Self-destructive behavior

SUICIDE�Ideation-�Gesture-�Attempt-

-thinking about suicide ranging to planning eventually including intent-an attempt in order to control the external environment, a cry for help-a nonfatal self destructive, self inflictive act

Examples of indirect self-destructive behavior, it ranges on a continuum

smoking, drinking, j walking, getting involved in a relationship right after anotherrelationship.

Social variables for people not getting help when thinking about suicide

�Ethics�Ignorance�Embarrassment�Shame�Fearof being labeled

CLINICAL VARIABLES%of individuals who commit suicide have a psychiatric illness%are under active psychiatric or mental health care2 reasons for committing suicide

�90�50�Lackof close relationships�Lackof personal freedoms

Who is most at risk for suicide?Age group?Race?

YYoungadults 20-24- 3rdleading causeYNon-Hispanicwhites twice as likely as blacks or hispanicsYAge65 and olderYNon-Hispanicwhite men over 65YDivorcedand widowed men more likelyYSinglemen twice as likely

What are the different axises?

Axis 1- clinical syndromesAxis 2- learning disabilities, challenges in intellectual functioning, personalitydisorders, chronic, maladaptive relationshipAxis 3-medical problems� hypothyroid� diabetesAxis 4-stressor� lost job, moveAxis 5- globalassessment of functioning� scale from 0-100� the lower the score the morelikely to need inpatient care. <40= inpatient care

Reasons for committing suicide:

�Secondaryto terminal illness�Feelinglike a burden to others�Anuntenable family situation�Anuntenable personal situation�Self-punishmentfor unacceptable behavior

Relationship between depression and committing suicide?

Higher risk as depression is lessening because you get more energy to actually do it.

THEORIESSociocultural- Interpersonal- BioloogicCognitive-

-loss of job, religion-percieved or real rejection, abandonment, guilt- hormones, serotonin-black and white thinking, constriction of thought (narrow view of the world,

SUICIDE ASSESSMENTVerbal: Bahavioral:Somatic: Emotional:

YOvert-�I wish I were dead�, �life isn�t worth living�YCovert-�things are never going to work out for me�-giving away possessions, putting affairs in order-social withdraw, then pulling away isolates them andmakes it more difficult to get better alone.-helplessness, hopelessness, irritability, exhaustion.

When is the risk of a second suicide attempt highest?

first 2 years, especially 3 months.

What makes them more prone reguardless of the answer to any other questions?

Psychosis and command hallucinations.

Risk factors to assess when dealing with suicide:

�Gender; age�Previous attempts�Presenting symptoms�Psychiatric illness�Severe life events�Poor impulse control�Family history

Risk factors in hospitalized depressed pts:

�Highlevels of anxiety�Firstweek of admission�Firstmonth after discharge

Risk factors in older pts:

Death of a loved one

Minimum precautions: Moderate precautions:Maximum precautions:

- someone in arms distance at all time- must be in your eyesight at all time see them every 15 minutes- this is if they say they will come find someone if they are feeling like doing something

Risk factors for patients with alcoholism:

�Lossof a close relationship in the previous 6 weeks�Concurrentuse of other drugs�Latein the course of illness

Risk factors in depressed adolescents:

�Comorbidsubstance abuse�Priorsuicide attempt�Familyhistory of major depression�Previousantidepressant treatment�Historyof legal problems�Handgunavailable in the house

Suicide prevention

zTake any threatseriouslyzTalk openly anddirectlyzInstitute appropriatelevel of precautionszBe mindful of objectsthat can be used for self-harmzDetermine if contractis needed*zConsistently observeclientzDevelop a care planzEncourage hope andself-carezPerformphysical assessment- look for any other obvious injurieszMindfulof family and client needszMonitorpersonal feelings- zHelpclient identify and develop protective factors*

Protective factors against suicide:

�Effectiveand appropriate clinical care for mental, physical, and substance abuse disorders�Easyaccess to a variety of clinical interventions and support for help-seeking�Restrictedaccess to highly lethal methods of suicide�Familyand community support�Supportfrom ongoing medical and mental health care relationships�Supportfrom ongoing medical and mental health care relationships�Learnedskills in problem solving, conflict resolution, and nonviolent handling ofdisputes�Culturaland religious beliefs that discourage suicide and support self-preservationinstincts

Possible nursing diagnoses:

�Riskfor violence, self-directed�Ineffectiveindividual coping�Hopelessness�Powerlessness�Chroniclow self esteem�Spiritualdistress

Counceling- on the basic level effective intervention---Information to convey: ----

YEstablishrapportYProblemsolvingYReaffirmhopeYCrisisis temporaryYUnbearablepain can be survivedYHelpis availableYYouare not alone