Evaluación suicidio Flashcards
What is the primary thought disorder in suicide according to Edwin Shneidman?
Pathological narrowing of the mind’s focus, called constriction, leading to seeing only two choices: something painfully unsatisfactory or cessation.
What is the duty of mental health professionals when they discover that a client is suicidal?
A professional duty to protect.
What landmark cases established the duty to protect in mental health care?
Tarasoff v. Board of Regents of California (1974) and Tarasoff v. Regents of the University of California (1976).
What percentage increase in suicide rates has been observed in the United States over the past 14 years?
Over 30% increase.
What is the current suicide rate in the United States per 100,000 individuals?
13.4 deaths per 100,000 individuals.
True or False: It is currently possible to accurately predict who will die by suicide.
False.
What is a suicide risk factor?
A measurable demographic, trait, behavior, or situation that has a positive correlation with suicide attempts and/or death by suicide.
Name three mental disorders that confer greater risk for suicide.
- Depression
- Bipolar disorder
- Schizophrenia
What symptom clusters increase suicide risk in individuals with clinical depression?
- Hopelessness
- Severe anxiety
- Panic attacks
- Severe anhedonia
- Alcohol abuse
- Substantially decreased ability to concentrate
- Global insomnia
- Repeated deliberate self-harm
- History of physical/sexual abuse
- Employment problems
- Relationship loss
What specific risk factors predict increased suicidality in clients with bipolar disorder?
- Multiple hospitalizations
- Depressive or mixed polarity of first episode
- Presence of stressful life events before illness onset
- Younger age at onset
- No symptom-free intervals between episodes
- Being female
- Greater number of previous episodes
- Cyclothymic temperament
- Family suicide history
- History of cocaine or benzodiazepine abuse
Fill in the blank: Over 90% of individuals who die by suicide have a _______.
diagnosable mental disorder.
What is the relationship between substance abuse and suicide?
Research links alcohol and drug use to increased suicide risk, especially when combined with other risk factors.
What is the significance of insomnia in relation to suicide risk?
Insomnia is an independent risk factor for suicide.
What is a common risk factor for youth diagnosed with conduct disorder?
Higher suicide risk, especially with co-occurring depression and/or substance abuse.
What is the importance of developing a positive working alliance with potentially suicidal clients?
It is far more important than merely knowing suicide risk factors and warning signs.
What warning is included on all SSRI medication labels in the United States?
Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults.
True or False: An absence of risk factors and warning signs guarantees safety from suicidal impulses.
False.
What does the term ‘constriction’ refer to in the context of suicide?
A pathological narrowing of the mind’s focus.
What should clinicians prepare for when working with clients?
The possibility of clients being suicidal.
What are some factors linked to increased suicide risk?
- Social isolation/loneliness
- Previous attempts
- Non-suicidal self-injury (NSSI)
- Physical illness
- Unemployment or personal loss
- Military personnel and veteran status
- Sexual orientation and sexuality
- Firearms availability
- Suicide contagion
- Abuse and bullying
- Demographics
These factors highlight the complex interplay of social, personal, and contextual elements that influence suicide risk.
What is the significance of previous suicide attempts?
Previous attempts are one of the most reliable and potent predictors of future suicidal ideation, attempts, and death by suicide across the lifespan.
This information is supported by research from Van Orden et al. (2010).
What are SSRIs and what warning do they carry?
SSRIs (Serotonin Specific Reuptake Inhibitors) carry a black box warning indicating that antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults.
This warning was stated by the US Food and Drug Administration in 2007.
Fill in the blank: The acronym IS PATH WARM is used to remember _______.
suicide warning signs.
What does ‘psychache’ refer to in Shneidman’s theory?
Psychache refers to the intense personal pain, anguish, shame, and other negative emotions associated with suicidal crises.
What are Joiner’s two proximal causes of suicidal intent?
- Thwarted belongingness (social isolation)
- Perceived burdensomeness
True or False: The rate of male suicide is nearly four times the rate of females.
True.
What are some general suicide protective factors?
