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Name
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Chen Siu
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DOB
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04/11/1989 (28 years)
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Occupation
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Lawyer
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History
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Note for actor/actress: Quiet, silent, and expressionless. Not receptive to normal conversation. Not responsive if the interviewer is asking question at a normal, lively pace and tone. Unable to look at the interviewer in the face. Only answer if the questions are short and empathic. Do not volunteer information unprompted.
I want to die… There’s no point in me living anymore. I left my family just to be with my partner… Even she chose left me… I have no one now. I am even bad at work. I could not concentrate, and I get agitated at my clients. My boss told me to take time off. I took paracetamol… loads… enough to kill me I went to different pharmacies and buy them separately so that I won’t be found. My colleagues at work came to check on me. They got worried when they couldn’t get through to me. They called the police. I regret being found… I would rather die. I left a note. I want Dominica (my ex-partner) to regret that she left me… I don’t see a point in living on… I don’t know what to look forward to in life… I have no interest in my job which I used to enjoy, I have no energy They keep telling me that I’m worthless… [When prompted about hallucinations] I hear voices, in my head… when no one is in the room. I can’t stop them talking to me. It happened after I lost Dominica… [When prompted about what I want to do if I’m being sent home] I wanna go home. I don’t need to be in the hospital… I just want to lie in my bed and be away from people. [When prompted about my intention on committing suicide] I’ll jump right in front of the tube. That ought to do the trick… |
Past Medical History
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None
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Drug History
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None. No allergies
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Family History
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Mother was quite depressed after I was born but this got better. She had a lot of complications with massive bleeds when I was born
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Social History
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Occasional alcohol, non-smoker. Work colleagues always have it together and there is no room for slacking. If they find out they will fire me. My mother went through so much to have me, she would not understand
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Introduction & consent
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Name, age, occupation
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Establishes duration of thoughts on self harm or suicide attempt
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Establishes triggers/stressors/life events
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Explores planning for most recent occurrence e.g. finances, letter, buying equipment or medication
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Asks if this has occurred previously
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Explores any precautions made
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Explores method used
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Explores purpose
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Explores expectation of lethality
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Asks how they were found
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Asks how they feel about it now
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Asks how they feel about being alive
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Explores views of the future
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Asks if they are likely to harm themselves again and reasons why (not)
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Screens core symptoms of depression (low mood, anergia, anhedonia)
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Screens for cognitive symptoms: feeling hopeless, worthless, helpless, poor memory/concentration and guilty
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Screens hallucinations or delusions
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Explores available support
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Identifies level of insight and willingness to accept treatment
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Looks for substance misuse
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Previous medical & psychiatric history
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Family history of psychiatric or medical disorders
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Drug history, alcohol, smoking and allergies
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Ideas "Was there anything you thought it might be?"
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Concerns "What about it is worrying you in particular?"
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Expectations "Is there anything in particular you were hoping we would to today?"
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Communication skills (empathy and avoids jargon)
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Summarises back to patient
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Classifies immediate risk of further self harm & suicide and whether patient can be safely discharged
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Q1. How would you manage the patient?
I would ensure that the patient is physically stable. Then I’ll perform a mental state examination and take a full psychiatry history. I’ll assess the patient’s capacity if she refuses medical treatment. I will also refer the patient to liaison psychiatry team for further assessment of her depression.
Q2. What are the risk factors of suicide?
- Life events and stressors
- Extreme social class (Class I and V)
- Social isolation
- Stressful occupation
- History of mental health illnesses: depression, schizophrenia
- Previous attempts of suicide and self-harms
- Substance abuse and dependence
- Personality disorder
- Chronic physical illness
- Family history of suicide