Ch. 25 Suicide and Non-Suicidal Self-Injury Crisis and Disaster

A. Self-limiting

Which term is most applicable to crisis? A. Self-limiting B. Boundaries C. Amnesia D. Chronic

Crisis

the struggle for equilibrium and adaptation in its aftermath

Secondary care for suicidial patients

treatment of the actual suicidal crisis. takes place in clinics, hospitals, jails, and telephone hotlines.

Counseling

crisis techniques, problem solving are necessary. Staff should be warm, sensitive, interested, and consistent. Some counselors use a no-suicide contract.

1. Sex (male) 2. Age 25 to 44 or 65+ years 3. Depression 4. Previous attempt 5. Ethanol use 6. Rational thinking loss 7. Social supports lacking or recent loss 8. Organized plan 9. No spouse 10. Sickness

10 major risk factors to assess suicidal potential

1. Preparedness 2. Mitigation 3. Response 4. Recovery 5, Evaluation

Each catastrophic event will set in operation a 5-phase disaster management continuum including what?

copycat suicide

Follows a highly publicized suicide of a public figure, an idol, or a peer in the community.

Erich Lindemann

Formed the foundation of crisis theory. Even though grief is normal, preventative interventions could eliminate or decrease potential serious personality disorganization and the devastating psychological consequences of the sustained effects of severe anxiety

Tertiary care

Helps those who have experienced a severe crisis and now recovering from a debilitating mental state Facilitate optimum functioning Prevent further emotional disruptions.

Send home with follow-up

If someone has a score of 0-2 in the SAD PERSONS scale what will happen?

Close follow-up; consider hospitalization

If someone has a score of 3-4 in the SAD PERSONS scale what will happen?

Strongly consider hospitalization, depending on confidence in the follow-up arrangement

If someone has a score of 5-6 in the SAD PERSONS scale what will happen?

Hospitalize or commit

If someone has a score of 7-10 in the SAD PERSONS scale what will happen?

Lethality

Indicated how quickly a person would die by that mode.

Secondary care

Intervention during an acute crisis and prevents prolonged anxiety Safety is primary focus Assess problem, social supports and coping styles

Suicidal self-injury

Is manifested by deliberate and direct attempts to cause bodily harm that does not result in death.

Introductory phase of CISD

Meeting purpose is explained; an overview of the debriefing process is provided; confidentiality is assured; guidelines are explained; team members are identified; and questions are answered.

Primary care

Promotes mental health and prevents crisis Recognize potential problems, teach coping skills, reduce life changes to reduce stress

1. using a gun 2. hanging 3. jumping off a high place

What are 3 types of hard methods of suicide?

1. Trial-and-error attempts fail 2. Anxiety can escalate to severe level or panic 3. Automatic relief behaviors mobilized (i.e., withdrawal and flight) 4. Some form of resolution may be devised (i.e., compromising needs or redefining situation)

What are four parts of the Crisis Phase 3?

1. Conflict or problem 2. Self-concept threatened 3. Increased anxiety 4. Use of problem-solving techniques and defense mechanisms 5. Resolve conflict or problem 6. Reduce anxiety

What are six parts of the Crisis Phase 1?

1. Defense mechanisms fail 2. Threat persists 3. Anxiety increases 4. Feelings of extreme discomfort 5. Functioning disorganized 6. Trial-and-error attempt to solve problem and restore normal balance

What are six parts of the Crisis Phase 2?

1. Do crisis assessment 2. establish rapport and good relationship, 3. identify major problems 4. deal with feelings and emotions 5. explore and find alternatives 6. develop and formulate an action plan 7. then have a follow up plan and agreement

What are the seven stages of the model of crisis intervention that Albert Roberts made.

1. Problem is unsolved and coping skills are ineffective 2. Overwhelming anxiety 3. Possible serious personality disorganization, depression, confusion, violence against others, or suicidal behavior

What are three parts of the Crisis Phase 4?

"It's okay now. Soon everything will be fine."; "things will never work out"; "I won't be a problem much longer"

What are three types of Covert Statements.

"I can't take it anymore"; "Life isn't worth living anymore"; "I wish I were dead"

What are three types of Overt Statements.

Maturational

What type of crisis is this? - New developmental stage is reached - Old coping skills no longer effective - Leads to increased tension and anxiety

Situational

What type of crisis is this? Arise from events that are: Extraordinary, External, and Often unanticipated.

Adventitious

What type of crisis is this? Unplanned and accidental (Natural disaster, National disaster, Crime of violence)

the first few days following admission and during staff rotation.

When is suicide the highest during hospitalization?

Lithium; second generation antipsychotics; ECT

___________ may help decrease suicidal ideation, _____________________________ may help with agitated/psychosis. And _______ may be treatment of choice for one who is actively suicidal.

Impaired social interaction

____________________ is characterized by difficult interpersonal relationships, isolation, and few or no social supports.

Disturbed personal identity

_______________________ is identified by self-hatred and feelings of being overwhelmed and ineffectual.

Suicide

is possible when pain and hopelessness are present.

crisis intervention therapy

is short term, form 1-6 weeks, and focuses on the present problem only.

maturational crisis

may occur associated with leaving home during late adolescence, marriage, birth of a child, retirement, or death of a parent.

adventitious crisis

results from events that are unplanned and may be accidental, caused by nature, or human made. This type of crisis results from a natural disaster, a national disaster, or a crime of violence.

