Risk assessment

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The study of suicide at any age is primarily for the purpose of prevention. In older people this means that episodes of deliberate self-harm need to be considered seriously, even when they do not appear to be so. A quantitatively small overdose of a relatively less lethal drug is frequently no indication of the seriousness of suicidal intent. Primary care doctors should be aware of the suicide risk in those attending with physical disorders, especially where the patient's complaints seem to be out of proportion to the actual evidence of disease. Nor is the identification of a physical illness a reason to relax vigilance over suicide risk. Dismissal of an older person's wish to die as 'rational' is probably wrong in most cases, but in any case should never be done before a thorough assessment of the mental state concentrating in particular on depressive disorder. Anxiety is frequently so prominent a presenting symptom of depressive disorder in elderly people, that other manifestations, such as suicidal thinking may be overlooked. Whilst elderly people respond well to antidepressant medication, many live alone. Thus, a prescription for perhaps a month of treatment might be an enhancement of suicide risk. It is therefore prudent either to arrange close supervision or administration of medication by a carer rather than the patient themselves, or for no more than a week's supply to be dispensed at a time. Many pharmacists are willing to assist in this and provide proprietary boxes with compartments for each dose, such as a Dosette or Nomad system.

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