suicidal thoughts and behaviors

Question 1

suicidal ideation

Answer 1

thinking about killing oneself

Question 2

suicide attempt

Answer 2

engaging in potentially self-injurous behavior with the intention of death

Question 3

suicide

Answer 3

intentional act of killing oneself by any means

Question 4

nonsuicidal self-injury

Answer 4

intentional damage to ones own body tissue, without conscious suicidal intent, and for purposes not socially or culturally sanctioned

Question 5

epidemiology of suicide

Answer 5

10th leading cause of US for all ages; 2nd leading cause of death for 10-34 year olds; 4th leading cause of death for 35-54 year olds; age-adjusted suicide rate has increases 33% from 1999-2017

Question 6

comorbidities of suicide

Answer 6

46% of those who die by suicide have a diagnosed mental illness such as depressive disorder, substance use, psychosis; suicide is a behavior not a diagnosis; very important to treat coexisting psychiatric disorder

Question 7

those at an increased risk for suicide

Answer 7

anxiety disorders, personality disorders, eating disorders, trauma-related disorders

Question 8

biological risk factors for suicide

Answer 8

family tendency- higher among monozygotic twins (identical), genetic and epigenetic factors; low serotonin levels with depressed mood- low serotonin in CSF, brainstem, and frontal cortex

Question 9

cognitive factors for suicide

Answer 9

freud- unacceptable aggression turned inward; menningers three parts to suicide hostility- wish to kill (revenge), wish to be killed (guilt), wish to die (hopelessness); aaron beck- central emotional factor is hopelessness, cognitive styles contributing to risk are rigid all or nothing thinking and inability to see different options and perfectionism

Question 10

environmental factors to suicide risk

Answer 10

family conflict- adverse childhood experiences increase risk by 2.7x; clusters of suicide or copycat suicides- teens at risk due to immature prefrontal cortex

Question 11

cultural factors to suicide risk

Answer 11

religious beliefs, family values, sexual orientation, gender identity, bullying behavior, attitude toward death (S. korea has 10th highest suicide rate- familial honor vs shame), climbing rates of suicide in US

Question 12

social factors to suicide risk

Answer 12

relationship problems, recent or imminent crises, substance use, health problems, financial problems, legal problems, loss of housing

Question 13

other risk factors to consider to suicidie risk

Answer 13

family HX of suicide, ACEs, previous suicide attempts, HX of mental disorders, HX or alcohol/substance use, hopelessness, impulsiveness, isolation, easy access to lethal methods, unwillingness to seek help due to stigma around mental health

Question 14

protective factors related to suicide risk

Answer 14

effective mental healthcare: easy access to variety of clinical interventions; strong connections to individuals, fam, community, social institutions; safe and happy marriage; having children; problem-solving and conflict resolution skills; contact with provides

Question 15

nursing process- assessment of suicide

Answer 15

verbal and nonverbal cues: overt statements- “life isnt worth living anymore”; covert statements- “its ok now. soon everything will be fine”; nonverbal cues- giving away possessions, writing letters, mood lift following antidepressants (may give enough energy to follow through); lethality of plan- high risk vs low risk; HX of attempts; family HX; social support; presence/absence of psychosis

Question 16

high risk suicide plans

Answer 16

using gun, jumping off bridge, hanging, CO poisoning, staging car crash

Question 17

low risk suicide plans

Answer 17

cutting wrists, inhaling natural gas, ingesting pills

Question 18

potential screening questions for suicidal ideation

Answer 18

have you ever felt that life was not worth living? have you been thinking about death recently? did you ever think about suicide? have you ever attempted suicide? do you have a plan for completing suicide? if you have a plan, what is it?

Question 19

nursing self-assessment

Answer 19

may experience fear, grief, anger, puzzlement, condemnation of suicidal feelings or intent; acknowledge feelings to team member to avoid countertransference

Question 20

possible nursing problems/diagnoses

Answer 20

risk for suicide (highest priority), self-care deficit, impaired sleep, impaired nutritional intake, anxiety

Question 21

outcome identification of suicide

Answer 21

suicide self-restraint- remaining free from injury, describing self-worth, reaching out to others for help

Question 22

planning for those who are suicidal

Answer 22

depends on pt condition; interventions could target underlying condition of depression, anxiety, psychosis

Question 23

nursing implementation for suicidal pt

Answer 23

psychosocial- safety planning, careful med admin (mouth checks; only day by day supply); health teaching/promotion- prevention efforts; case management- aftercare referrals; milieu therapy- observational checks (highest risk during first few days and on shift rotation); documentation of care; suicide survivors; evaluation is ongoing

Question 24

examples of ongoing evaluations

Answer 24

changes in mood, thinking, and behavior; increases in expression of emotions, thoughts, or feelings; widening of social network

Question 25

suicidal environmental guidlines

Answer 25

plastic utensils (count when collected), no private room (door open), jump/hang-proof bathroom, minimal length electrical cords, unbreakable windows, locked windows, locked doors to non-patient areas, monitor/remove potentially harmful gifts, assess pt belongings in their presence, search pt for harmful objects

Question 26

suicidal treatment modalities

Answer 26

biological treatment- pharmacotherapy for underlying conditions, brain stim therapy for decreasing ideation (ECT/TMS); psychological therapies- talk therapy

Question 27

nonsuicidal self-injury epidemiology

Answer 27

15% of adolescents; 17-35% of college students; peak is between age 20-29; female to male ratio 3:1

Question 28

nonsuicidal self-injury comorbidities

Answer 28

other mental health disorders such as depression, anxiety, eating disorders, substance use disorders; 70% of females with borderline personality disorder are affected by NSSI

Question 29

risk factors for nonsuicidal self-injury

Answer 29

biological- increased stress vulnerability; cognitive- positive reinforcement (attention by someone) or negative reinforcement (reduction of anxiety); environmental- parental harsh punishment, limited monitoring by parent, poor quality of attachment; societal- phenomenon (social media), can be very isolating

Question 30

NSSI nursing process assessment

Answer 30

be empathetic; assess type of injury, triggers, frequency, motivation; watch for transference and set boundaries early

Question 31

nursing process diagnosis NSSI

Answer 31

risk for self-mutilation, self-mutilation

Question 32

nursing process outcomes identification for NSSI

Answer 32

coping, social support, adherence (meds)

Question 33

nursing process for planning for NSSI

Answer 33

6 step approach: limit setting for safety, developing self-esteem, discover motive and its role, discovery of self-control, replacement with coping skills, entering maintenance phase

Question 34

nursing process implementation for NSSI

Answer 34

caring for injuries, establishing therapeutic alliance, teach coping skills, promote reflective dialogue

Question 35

nursing process evaluation NSSI

Answer 35

continue to evaluate pt communication and perception

Question 36

treatment modalities for NSSI

Answer 36

biological treatment or psychological treatment

Question 37

biological treatment for NSSI

Answer 37

pharmacotherapy for comorbid conditions before targeting NSSI: evidence of using meds to target serotonergic, dopaminergic, and opioid systems- SSRIs/SNRIs, second gen antipsychotics, opioid antagonist

Question 38

psychological therapies

Answer 38

advanced practice roles- CBT, DBT, group therapy; DBT aka dialectical behavior therapy focused on distress tolerance

Question 39

dialectical behavioral therapy

Answer 39

focuses on helping individuals accept the reality of their lives and behaviors and helps to change their lives and unhelpful behaviors