Suicide

Question 1

SI

Answer 1

all encompassing term for thoughts of death, wish to die, plans

Question 2

Suicidal behavior

Answer 2

acts associated with intent like collecting means

Question 3

Suicidal attempt

Answer 3

engaging in possible injurious bx with intent of death

Question 4

Interrupted self-directed by other

Answer 4

another person stops them at any stage in the process or plan

Question 5

Interrupted self-directed by self

Answer 5

they stop themselves

Question 6

death by suicide

Answer 6

intent to die with death be self-injurious bx

Question 7

suicide survivors

Answer 7

includes circl of ppl around one who died

Question 8

postvention

Answer 8

mental care to survivor or circle of ppl
- get support, understanding, referrals

Question 9

Warning signs

Answer 9

ind or group of bx or emo cues that may indicate contemplation or immediate risk for suicide

Question 10

Cluster suicides

Answer 10

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

Question 11

DSM-5 suicide bx

Answer 11

• does not include SI or preparatory acts for suicide
• attempt w/i last 24M
• cannot occur in delirium, political or religious objective, not NSSI

Question 12

2016 Joint commission sentinel event alert 56

Answer 12

S major prob w/i hospitals

Question 13

2019 Ntl pt safety goal

Answer 13

ID high risk goal but did not see major improvements w/i this
- est screenings, enviro risk assessment, documentation

Question 14

Suicide prevention

Answer 14

• 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

Question 15

Ind risk factors for S

Answer 15

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

Question 16

Relationship risk fx

Answer 16

fam/loved one with hx S, lose relx, high conflict or violence, social iso

Question 17

Community risk for suicide

Answer 17

clusters, lose resources, stress of acculturation, comm violence, historical trauma, discrimination

Question 18

Societal risk factors

Answer 18

stigma, easy access to lethal means

Question 19

Warning signs of S

Answer 19

• 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

Question 20

Protective fx for S

Answer 20

• 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

Question 21

C-SSRS

Answer 21

• 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

Question 22

Will most pt answer honestly is directly asked?

Answer 22

YES
and won’t inc risk of S

Question 23

Benefit of screening everyone for S

Answer 23

decreases stigma

Question 24

Stanley-Brown safety plan intervention

Answer 24

• 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

Question 25

overt cues of S

Answer 25

i want to die, life not worth living

Question 26

covert cues of S

Answer 26

its ok, all will be good soon, nothing good anymore and can't wait to change

Question 27

S assessment

Answer 27

- know risk and protective - ask directly--how often have thoughts, have attempted? - verbal and nonverbal - assessment of lethality of plan - self-assessment

Question 28

Highest risk for S

Answer 28

Definite time, place, and plan

Question 29

Envrio safety for S

Answer 29

- 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

Question 30

Safety management for S

Answer 30

- 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

Question 31

Pt observation

Answer 31

- provider decides obs level - nurses can escalate then get order - can dec per MD/APRN order - acute care 1:1 with staff

Question 32

NC for S

Answer 32

- 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

Question 33

NSSI

Answer 33

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

Question 34

Where does NSSI often occur

Answer 34

Thighs and dorsal forearm

Question 35

Why is NSSI done

Answer 35

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

Question 36

NSSI DSM-5

Answer 36

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

Question 37

Do ppl with NSSI often seek help

Answer 37

Most don't

Question 38

NSSI at risk pops

Answer 38

fem, esp before age 29

Question 39

NSSI comorbidity

Answer 39

dep/anx, SUD, ED, BPD

Question 40

Biological risk fx for NSSI

Answer 40

altered 5-ht, dp, nor

Question 41

cognitive risk fx for NSSI

Answer 41

self-punishment, positive reinforcement

Question 42

Enviro risk fx for NSSI

Answer 42

cultural diff

Question 43

Societal risk fx for NSSI

Answer 43

social phenomenon (peers engage)

Question 44

s/s NSSI

Answer 44

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

Question 45

NSSI NC and actions

Answer 45

- 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

Question 46

Are NSSI ppl likely to show up in the ED?

Answer 46

No