- Reasons for living
- Higher global functioning
- Social support
- Life evaluations
- Frequent religious service attendance
- Suicide-related beliefs
These factors help decrease suicide risk or aid in resisting suicidal impulses.
What is suicide contagion?
Suicide contagion is the indirect or direct passing on of suicidal behavior from one person to another.
What is the relationship between firearms availability and suicide rates?
Firearms constitute a highly lethal suicide method, and access to firearms is a suicide risk factor.
Which demographic has the highest suicide rate according to the CDC’s 2013 data?
Whites have the highest suicide rate at 14.2/100,000.
What is the focus of contemporary suicide prevention approaches?
Contemporary approaches focus on integrating a constructive perspective that emphasizes personal meaning and reality rather than solely on illness.
Fill in the blank: Protective factors offer clinicians no detectable statistical or predictive _______.
advantage.
What does the research suggest about the relationship between social support and suicide risk?
Social support functions as a protective factor against suicide risk.
What is the impact of bullying and abuse on suicide risk?
Bullying and abuse can lead to suicide ideation, attempts, and death by suicide.
What is the focus of the constructive perspective in suicide prevention work?
Individuals construct their own personal meaning and reality.
What do constructive theorists believe shapes our individual reality?
What we consciously focus on, such as relaxation, anxiety, depression, or happiness.
How should clinicians approach suicide assessment and treatment according to constructive theorists?
They should emphasize clients’ strengths, resources, and potentials rather than illness-based weaknesses.
What is suicide ideation considered to be a sign of?
Distress, not deviance.
What percentage of college students experience suicide ideation annually?
Approximately 21%.
Why is viewing suicide ideation as deviant considered impractical?
It primarily communicates emotional pain and distress.
What negative effect can the belief that suicide ideation is pathological have on the clinician-client relationship?
It creates distance and may lead clients to be less open about their suicidal thoughts.
What should clinicians balance alongside risk factor assessments during clinical interviews?
Wellness-oriented questions.
What is the recommended approach when working with suicidal clients?
Collaborative approaches, such as the Collaborative Assessment and Management of Suicide (CAMS).
What does CAMS emphasize in the treatment of suicidal clients?
A humane encounter that honors clients as experts regarding their suicidal thoughts and feelings.
What acronym helps recall the components of a comprehensive suicide assessment interview?
RIP SCIP.
What does the ‘R’ in RIP SCIP stand for?
Risk and Protective Factors.
What does the ‘I’ in RIP SCIP represent?
Suicide Ideation.
What does the ‘P’ in RIP SCIP refer to?
Suicide Plan.
What should clinicians explore regarding suicide ideation?
Frequency, triggers, duration, and intensity of thoughts.
What is a common fear clinicians have when asking about suicide ideation?
That it will put suicidal ideas in clients’ heads.
What is the gentle assumption technique in suicide assessment?
Presuming that certain behaviors are already occurring and structuring questions accordingly.
How should clinicians respond when a client discloses suicide ideation?
Validate and normalize the experience.
What is an important aspect of communication when discussing suicide ideation?
Emanate calmness and curiosity rather than judgment.
Fill in the blank: A comprehensive suicide assessment interview includes gathering information about _______.
[suicide risk and protective factors].
True or False: Suicide ideation is considered a deviation from normal behavior.
False.
What can focusing exclusively on risk factors during clinical interviews inadvertently facilitate?
An iatrogenic process.
What is the aim of a collaborative therapy alliance in suicide assessment?
To treat clients with suicide potential more effectively.
What should clinicians do if clients deny suicidal thoughts?
Acknowledge and accept the denial, while noting that you may still need to explore further.
What are two key aspects to assess when exploring suicidal thoughts?
Duration and Intensity
Duration refers to how long thoughts of suicide persist, while intensity evaluates how strong those thoughts are.
What approach should be taken when exploring suicide ideation with clients?
Emanate calmness and curiosity, rather than judgment
This approach fosters a collaborative and empathic exploration of the topic.
What should a therapist do if a client denies suicidal thoughts?
Acknowledge and accept the denial, then revisit the topic later
This is important if the denial seems genuine.
What is recommended when conducting a formal diagnostic assessment for depression?
