21. Suicide

Question 1

person is thinking about suicide

Answer 1

suicide ideation

Question 2

includes willful, self-inflicted life threatening attempts that have not led to death

Answer 2

suicide attempt

Question 3

act of intentionally ending one’s own life and opting for nonexistence

Answer 3

suicide

Question 4

voluntary apparent attempt at suicide where the aim is not death (intent varies)

Answer 4

parasuicide

Question 5

probability that a person will die by suicide; likelihood that a method of death will succeed

Answer 5

lethality

Question 6

myths of suicide

Answer 6

• people who talk about suicide don’t die by it
• suicide happens without warning
• people who die by suicide are fully intent on dying-
  suicides occur more frequently during holidays
• improvement after suicide crisis means risk of over

Question 7

a bodily lesions resulting from acute overexposure to energy (mechanical, thermal, electrical, chemical, or radiant)

Answer 7

physical injury

Question 8

examples of physical injury

Answer 8

• suffocation
• poisoning or overdose
• lacerations
• gunshot wounds

Question 9

examine factors that identify whose who are most likely to attempt suicide

Answer 9

ideation of action theories

Question 10

3 interactive factors that indicate a high risk of suicide

Answer 10

• thwarted belongingness: feelings of loneliness or isolation
• perceived burdensomeness: feelings of being a burden to others
• acquired capability for suicide: heightened sense of fearlessness and a high pain threshold (develops over time)

Question 11

progression from suicide ideation to suicide attempt

Answer 11

volitional factors

Question 12

4 volitional factors

Answer 12

• acquired capability
• access to lethal means
• planning
• impulsivity

Question 13

a lack of social connection that contributes to suicide thoughts and actions

Answer 13

social distress

Question 14

examples of social distress

Answer 14

• single
• separated or widowed
• homeless w/o religious affiliations
• interpersonal conflict
• sexual minorities
• bullying

Question 15

suicide behavior that occurs after the suicide death of a known other

Answer 15

suicide contagion

Question 16

T/F: poverty and economic disadvantage is associated w/ suicide

Answer 16

True

Question 17

protective factors from suicide

Answer 17

• family and community support
• skills in problem solving, conflict resolution, and non-violent ways of handling disputes
• cultural and religious beliefs
• easy assess to clinical care

Question 18

marital status risk factors for suicide

Answer 18

single 2x more likely than married people

Question 19

gender risk factors for suicide

Answer 19

women attempt suicide more often but men succeed more (more lethal methods)

Question 20

age risk factors for suicide

Answer 20

• risk of suicide increases w/ age

- highest risk group: males 22-44 years old and white males over age 75

Question 21

ethnicity risk factors for suicide

Answer 21

• American Indian/Native Alaska have highest risk

- Caucasian is second highest

Question 22

social risk factors for suicide

Answer 22

• no religious affiliation
• highest and lowest social classes have higher risk than middle class
• unemployment or increased financial burden

Question 23

physical risk factors for suicide

Answer 23

• psychiatric illness (mood disorders most common)
• severe insomnia
• alcohol and barbiturate use
• psychosis w/ command hallucinations
• chronic painful or disabling illness
• family Hx of suicide
• loss of loved one through death or separation

Question 24

largest risk factor of suicide

Answer 24

previous suicide attempt (about half of those who die by suicide have hx of attempts - usually within years)

Question 25

3 areas of suicide assessment

Answer 25

- thoughts or ideation - intention - behavior

Question 26

2 important questions to aks pt to establish suicide ideation

Answer 26

- over the past month, have you wished you were dead or wished you could go to sleep and not wake up? - over the past month, have you had any actual thoughts of killing yourself - answer "yes" to either question = risk (learn intent)

Question 27

how to establish suicidal intent

Answer 27

past or present evidence (explicit or implicit) that a person - wishes to die - means to kill him/herself - understands probable consequences of his/her actions or potential actions

Question 28

questions to ask to assess suicidal intent

Answer 28

over the past month have you - been thinking how you might do this - had these thoughts and some intention of action on them - started to work out the details of how to kill yourself - if yes, did you intend to carry out this plan

Question 29

thought of at least one method w/ no intent on acting on thoughts and has not worked out details

Answer 29

intent; method

Question 30

thought of method but would never go through with it

Answer 30

suicide thoughts w/ no intent

Question 31

thought about method but not sure if would go through with it (possible)

Answer 31

some intent; no plan

Question 32

thoughts of killing oneself with plan fully or partially worked out and some intent to carry it out

Answer 32

suicidal thoughts with specific plan and intent

Question 33

how to assess suicidal behavior

Answer 33

Have you ever done anything started to do anything or prepared to do anything to end your life in the past 3 months?

Question 34

acts or preparation towards self-directed violence; before potential for injury has begun; anything beyond verbalization or thought

Answer 34

preparatory behavior

Question 35

examples of preparatory behavior

Answer 35

- collecting pills - obtaining gun - giving away valuables - writing a will - went to a bridge but didn't jump - tried to shoot or hang self

Question 36

behavioral cues of potential suicide

Answer 36

- giving away possessions - writing farewell notes - making a will or putting affairs in order - sudden improvement after being depressed/withdrawn (more energy to carry out suicide) - neglecting personal hygiene

Question 37

interventions for crisis period

Answer 37

- hospitalization w/ suicide precautions or observations - keep accurate records of pt; document activity every 15 minutes (per protocol) - encourage pt to discuss feelings/problem-solving alternatives - support or develop safety plan

Question 38

interventions for outpatient setting

Answer 38

- don't leave person alone - refer for a comprehensive assessment - enlist help of family or friends - schedule frequent appointments - establish rapport and promote trusting relationship

Question 39

prioritized written list of coping strategies and sources of support for anyone who has had a suicidal crisis; collaborated on by clinicians and patient

Answer 39

safety plan

Question 40

3 characteristics of safety plan

Answer 40

- brief - in patient's own words - easy to read

Question 41

steps of safety plan

Answer 41

- warning signs: when to use safety plan - internal coping strategies: problem-solving strategies that can be done on their own - social contacts who may distract from crisis: places that help person feel safe - family member or friends who may offer help: prioritize list - professionals and agencies to contact for help - making environment safe: remove firearms, prescriptions etc. - write down 1 thing important to person and worth living for

Question 42

safety plan followup

Answer 42

- assess likelihood of following safety plan - where safety plan is kept and can be accessed - evaluate format - review periodically

Question 43

education for family and friends of suicidal patient

Answer 43

- take any hint of suicide seriously - don't keep secrets - be a good listener - express to patient feelings of personal worth - restrict access to firearms or other means of self-harm