PSYC 317 EXAM 2 STUDY GUIDE

Psychotic Decompensation:

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As Nancy Ludt said in presentation:

- "Losing a child has a different meaning than losing a parent. When you lose your parent, you lose your past, but when you lose a child, you lose your future."

Quarter Life Crises Phases:

- 1) A feeling of being locked in by your life choices - 2) A rising sense of "I have got to get out" and that change is possible - 3) Quitting whatever is making you feel trapped and embarking on a "time out" period to try out new experiences to figure out who you want to be - 4) A period of rebuilding your life - 5) Developing and cementing new commitments that better reflect your interests and aspirations

Worden Offers four tasks of Mouring:

- 1) Accepting the reality of the lost - 2) Experiencing the pain of grief - 3) Adjusting to an environment from which the deceased is missing - 4) Withdrawing emotional energy from the deceased and reinvesting it in another relationship

Suggestions for Those Suffering Loss:

- 1) Acknowledge the loss - 2) Take your feelings seriously - 3) Talk to others - 4) Make necessary accommodations - 5) Be patient - 6) Find your own way to memorialize the loss - 7) Do not forget Crisis counselors should encourage someone grieving to do the following as well: - 1. Tell others how you feel. Talk to supportive peers and family about the loss. - 2. Stay active with the things you like to do. - 3. Maintain a healthy diet. - 4. Take time for leisure activities. - 5. Spend time with friends and family. - 6. Maintain control where you can. - 7. Seek to gain perspective on the experience. Do not neglect meditation, reflection, and spiritual connection.

Stiener has developed an outline for assessing a person's potential suicide, which might be useful for crisis workers in assessing suicide:

- 1) Ask if the person has thought about killing themself. - 2) Ask family members if they are concerned that the person will commit suicide. - 3) Check the person's plan for suicide. - 4) Check the person's mental status. - 5) Check the history of suicide in the person's life. - 6) Find out what the individual's support system is like. - 7) Find out how much control the person has. - 8) Ask the person for a commitment to talk with you, to see you in two days, or to give up all rights to suicide for a set period of time. Have the person tell you how they will do that.

Three Foundations of Loss:

- 1) Bereavement - A state of involving a loss: to take away from, to rob, to dispossess. - 2) Grief - The feelings of sorrow, guilt, anger, and confusion that arise when one experiences a loss (affect). - 3) Mourning - The overt expression of grief and the usual response to bereavement influenced by culture and/or religion.

Schneider (1994) states, "It is not possible to be a facilitator of the growth aspect of bereavement if the helper is not also experiencing growth in relation to personal losses." Really???:

- 1) Compassion Fatigue - 2) Emotional Investment - 3) Overload - 4) Counter-Transference

Evolutional Crises (Also called "normal passages"):

- 1) Creating a Martial Subsystem - 2) Creating a Parental Subsystem - 3) Creating a Sibling Subsystem - 4) Creating Grandparental Subsystem

Kubler-Ross Stages of Grief and Loss:

- 1) Denial and Isolation - 2) Anger - 3) Bargaining - 4) Depression - 5) Acceptance

Myths About Suicide:

- 1) Discussing suicide will cause the client to move towards death by suicide. - 2) Clients who threaten suicide don't attempt suicide. - 3) Suicide is an irrational act - 4) People who commit suicide are "insane" - 5) Suicide runs in families - it is an inherited tendency. - 6) Once suicidal, always suicidal. - 7) When a person has attempted suicide and pulls out of it the danger is over. - 8) A suicidal person who begins to show generosity and share personal possession is showing signs of renewal and recovery. - 9) Suicide is always an impulsive act

Some Don't's:

- 1) Don't lecture, blame, or preach to the clients. - 2) Don't criticize clients or their choices or behaviors. - 3) Don't debate the pro's and con's of suicide. - 4) Don't get mislead by clients telling you the crisis is past. - 5) Don't deny the client's suicidal ideas - 6) Don't try to challenge for shock effects. - 7) Don't ;eave the client isolated, unobserved, and disconnected. - 8) Don't diagnose and analyze behavior or confront the client with interpretations during the acute phase. - 9) Don't be passive. - 10) Don't overreact. Keep calm. - 11) Don't keep the client's suicidal risk a secret (be trapped in the confidentiality issue). - 12) Don't get sidetracked on extraneous or external issues or persons. - 13) Don't glamorize, martyrize, glorify, heorize, or deify suicidal behavior in others, past, or present. - 14) Don't fail to make yourself available and accessible. - 15) Don't terminate the intervention without obtaining some level of positive commitment. - 16) Don't forget to follow up. - 17) Don't forget to document and report.