Use a balance of positively and negatively oriented questions
This helps to capture a fuller picture of the client’s mood.
What type of questions can help assess mood-related symptoms in clients?
Open-ended questions
Examples include ‘How have you been feeling lately?’ and ‘Would you describe your mood for me?’
What is anhedonia?
A loss of interest or pleasure in usually enjoyable activities
The term literally means ‘without pleasure.’
What are positive neurovegetative symptoms questions aimed at?
Exploring physical symptoms related to eating and sleeping
These symptoms are considered cardinal features of biological depression.
What does the cognitive triad in depression refer to?
Negative thoughts about the self, others, and the future
This triad is a hallmark of depression.
What is hopelessness in the context of depression?
A significant cognitive symptom linked to suicidality
It may manifest as feelings of despair regarding life’s improvement.
What does the acronym SLAP stand for in assessing suicide plans?
Specificity, Lethality, Availability, Proximity
These areas help evaluate a client’s suicide plan.
What does specificity refer to in the context of suicide plans?
The details of the suicide plan
It assesses how well the person has thought through the necessary details.
How does lethality relate to suicide plans?
It refers to how quickly a suicide plan could result in death
Greater lethality is associated with greater risk.
What does availability mean when assessing suicide plans?
The accessibility of the means to commit suicide
If a method is not available, the immediate risk is lower.
What does proximity refer to in suicide risk assessment?
The closeness of social support and helping resources
Greater distance from support increases suicide risk.
What is the purpose of assessing client self-control?
To evaluate the client’s ability to manage suicidal impulses
This can help determine if hospitalization is necessary.
What are the four approaches to assessing arousal in clients?
- Subjective observation of increased psychomotor activity
- Client self-disclosure of feeling unsettled
- Questionnaire responses indicating agitation
- Historical evidence of agitation-related suicide attempts
Arousal can adversely affect self-control.
What does suicide intent measure?
How much an individual wants to die by suicide
Higher intent is linked to more lethal means and planning.
How can suicide intent be evaluated?
Using a scale from 0 to 10 regarding the desire to live or die
This provides a quantitative measure of the client’s feelings.
On a scale from 0 to 10, what does a rating of 0 indicate?
Absolutely certain you want to die.
What does a rating of 10 on the scale indicate?
Absolutely certain you want to live.
What assessment is used to infer intent based on client suicide plans?
SLAP assessment.
Which suicide-planning items are considered the strongest predictors of death by suicide?
Items on the BSIS.
What is the dialectical problem in suicide assessment protocols?
Whether to explore past attempts or to stay focused on the positive.
What should be integrated into the suicide assessment protocol while inquiring about intent?
Positively oriented questions.
What is the strongest predictor of suicide?
Previous attempts.
How should clinicians approach a client who has attempted suicide before?
Acknowledge and explore it with solution-focused questions.
When dealing with severely depressed clients, what type of questioning approach is recommended?
Use a continuum to rank intervention strategies.
What are three main sources of information for assessing risk and protective factors in clients?
- Client records
- Assessment instruments
- Collateral informants
What can client records provide in a suicide risk assessment?
Information about previous suicide ideation, attempts, and history of depression diagnosis.
What is important to do when exploring previous suicide attempts?
Do so in a constructive manner that contributes to treatment.
What are the advantages of using suicide assessment instruments?
- Collect extensive and reliable information
- Provide information quickly
- Standardized format
What are the disadvantages of using assessment instruments in suicide assessments?
- Impersonal
- Do not contribute to therapeutic alliance
- Responses may lack honesty
What should therapists do if a client endorses suicide-related questionnaire items?
Acknowledge and accept them as important discussion topics.
What do collateral informants represent in suicide assessments?
An unparalleled source of information about client risk and protective factors.
What should a therapist do when receiving information from a collateral informant?
Listen to what they say without breaching confidentiality.
What is the first rule of working therapeutically with suicidal clients?
Listen empathically.
Why is establishing a positive therapy relationship important in suicide assessment?
It is important for successful assessment and effective treatment.
What should therapists do to facilitate hope after understanding a client’s suicidality?
Make an empathic statement.