Teaching phase of CISD

the normality of the expressed symptoms is acknowledged and affirmed; anticipatory guidance is offered reading future symptoms; group is involved in stress-management techniques.

Preparedness

the protective plan designed before the event to structure the response, assess risk, and evaluate damage.

Suicide precautions

watch suicidal person continuously, include affect as you describe the person's behavior.

symptom phase of CISD

Participants describe their cognitive, physical, emotional, or behavioral experiences at the incident scene and describe any symptoms they felt following the initial experience.

Fact phase of CISD:

Participants discuss the facts of the ancient; participants introduce themselves, tell their involvement in the incident, and describe the event from their perspective.

thought phase of CISD

Participants discuss their first thoughts of the incident.

Reentry phase of CISD

Participants review material discussed, introduce new topics, ask questions, and discuss how they would like to bring closure to the debriefing.

acute confusion

Patients with ______________ have confusion and incoherence, and may have problems with substance abuse

ineffective denial

Patients with ___________________ talk about distressing events and make dismissive comments.They also display inappropriate affect and delay seeking care.

Safe

Person in crisis needs to feel what first!

numbness, confusion, and incoherence.

Symptoms of acute confusion include feelings of what three things?

isolation and little or no social support.

Symptoms of impaired social interaction include feelings of what two things?

situational crisis

arises from events that are extraordinary, external, and often unanticipated. the type of crisis may occur after the loss or change of a job, the death of a loved one, an abortion, change in financial status, divorce, or severe illness.

Mitigation

attempt to limit a disasters impact on human health and community function.

1. slashing ones wrist 2. ingesting pills 3. inhaling natural gas

What are three types of soft methods of suicide?

interpersonal turmoil

Always remember: suicidal behavior is the result of ___________________!

Recovery

actions focus on stabilizing the community and returning it to its previous status.

Crisis

- Profound disruption of normal psychological homeostasis - Normal coping mechanisms fail - Results in inability to function as usual - Acute and time-limited, lasting 4 to 6 weeks

history of suicide attempts

A ___________________ puts a person at a high risk of actually completing the suicide in the future.

B. Adventitious

A category 5 hurricane destroys homes and businesses in a community. How would this crisis be classified? A. Disequilibrium B. Adventitious C. Maturational D. Situational

B. Adventitious

A category 5 hurricane destroys homes and businesses in a community. How would this crisis be classified? A. Disequilibrium B. Adventitious C. Maturational D. Situational

B. The patient may have decided to commit suicide; the nurse should reassess suicidality.

A patient is hospitalized with major depression and suicidal ideation. He has a history of several suicide attempts. For the first 2 days of hospitalization, the patient eats 20% of meals and stays in his room between groups. By the fourth day, the nurse observes that the patient is more sociable, is eating meals, and has a bright affect. Which factor should the nurse consider? A. The patient is showing improvement and may be ready for discharge. B. The patient may have decided to commit suicide; the nurse should reassess suicidality. C. The patient is feeling rested, supported by the therapeutic milieu, and less depressed. D. The patient is benefiting from the antidepressant he has been taking for 4 days.

B. Major depression

A person with which psychiatric problem is most likely to complete suicide? A. Personality disorder B. Major depression C. Substance abuse D. Schizophrenia

4-6 Weeks

Crises are usually resolves within __-__ weeks.

maturational crisis

The ______________ of moving from childhood into adolescence may be difficult because many new coping skills are necessary.

recovery phase

The ____________________ includes actions focused on stabilizing the community and returning it to its functional status.

situational

The loss of a job at any time can result in a ___________ crisis. Being victimized, such as in a robbery, can result in this type of crisis if the individual's equilibrium is upset enough.

self-hatred and depression

The symptoms of chronic low self-esteem are what two things.

denial, hypervigilance, and panic.

The symptoms of posttrauma syndrome are what three things?

Parasuicide

This behavior most commonly consists of cutting/carving, burning, scraping/scratching skin, biting, hitting, ski picking and interfering with wound healing. For these behaviors to be considered significant they typically last as least a year and happen repeatedly.

Critical Incident Stress Debriefing (CISD)

This is a tertiary intervention directed toward a group that has experienced a crisis. Consists of a seven-phase group meeting that offers individuals the opportunity to share their thoughts and feelings in a safe and controlled environment.

Gerald Caplan

This man advanced crisis theory. Supported the need for community mental health centers. He outlined crisis intervention strategies.

Albert R. Roberts

This person made the 7 stage model of crisis interventions

Primary Care for suicide.

activities that provide support, information, and education to prevent suicide. takes place in the community, in primary care, in churches...etc

Response

actual implementation of the disaster plan

Health teaching

includes information about psychiatric diagnosis, medications, complementary therapies, and developmental crisis.

Tertiary care for patients with suicide

interventions with a circle of survivors left by individuals who completed suicide to reduce the traumatic aftereffects.

Aguilera and Mesnick

outlined framework for nurses for crisis assessment and intervention

reaction phase of CISD

participants talk about the worst thing about the incident- what they would like to forget and what was most painful.