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Varcarolis- Foundations of Psychiatric Mental Health Nursing

Suicide

The act of purposeful self-destruction represented by taking one's own life is accompanied by intense pain, hopelessness and a belief that there are no solutions.

Comorbidity

Suicide is not a disorder by itself but studies do show that 90% have at least 1 psychiatric disorder at the time of suicide. It occurs more frequently among.

Suicide occurs more frequently

in people with major depression or bipolar d/o, schizophrenia, alcohol and poly substance use, borderline and antisocial personality d/o and panic d/o.
Read p549 facts about suicide box 24-1

Biological factors

Studies suggest some genetic factors are associated with suicide. Also low levels of serotonin in the cerebrospinal fluid, brain stem, and the frontal cortex have been found in postmortem studies of suicide victims. Also physical illness is an important factor and the percentage increases with age. Depression

Suicide facts:

Suicide is the 11th leading cause of death for all ages.
• Suicide -1.3% of all deaths in the United States.
• > 32,000 suicides occur annually. equivalent of 89 suicides per day; one suicide q16 minutes, or 11.01 suicides per 100,000 pop.
• The National Violent Death Reporting System examined toxicology tests who committed suicide in 13 states: 33.3% tested + for alcohol; 16.4% for opiates; 9.4% for cocaine; 7.7% for marijuana; and 3.9% for amphetamines.

Gender Statistics

*Males take their own lives at nearly four times the rate of females and represent 79.4% of all U.S. suicides.
• During their lifetime, women attempt suicide about two to three times more often than men.
• 8th leading cause of death for males and the 17th leading cause for females.
• Among males, adults aged 75 years and older have the highest rate of suicide (nearly 38 per 100,000 population).
• Among females, those in their 40s and 50s have the highest rate of suicide (nearly 8 per 100,000 population).
• Firearms most commonly used method of suicide among males (approximately 58%).
• Poisoning most common method of suicide for females (39%).

Somatic conditions

Physical health-about ½ of people who commit suicide have physical illnesses. Loss of mobility, disfigurement, and chronic pain are especially associated with suicide.

Psychosocial factors

Freud theorized that suicide resulted from unacceptable aggression toward another that was turned inward.

Anger turned inward

is rage and rage drives people to suicide.

Karl Menninger described 3 parts:

the wish to kill, the wish to be killed and the wish to die.

Psychosocial factors

Aaron Beck identified a central emotional factor underlying suicide intent as hopelessness.

The suicidal persons most likely to act out suicidal fantasies

are those who have experienced the following:
A loss of love, a narcissistic injury, overwhelming moods such as rage or guilt, identification with a suicide victim.
Other reasons: revenge, reunion with a loved one, and rebirth.

Copycat suicide

Follows a highly publicized suicide of an idol or public figure. Adolescents are at high risk due to their immature prefrontal cortex that controls executive functions involving judgment, frustration tolerance, and impulse control.

Cultural factors

including religious beliefs, family values, and attitude toward death, have an impact on suicide rates.
European Americans and Native Americans have a higher rate than Hispanic, African Americans, and Asians.

Verbal clues:

overt and covert statements:
Asking someone if he or she is thinking of suicide does not give the person ideas.

Nonverbal clues:

a sudden brightening of mood with more energy( sometimes can occur after 2 weeks of antidepressants), giving away possessions, or organizing financial affairs.

Suicide risk

Determine the lethality or degree of suicide risk.

Suicide risk: Assessment

Three elements:
-is there a specific plan with details
-how lethal is the proposed method.
-does the client have access to the proposed method.
When the proposed method is available, the situation is more serious.

lethality of a method

which indicated how quickly one would die by the mode then you classify them as high or low risk.

High risk-

gun, jump off of high place, hanging. Poisoning with carbon monoxide, staging a car crash.

Low risk-

slash wrists, inhaling natural gas, ingesting pills.

Is there a hx of suicide attempts?

If so assess:
Intent-was there a high probability of being discovered
Lethality-what was the method
Injury-did the client suffer physical harm

Consider other factors:

physical condition, age, mental illness

Red flag-

person suddenly goes from sad to happy and peaceful.

Sad persons scale

It evaluates 10 major risk factors for suicide. It is a simple clear cut and practical guide for gauging suicide potential.
0-2 send home with f/u
3-4 close follow up consider hospitalization
5-6 strongly consider hospitalization
7-10 hospitalize or commit.

Problems encountered by nurses who deal with suicidal clients

Most suicidal clients experience extreme feelings of hopelessness, helplessness, ambivalence and anger. These in turn can produce strong negative reactions in others and nurses can respond with fear, anger, puzzlement, or condemnation. These must be acknowledged or the counter transference will interfere with the nurses ability to provide good care. Suicidal clients are especially sensitive to rejection.

Levels of prevention

Primary, Secondary, Tertiary

Primary intervention-

includes activities that provide support, information, and education to prevent suicide.

Secondary intervention-

is treatment of the actual suicidal crisis.

Tertiary intervention-

refers to interventions with the family and friends of a person who committed suicide.

Nurse roles in suicide precautions

One-on-one observation
Environmental guidelines
No harm contract----Evidenced based practice
box 24-4

Careful administration of meds.

Usually SSRIs are safer especially with overdose page 558. antidepressants, antianxiety meds, second generation antipsychotics and ECT therapy.

Evaluation

This is ongoing with the suicidal client. The nurse must be constantly alert to changes in the suicidal person's mood, thinking, and behavior.

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