Fill in the blank: Previous attempts are considered the ______ of all suicide predictors.
strongest
Fill in the blank: The more we know about specific stressors that triggered a past attempt, the better we can work together to help you cope with that ______ now and in the future.
stress
True or False: Suicide assessment instruments are effective in building therapeutic relationships.
False.
What is the purpose of assessment in the CAMS approach?
To help therapists understand the idiosyncratic nature of the client’s suicidality
This approach allows both parties to appreciate the client’s suicidal pain and suffering.
What empathic statement can facilitate hope in a client expressing depression?
Most people who get depressed get over it and eventually feel better
This statement reassures clients that recovery is possible.
Why might clients who are depressed struggle to recall positive experiences?
They may have difficulty remembering positive events or emotions
This can hinder their ability to focus on positive aspects of life.
What should clinicians do if suicidal clients cannot remember feeling better?
Empathize with the difficulty of recalling positive times
Understanding this struggle is part of providing emotional support.
What is central to suicide intervention?
Helping clients develop practical plans for coping with and reducing psychological pain
This includes strategies like relaxation and mindfulness.
What is a contemporary approach to no-suicide contracts?
Obtaining a commitment-to-treatment statement from clients
This emphasizes a commitment to intervention rather than solely avoiding suicide.
What are the six components of the Safety Planning Intervention (SPI)?
- Recognizing warning signs
- Employing internal coping strategies
- Utilizing social contacts
- Contacting family or friends
- Contacting mental health professionals
- Reducing potential use of lethal means
These components assist in creating a comprehensive safety plan.
When should the component of reducing lethal means be addressed in the SPI?
After completing the other five components
It may require assistance from family or friends.
What is a key focus when working with suicidal clients regarding alternatives to suicide?
Helping clients identify methods for coping with suicidal impulses
This helps clients to find more desirable life alternatives.
What did Shneidman (1980) suggest for clients struggling with suicidal thoughts?
Clients need help to ‘widen’ their view of life’s options
This can involve brainstorming alternatives to suicide.
What technique did Rosenberg (1999) recommend for suicidal clients?
Help clients understand that they desire to eradicate feelings of intolerable pain rather than to eradicate the self
This provides empathy while reframing their suicidal thoughts.
What is the therapist’s ethical responsibility when clients are a clear danger to themselves?
To intervene and provide protection
This may involve taking a directive role.
What may be necessary for clients who are acutely suicidal?
Hospitalization
While often considered less than optimal, it may be the best alternative.
What should a therapist consider when discussing hospitalization with a client?
The client’s feelings about hospitalization and its potential benefits
This involves addressing any negative views they may have.
What is recommended for clients with mild to moderate suicide potential?
They can usually manage their impulses on an outpatient basis
Close monitoring may be needed for more severe ideation.
What is the legal bottom line regarding documentation in cases of suicidality?
If an event wasn’t documented, it didn’t happen
Proper documentation is critical for legal protection.
What should therapists do in the event of a completed suicide of a client?
Seek professional and personal support to deal with grief and guilt
Consulting with an attorney may also be necessary.
What is an important consideration when discussing a deceased client’s situation with their family?
Maintain openness about sadness while avoiding discussions of guilt or regret
This helps to establish rapport with the family.
What can consultation with peers and supervisors provide for therapists working with suicidal clients?
- Professional support
- Feedback about practice standards
It helps monitor and evaluate professional competency.
What must be maintained even after a client’s death?
Confidentiality rules
What is required to share a client’s specifics with friends or family?
A signed release
How should a therapist approach discussions with a client’s family after death?
Be open about sadness but avoid discussing guilt or regret
What should therapists avoid saying when discussing a client’s death?
I only wish I had decided to hospitalize him after our last session
Why is talking with the family important after a client’s death?
It helps both the family and the therapist
How might families regard therapists after a client’s death?
As someone who was trying to help their loved one get better
What do families expect from therapists regarding their grief?
That the therapist shares their grief and loss
What should therapists not let overcome their humanity?
Legal fears
Fill in the blank: Unless you have a signed release, you cannot share with friends or family the specifics of what the client said in _______.
therapy
