Med4yu: Depression and suicide risk

This post mainly focus on how medical students should do when they are asking for the patient's history, especially those suspected with depression.

It is important to know if the depression that they are facing will lead to serious issues like harming themselves.

In normal hospital setting, you can see that it is quite often that physicians tie this two together, so we can access their situation in one session.

Try not to ask their history multiple times as it could affect the way they answer the question.

History taking always starts with

Remember to always be caring and a helpful listener.

1. Introduction

Name, age, occupation, marital status

2. Ask for chief complain.

complain + duration
Depression duration: >2 weeks >1 symptoms

3. Present History

ask symptoms that could help you differentiate depression from other diagnosis

they are helpful to differentiate the other diseases related.

you can refer to the notes in this link

4. How to diagnose depression?

Remember : SIG CAPES
If they have >1 symptoms
Check if they have

Sadness
Insomnia
Guilty feeling

Observe

Concentration
Agitation
Psycho-motor system
Energy
Suicidal idea

Check if there are any manic involve. it is important to use it to differentiate between bipolar or depression

Depression :

no manic
not under medication or drug usage (cannabis)

5. Check for their suicidal risk

Any signs of them trying to harm themselves? if yes check the below

Suicide assessment (5 points)

	Details	For example:
Ideation	Idea of trying to harm themselves	e.g. to jump off the plane, etc.
Plan	Any realistic plan to harm themselves?	Booked a flight ticket
Means	Do you have the materials?	Already have a knife at home.
Intent	Do you intent to, when?	By next month
History	Past history	Prior suicide attempts, abort attempts, self-harm

SAD PERSONS scale is needed to further evaluate their risk.
Then you should check with the SAD PERSONS scale to figure out their score if they need further treatment or not.

score >7 :

Admit them immediately and get consent from them or their family members
Bio-psycho social therapy : relaxation technique, CBT, systemic desensitizing, BZD, SSRI,
Family support