Risk of Sucide

Risk Factors for Suicide

Suicide risk is greatly increased with the presence of both depression and an anxiety or disruptive disorder.

Suicidal behavior risk factors have been classified into 2 separate categories: predisposing factors and precipitating factors. Predisposing factors are those that directly increase an adolescent's risk for suicide. They include the following.

Previous Suicide Attempt

Adolescents who have had a previous suicide attempt are much more likely to try again, with an even more marked increase in those with multiple previous attempts. Between one quarter and one third of adolescents who attempt suicide will go on to try again, with the greatest risk for recurrence falling between 6 months and 1 year after their first attempt.

History of a Prior or Ongoing Psychiatric Disorder

A prior or ongoing psychiatric disorder is a major risk factor for suicide, with studies showing that adolescents who commit suicide have a higher rate of depression, substance abuse disorders, eating disorders, anxiety disorders, and antisocial disorders.

History of Sexual or Physical Abuse

Studies have shown that adolescents who are victims of sexual or physical abuse are up to 3 times more likely to commit suicide and up to 8 times more likely to have repeated suicide attempts.

History or Exposure to Violent Behavior

Adolescents who have been exposed to high levels of violence are twice as likely to attempt suicide as those who have not.

Family History of Suicidal Behavior or Mood Disorders

A family history of suicidal behavior plays both a genetic and environmental role in increasing the risk for an adolescent's likelihood to attempt or commit suicide.

Biological Factors, Including Male Sex and Gay or Lesbian Sexual Orientation

Boys are about 5-6 times more likely to complete suicide than girls. Gay and lesbian teens are much more likely to have suicidal ideations and attempt suicide than heterosexual teens. There is some evidence to suggest that those adolescents with smaller concentrations of serotonin and all of its metabolites and receptors and neurons are at a greater risk of attempting and committing suicide.

In addition to these 6 direct risk factors, 4 main precipitating, or potentiating, factors play a role in adolescent suicide. Although they are not sufficient in and of themselves to increase suicide risk, they can synergistically increase the likelihood of some form of suicidal behavior when they are present. They include:

• Substance abuse
  
  
• Access to firearms or other means
  
  
• Social stress, such as interpersonal conflicts with friends, family, or law enforcement
  
  
• Emotional factors, such as feelings of despair or hopelessness.

OSCE : DHF History Taking

Particulars of the Patient
Name, age, residence etc as usual. Age is important for disease occurance..
Residence is important in this case because of possible outbreak. Anyone with similar illness in the neighborhood should be enquired

Chief complaints
Fever and flulike symptoms
Muscle and bone aches
red spots
vomitting, coffee-ground vomiting, black stools
abdominal pain
headache and periorbital pain
rash

Symptom Analysis

Fever
-onset- acute, ask the exact day the fever first appeared because it is useful for management.
The disease is worst in day 3 to 6. If the continuous monitoring including haematocrit traces good, patient can be discharged at day 7.
nature-continuous,
any associations-flulike symptoms +, headache, periobital pain, etc

Muscle and Bone Aches

Bleeding manifestations
-(spots appear on the body, leading questions are avoided if possible.)
-(do you notice anything appears on your body? is appropriate)
-if the child reponse is a lot of spots appears, you should specify what kind of spots are there -by asking more questions on them. --day of appearance, type of spots
-petechiae?, Pupura?, Echymosis?, Rash?
-Epistasis? Is there any blood coming out from your body, example nasal bleeding?
-Do you vomit? What color is the vomitus?
- Are they coffee ground colored?
-If the response is yes, you have to prove that it is not due to having coffee before vomiting?
You should specify that by asking whether he took coffee or not before vomiting.
-Malena ? What is the color of your poo-poo? (Is it black? is a leading question that may give false positives and not encouraged in children because they may easily nod their head.)
The malena stool is tarry black. Should be distinguished from brown color asking in details.

Abdominal pain
onset, usually 3 to 7 days after onset of fever, vague discomfort, dull in nature, tense right hypochondrium.

Urine color
May be pink to red in severe disease. If it presents, urinary becomes an issue to go details.
Bleeding at the end of voiding or before the start is likely from urithera , prostate and bladder neck.
Mixure of blood with urine with red, pink or strawberry color is likely from the upper urinary tract . Other urinary symptoms needs to be excluded.

Associated symptoms and complications needs to be asked

Conversions,
Sweating and faint, common in frequent vomiting
Paler with rashes
Lethergy,etc

Recovery Rash

It is typical confluent rash with whorls of pales and reds usually in the leg appearing at the recovery phase usually from Day 6 to Day 10.
It indicates that the disease is at the recovery phase.
It is retrospectively diagnotic of Dengue Fever.

The rash should be asked about if the child is at day 6 or later, however children may not notice though care giver may find them while tepid sponging.

Interview

After History taking, the examinor may interview you.

About epidermiology, natural history of disease, life cycle of Aedes,etc
About investigations and observation
About treatment, including fluid caculations and DSS emergency management
About prevention
About recovery rash and its clinical importance

The END. GOOD LUCK