Suicide Flashcards
SI
all encompassing term for thoughts of death, wish to die, plans
Suicidal behavior
acts associated with intent like collecting means
Suicidal attempt
engaging in possible injurious bx with intent of death
Interrupted self-directed by other
another person stops them at any stage in the process or plan
Interrupted self-directed by self
they stop themselves
death by suicide
intent to die with death be self-injurious bx
suicide survivors
includes circl of ppl around one who died
postvention
mental care to survivor or circle of ppl
- get support, understanding, referrals
Warning signs
ind or group of bx or emo cues that may indicate contemplation or immediate risk for suicide
Cluster suicides
inc incidence of suicides when stories of suicide increases, stories are repeated, front page or beginning of broadcast, well-known person or dramatic headline
- occur closer in space and time than would be normally expected
DSM-5 suicide bx
- does not include SI or preparatory acts for suicide
- attempt w/i last 24M
- cannot occur in delirium, political or religious objective, not NSSI
2016 Joint commission sentinel event alert 56
S major prob w/i hospitals
2019 Ntl pt safety goal
ID high risk goal but did not see major improvements w/i this
- est screenings, enviro risk assessment, documentation
Suicide prevention
- know risk and warning
- screen and ask others
- ID protective fx, make safety plan, dec access to lethal means
- give ind resources for s prevention
- make comm based sys to respond to S risk
Ind risk factors for S
previous attempt
hx dep or other mental illness, alc or SUD, phys health, chronic ill, criminal/legal prob, job/financial prob, feel hopeless, current or prior hx adverse childhood experiences
Relationship risk fx
fam/loved one with hx S, lose relx, high conflict or violence, social iso
Community risk for suicide
clusters, lose resources, stress of acculturation, comm violence, historical trauma, discrimination
Societal risk factors
stigma, easy access to lethal means
Warning signs of S
- feel hopeless, burden
- preoccupied with death
- inc sub use esp alc
- anger, irritable, resentment
- iso, w/d from fam/friends
- looking for lethal means of access
- mood swings
- inc anx
- give away possessions
- sudden uplifting mood
- sleep inc or dec
Protective fx for S
- ind - good coping, reasons for living, strong cultural ID
- relx - strong connection
- comm - feel connected, availability of good hc and behavioral care
- societal - strong sense of cultural ID, cultural, religious, moral objective to S
C-SSRS
- assesses risk and protective fx
- need protocol for screen pos if using this tool
- know documentation for this
- acquires risk level if SI is detected and reassess regularly
Will most pt answer honestly is directly asked?
YES
and won’t inc risk of S
Benefit of screening everyone for S
decreases stigma
Stanley-Brown safety plan intervention
- plan for how to get help, how to make environment safe, what makes life worth living
- if pt get all the way thru plan, go to ED
- better than “no S contract”—not used
overt cues of S
i want to die, life not worth living
covert cues of S
its ok, all will be good soon, nothing good anymore and can’t wait to change
S assessment
- know risk and protective
- ask directly–how often have thoughts, have attempted?
- verbal and nonverbal
- assessment of lethality of plan
- self-assessment
Highest risk for S
Definite time, place, and plan
Envrio safety for S
- search pt and assess belonging for harmful objects
- safe gown, no strings, perfume bottles, mirros, meds, lock window, low bed
- keep extra stuff out
- door open, no private room
- lock doors to non-pt area or empty pt room
- monitor gifts for harm objects
Safety management for S
- reassess risk if condx changes
- safety plan intervention for all pt with IDed risk
- ID and mitigation of enviro safety concerns on all pt care units
- may need HCP sitter order
- great hand off comm
- safety rounds
- means management in facility and before d/c
Pt observation
- provider decides obs level
- nurses can escalate then get order
- can dec per MD/APRN order
- acute care 1:1 with staff
NC for S
- room close to nurse station and round
- watch med ingestion for cheeking
- teach coping
- access firearms or self-harm methods
- give comm resources and 988 at d/c
- brief, freq intx
- fight stigma
NSSI
deliberate and direct attempts to inflict painful injuries to body surface w/o intent to die
- cuts, burns, scratch, bite, hit, pick, interfere with wound healing
Where does NSSI often occur
Thighs and dorsal forearm
Why is NSSI done
desire for relief from neg thoughts, feelings
- punishment from “bad deeds” often poor social interactions
- intent to alleviate psychic pain and numb, suffer from poor interpersonal
- short euphoria
NSSI DSM-5
A. Occur at least 5d in last year to…
- relieve neg thought and feeling
- resolve interpersonal probs
- induce pos feeling state
B. Must precede by neg feels, conflict with others, preoccupation with bx
C. Behavior not socially sanctioned (pierce, tattoo, cultural/religious rituals)
D. cause signif distress or interfere with functioning
E. should not occur solely in context of other mental dx
Do ppl with NSSI often seek help
Most don’t
NSSI at risk pops
fem, esp before age 29
NSSI comorbidity
dep/anx, SUD, ED, BPD
Biological risk fx for NSSI
altered 5-ht, dp, nor
cognitive risk fx for NSSI
self-punishment, positive reinforcement
Enviro risk fx for NSSI
cultural diff
Societal risk fx for NSSI
social phenomenon (peers engage)
s/s NSSI
scars, fresh cut, bruise, broken bones, shar objects on hand, long clothes in hot weather, freq accidents, lots time alone, interpersonal struggle, question ID, behavioral instability, hopeless, helpless, impulsive
NSSI NC and actions
- therapeutic relationship with fam or friend, counselor
- care for wound/injury
- psychotherapeutic intervention like healthy coping w/o dependence on others
- CBT, DBT, group therapy
- psychopharm
- self-harm scale
Are NSSI ppl likely to show up in the ED?
No
