Suicide

Questions

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 so, what is your plan for suicide?

Suicide

Intentional act of killing oneself by any means client who is suicidal can be ambivalent about death

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

Major Depression

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Medical illness with confusion or uncertainty about diagnosis or prognosis History of psychiatric illness (depression or psychosis) ( loss of a therapeutic relationship) Alcohol or drug use Poor social support ( ie living alone) Family history of suicide

Client education lithium carbonate

Minimize GI effects by taking with food or milk comply with laboratory appointments needed to monitor for lithium effectiveness and adverse effects

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Prolonged hospitalization + difficult relationships/conflicts with staff Debilitating medical illness with pain or disability or both Terminal illness with profound hopelessness Previous suicide attempts Age 20-30 or older than 70 Suicide ideation/threats

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Psychiatric disorders Alcohol or substance use disorders Male gender Increasing age Race (85%-90% Caucasians) Religion Marriage Profession Physical health

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Recent disruption or loss of interpersonal relationship Negative environmental changes in the last month Recent psychiatric hospital discharge Recent Legal conviction Recent financial or personal loss -death -divorce - separation -early object loss (age 3-5 to adolescence)

Second generation antipsychotics

Risperidone Olanzapine

Second generation antipsychotics education

maintain healthy diet and exercise report findings of agitation, dizziness, sedation, sleep disruption

Lithium carbonate

maintain healthy diet and exercise to minimize weight gain maintain fluid intake to 2-3L per day maintain adequate sodium intake

Adverse effects SSRIs

nausea, HA, CNS stimulation, agitation, insomnia, anxiety sexual dysfunction

Psychosocial factors

sense of hopelessness intense emotions poor interpersonal relationships at home, school, work developmental stressors history of abuse/trauma

Older adult clients

untreated depression loss of employment/finances feelings of isolation or powerlessness prior attempts at suicide change in functional ability declining physical health alcohol/other substance abuse disorder loss of loved ones

Biological factors

family history of suicide physical disorders (aids, cancer, cardiovascular disease, stroke, chronic kidney disease, cirrhosis, dementia, epilepsy, head injury, Huntington's disease, MS)

Sedative hypnotic anxiolytics (benzodiazepines)

Diazepam Lorazepam

LGBT and bullying

Online bullying Name calling Verbal harassment Physical harassment White LGB and Hispanic bisexual females more likely to be bullied than white heterosexuals Black LGB's vulnerability to bullying was about the same as white heterosexual youths Sexual minority youths were more likely to report suicide ideation

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Precautions against discovery or intervention Deception or concealment about timing, place etc. YOUR "GUT" FEELING about a patient's suicidal risk Suicide note written or in progress Suicide planning and/or preparation Methods available or easily obtained Isolation

cultural factors

american indian and alaskan native ethnic groups have the highest rate

Risk factors

- females are more likely to attempt, bu males (adolescent,t middle, and adult) are more likely to complete it -active military personnel/veterans -lesbian, gay, bisexual, or transgender -commorbid mental illness (depression, substance use, schizophrenia, bipolar disorder, personality disorders)

Myths about suicide

-People who discuss suicide will not actually commit suicide -People who are suicidal only want to hurt themself, not others -There is no way to help someone who really wants to kill themselves -Asking a client about suicide will cause them to actually commit suicide -Ignoring verbal threats of suicide, or challenging a person to carry out suicide's plans, will reduce the individual's use of these behaviors -People who talk about suicide are only trying to get attention

3. A client with a history of a suicide attempt has been discharged and is being followed in an outpatient clinic. At this time, which is the most appropriate nursing intervention for this client? Provide the client with a safe and structured environment. Isolate the client from all stressful situations that may precipitate a suicide attempt. Observe the client continuously to prevent self-harm. Assist the client to develop more effective coping mechanisms.

Assist the client to develop more effective coping mechanisms.

Which is a misconception about suicide? A. Eight out of ten individuals who commit suicide give warnings about their intentions. B. Most suicidal individuals are very ambivalent about their feelings about suicide. C. Most individuals commit suicide by taking an overdose of drugs. D. Initial mood improvement can precipitate suicide.

C. Most individuals commit suicide by taking an overdose of drugs. gunshot wounds are leading cause of death

Antidepressants: selective serotonin re-uptake inhibitors

Citalopram Fluoxetine Sertaline

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Current hopelessness, anger or both Recent medical care Indirect references to own death, arrangement for death

Completed suicide

Suicide successfully resulting in death "Death by suicide"

Which method of suicide has the highest lethality? Ingesting pills Cutting one's wrists Inhaling natural gas Self-inflicted gunshot wound

Self-inflicted gunshot wound

Non-suicidal self injury

Self-injury directed to the surface of the body to induce relief from a negative feeling/cognitive state or to achieve a positive mood state

Suicidal ideation

Thinking about killing oneself hopelessness, helplessness, feelings of inner pain

Environmental factors

access to lethal methods (firearms) lack of access to adequate mental health care unemployment

2. The nurse is caring for an actively suicidal client on the psychiatric unit. What is the nurse's priority intervention? a. Discuss strategies for the management of anxiety, anger, and frustration. b. Provide opportunities for increasing the client's self-worth, morale, and control. c. Place client on suicide precautions with one-to-one observation. d. Explore experiences that affirm self-worth and self-efficacy.

c. Place client on suicide precautions with one-to-one observation.

selective serotonin re-uptake inhibitors: things to know

decreased risk of lethal toxicity do not stop taking it suddenly can take 1-3weeks for therapeutic effects (for initial response) up to 2 months (for maximal response) avoid hazardous activities follow a healthy diet (weight gain can occur) monitor for indications of increased depression and intent of suicide

Education for benzodiazepines

observe for CNS depression (sedation, lightheaded, ataxia, decreased cognitive function) avoid use of other CNS depressants avoid hazardous activities (driving) caffeine interferes with desired effects do not abruptly discontinue (gradually taper dose)