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Side effects of SSRIs
- sexual dysfunction
Side effects of tricyclic antidepressants (TCAs)
- dry mouth
- urinary retention
- blurred vision
- cardiac toxicity
Side effects of MAOIs
- hypertensive crisis
Sx of serotonin syndrome
- hyperactivity or restlessness
- tachycardia, cardiovascular shock
- altered mental states
- irrationality, mood swings, hostility
- abdominal pain, diarrhea, bloating
- apnea, death
This type of medication should not be stopped abruptly
- can lead to serotonin withdrawal
Toxic effect of MAOIs can cause this
HTN crisis: severe headache, tachycardia, palpitations, hypertension, N/V
Define suicide intent
the degree to which a person intends to act on suicidal ideation
Top four risk factors for suicide
- suicidal ideation with intent
- lethal suicide plan
- history of suicide attempts
- family history of suicide
mechanisms of suicidality
- acutely overwhelming physical, social and/or psychological situation (stressors)
- Usual coping methods are overwhelmed and person sees no way out
- high ambivalence
- ~50% have EtOH in their blood at time of suicide
Risk assessment considerations
- current suicidal ideation and/or plan
- past hx
- current mindset (seeing no alternatives, etc.)
- substance abuse/dependence
- minimization of distress, lack of forthcomingness about feelings, unwilling to admit to suicidal ideation/plan, high ambivalence
- current depression and treatment response (enough energy to care out plan?)
What is "Flight into Health"?
- A patient demonstrates rapid improvement, but it is "too good to be true".
- A sign of possible suicidal intention (get released from care/in-patient setting so that they will be able to complete their plan).
Assessment questions for suicide risk
- Life isn't worth living?
- Others would be better off?
- How often do you think above?
- do you want to kill yourself?
- have you ever tried? How?
- If you try, plan?
- when did you last have these thoughts?
- feel like acting on them?
- What stopped you? (VERY IMPORTANT)
- When might you do it?
- lethality assessment (do you have the means?)
- who can you call before suicide? (interpersonal resource)
Intervention policy - hierarchy of needs
- biological/physical needs
- social interaction/doing
What is the 'contracting approach' with inpatients?
- Have an agreement with pt to let you know if feeling out of control/ready to act on suicidal ideation/plan.
- DO NOT rely on exclusively
- work with the side of teh person that wants to live
- Detemine what prevents
- help activate social support
- provide structure to day (reduce rumination
- provide statements of hope