Suicide Flashcards
(28 cards)
Suicidality
all suicide-related behaviors and thoughts of completing or attempting suicide and suicidal ideation
Suicidal Ideation
thinking about & planning one’s own death; it includes excessive or unreasoned worrying about losing a loved one
Suicide Attempt
nonfatal, self-inflicted destructive act with explicit/implicit intent to die
Parasuicide
voluntary, apparent attempt at suicide, commonly called a suicidal gesture, in which the aim is not death
- sometimes death is the result though
- -ex: taking too many pills but not intending to commit suicide
Lethality
the probability that a person will successfully complete suicide
Epidemiology of Suicide
- Suicide is the 10th leading cause of death
- 38,000 annually in the US
- 25 attempts per suicide annually (950,000)
- Mountain regions have the highest rates
- Suicides can be disguised as vehicular accidents or homicides
- Healthy People 2020 directly targets the reduction of deaths by suicide
Who is most vulnerable to suicidality?
- Suicide of a primary family member
- Psychiatric disorder
- Previous attempt
- Loss (grief)
- Unrelenting physical illness
- Poverty
Suicide Intent
- Do they have a suicide plan and means of executing it?
- Inability to enter into a commitment to treatment contract
*Always want to assess for intent
Suicide Risk
- White or Native
- American male adult
- Non Hispanic white or Native American male adolescent
- Elderly man
- Gay, lesbian, or bisexual
- Access to firearm
- Middle aged woman
- Mental illness
- 51% abused children attempt
Suicide: Disinhibition
- Impulsivity
- Isolation
- Psychotic thoughts
- Drug or alcohol use
Special Populations: Children and Adolescents
- 15% high school students have contemplated suicide & 7% have attempted
- Suicide contagion - Adolescents -Cluster suicides (suicide pacts, copy cat syndrome), more media coverage of a celebrity suicide increases copy cat suicides
- Adolescents are influenced by prevention measures
Special Populations: Adults
- Armed services Iraq & Afghanistan a leading cause, combat exposure & for women military sexual trauma
- Ages 45-54 peak & another peak after age 75
Etiology: Genetic
runs in families, identical twin whose twin showed suicidal behavior has 11 X the risk for suicidal behavior
Etiology: Physiologic Effects on Child Abuse
constant stress, altered serotonin/dopamine metabolism
Etiology: Reaction to Surviving Suicide
if they were sorry they did not die they are more likely to attempt again
Etiology: Depression
and neurotransmitter changes
Assessment
- Look for warning signs-giving away cherished belongings, depression, talk of suicide or death
- Identification of suicidal ideation
- Elicitation of a plan
- Determination of the severity of intent
- Evaluation of availability of means
- Sudden improvement may mean the person has developed a plan
- Assess for mental illness
- When you put someone on antidepressants, they look & act better, but they don’t feel better yet
Nursing Diagnosis
- Risk for suicide
- Risk for self directed violence
- Impaired social interaction
- Ineffective coping
- Chronic low self-esteem
Interventions
- Safety
- Work on their will to live
- Commitment to treatment statement
- Physical care of self-inflicted injury - Involuntary commitment to treatment
- Referral to an appropriate clinician
- Medication management - Psychoeducation
- Changing negative thought patterns
- Developing a contingency plan
- Stigma reduction - Developing support networks
- Electroconvulsive therapy
Interventions
Treating any underlying mental illness is protective
Interventions: Depression
treat with Selective Serotonin Reuptake Inhibitors (SSRI’s) which are not generally as lethal in overdose as other antidepressants (Tricyclic antidepressants are more lethal in overdose).
Interventions: Schizophrenia & Schizoaffective
Clozapine (clozaril) is an atypical antipsychotic that is protective for suicide
Commitment to Treatment Statement
Recent research findings do not support ongoing use of No Self Harm Contracts
A Commitment to Treatment Statement may be used instead. The patient writes & signs it to commit to
- Trying new approaches
- Engage in treatment
- Access emergency services if needed
- Communicate openly & honestly in treatment about all issues including suicide
- It does not explicitly restrict the patients rights regarding suicide
Discharge Planning
- Outpatient care at level of intensity needed by the patient
- Rx prescription
- Involve the patient and significant others in plans to make the home environment safer
- Document current suicide assessment before patient leaves
