PBL Question- Hayleigh

You are a PA working a night shift in A+E when a young male is brought in following a self-reported
paracetamol overdose. He is currently stable. You take a history and ask him about the attempt. The
patient explains he had the intention of ending his life; he got drunk, locked his bedroom door and
took the paracetamol tablets. You ask some more questions and do a general physical exam.

Using the information above and additional details gathered in the options below, what particularly
makes the patient a high suicide risk and are therefore are unable to send him home?

a) Never been in a relationship

b) He has physical signs of skin picking on his fingernails and down his arms
c) He has taken 8 paracetamol tablets
d) He often has feelings of hopelessness
e) He has just achieved a First in his undergraduate degree
Answers

a) Partially correct; history of being single has been shown to increase suicide risk, due to
feelings of loneliness or inadequacy
b) Partially correct; this is a sign of potential undiagnosed anxiety, which puts patients at a
greater risk
c) Most correct; this is a self-reported suicide attempt. Despite 8 tablets not being enough to
kill a person, this patient believes they can. Therefore, they had intent so are at higher risk of
completion when discharged.
d) Partially correct; this is a depressive symptom, which does put him at risk.
e) Incorrect; academic achievement is actually regarded a protective factor against suicide.

References

NICE (2021). Depression- Management- Assessing Risk of Suicide. [online] NICE. Available at:
https://cks.nice.org.uk/topics/depression/management/new-or-initial-management/#assessing-risk-
of-suicide.

NICE (2021b). Self-Harm- Management. [online] NICE. Available at:

https://cks.nice.org.uk/topics/self-harm/management/acute-management-of-a-person-at-risk-of-
self-harm/.