the presence of suicidal ideation/plan EXCEPT when: (a) Current impulsive behavior and severe agitation (b) Patient has a stable and supportive living situation (c) Patient can cooperate with recommendations for follow-up (d) Plan/method and intent have low lethality
(a) Current impulsive behavior and severe agitation
There are more homicides than suicides each year in the United States. (a) True (b) False
(b) False
While depression is more common in men, successful suicide is more common in women. (a) True (b) False
(b) False
A current presentation of suicidality includes all of the following EXCEPT: (a) Gender and geographical components (b) Specific methods considered for suicide, including their lethality and the patient's expectation about lethality, as well as whether firearms are accessible (c) Alcohol or other substance use associated with the current presentation (d) Reasons for living and plans for the future
(a) Gender and geographical components
