Suicide

Question 1

Suicidality

Answer 1

all suicide-related behaviors and thoughts of completing or attempting suicide and suicidal ideation

Question 2

Suicidal Ideation

Answer 2

thinking about & planning one’s own death; it includes excessive or unreasoned worrying about losing a loved one

Question 3

Suicide Attempt

Answer 3

nonfatal, self-inflicted destructive act with explicit/implicit intent to die

Question 4

Parasuicide

Answer 4

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

Question 5

Lethality

Answer 5

the probability that a person will successfully complete suicide

Question 6

Epidemiology of Suicide

Answer 6

• 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

Question 7

Who is most vulnerable to suicidality?

Answer 7

• Suicide of a primary family member
• Psychiatric disorder
• Previous attempt
• Loss (grief)
• Unrelenting physical illness
• Poverty

Question 8

Suicide Intent

Answer 8

• 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

Question 9

Suicide Risk

Answer 9

• 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

Question 10

Suicide: Disinhibition

Answer 10

• Impulsivity
• Isolation
• Psychotic thoughts
• Drug or alcohol use

Question 11

Special Populations: Children and Adolescents

Answer 11

• 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

Question 12

Special Populations: Adults

Answer 12

• Armed services Iraq & Afghanistan a leading cause, combat exposure & for women military sexual trauma
• Ages 45-54 peak & another peak after age 75

Question 13

Etiology: Genetic

Answer 13

runs in families, identical twin whose twin showed suicidal behavior has 11 X the risk for suicidal behavior

Question 14

Etiology: Physiologic Effects on Child Abuse

Answer 14

constant stress, altered serotonin/dopamine metabolism

Question 15

Etiology: Reaction to Surviving Suicide

Answer 15

if they were sorry they did not die they are more likely to attempt again

Question 16

Etiology: Depression

Answer 16

and neurotransmitter changes

Question 17

Assessment

Answer 17

• 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

Question 18

Nursing Diagnosis

Answer 18

• Risk for suicide
• Risk for self directed violence
• Impaired social interaction
• Ineffective coping
• Chronic low self-esteem

Question 19

Interventions

Answer 19

1. Safety
   - Work on their will to live
   - Commitment to treatment statement
   - Physical care of self-inflicted injury
2. Involuntary commitment to treatment
   - Referral to an appropriate clinician
   - Medication management
3. Psychoeducation
   - Changing negative thought patterns
   - Developing a contingency plan
   - Stigma reduction
4. Developing support networks
5. Electroconvulsive therapy

Question 20

Interventions

Answer 20

Treating any underlying mental illness is protective

Question 21

Interventions: Depression

Answer 21

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).

Question 22

Interventions: Schizophrenia & Schizoaffective

Answer 22

Clozapine (clozaril) is an atypical antipsychotic that is protective for suicide

Question 23

Commitment to Treatment Statement

Answer 23

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

Question 24

Discharge Planning

Answer 24

• 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

Question 25

Short Term Outcomes

Answer 25

- Maintaining the patient’s safety - Averting suicide - Mobilizing the patient’s resources

Question 26

Long Term Outcomes

Answer 26

- Maintaining the patient in psychiatric treatment - Enabling the patient and family to identify and manage suicidal crises effectively - Widening the patient’s support network

Question 27

Postvention

Answer 27

After a suicide... - Work through grief with others - Preserve treatment team integrity vs. blaming and splitting - Community meeting with patients - In house memorial service - Continuous Quality Improvement - -> "what could we have done differently?," trying to prevent it from happening again - Acknowledge anniversary reactions

Question 28

Family Response

Answer 28

Undue and prolonged suffering can be caused by the sudden shock The grieving over the way the death occurred, the social processes affecting the survivor, and the effect of the suicide on the family are unique Coping abilities mediate grief responses