Interventions for Developmental/Evolutional Crises:

- 1) Family Systems Theory: -- If one person tries to change his/her behavior, the family will prevent the change from happening (homeostasis). -- Reframing and assigning positive connotations meaning - 2) Structural Family Therapy: -- Focuses on moving the family together through each person's developmental stage -- Learning new adaptive roles -- Enmeshment and disengagement

Crisis related to Adolescence and Young Adulthood:

- 1) Fear of Missing Out (FOMO): "A feeling of anxiety that an exciting or interesting event may currently be happening elsewhere" The process of according to Herman: -- 1. Many Options Available -- 2. Perceived Ability to Exhaust -- 3. Predictive Imaginary -- 4. Fear of Missing Out - 2) Quarter-Life Crisis: A feeling of being locked in by your life choices: -- A rising sense of "I have got to get" and that change is possible -- Quitting whatever is making you feel trapped and embarking on a "timeout" period to try new experiences to figure out who you want to be -- A period of rebuilding your life. -- Developing cementing new commitments that better reflect your interests and aspirations.

Grief can manifest in one, or all of the following ways (Assessing for symptoms):

- 1) Feelings/Emotions - 2) Physical Sensations (Stomach Aches, Weak Depersonalization) - 3) Cognitions (Disbelief, Confusion, Preoccupation, Transient Hallucinations/Non-psychotic or Pseudo-hallucinations) - 4) Behaviors (Sleep Disturbances, Appetite, Decrease, Social Withdrawal, Sighing/Crying, Holding On/Bedroom)

Simeon and Hollander offer some questions that can be used to identify and assess the severity of cutting and other forms of self-harm:

- 1) Have you ever intentionally hurt yourself in any way? - 2) When you hurt yourself, were you trying to commit suicide? - 3) How old were you when you first hurt yourself? - 4) How often do you hurt yourself? - 5) Have you had to seek medical treating for hurting yourself? - 6) How do you feel after you hurt yourself? - 7) Do you ever have the urge to hurt yourself? - 8) Do you want to stop hurting yourself? - 9) Have you ever been able to stop right before you hurt yourself? - 10) Do you use use drugs or alcohol before you hurt yourself? - 11) Is there a certain time of day that makes you feel like hurting yourself? - 12) Is there a certain situation or place that makes you feel liked hurting yourself? - 13) Is there a certain person or people who makes you feel like hurting yourself? - 14) Do you know of anyone in your family who has hurt themselves? - 15) Do you have friends or anyone you know hurts themselves?

Counseling Principles and Procedures:

- 1) Help survivors actualize the loss. - 2) Help them identify and express feelings. - 3) Help survivors live without the deceased. - 4) Facilitate emotional withdrawal from the deceased. - 5) Provide time to grieve. Prepare for 3 month/1 year/anniversaries/holidays. - 6) Normalize the grieving process. - 7) Allow for individual responses/coping. - 8) Encourage a support system.

Developmental Crises:

- 1) Proposed by Erik Erikson - 2) Role developmental crisis is progressive - 3) Critical periods of normal development brings risk of a crisis

The Scope of the Suicide Crisis:

- 1. Suicide is the 10th leading cause of death among Americans. - 2. On average, there are 117 suicides per day. - 3. Firearms account for almost 50% of suicides. - 4. Men die by suicide 3.5x more than women. - 5. The rate of suicide is highest in middle age - white men in particular. - 6. Highest suicide rate was among whites (14.7 per 100,000), and Hispanics (6.3 per 100,000), second was among American Indians and Alaskan Natives (6.3 per 100,000), Asians (5.9 per 100,000) and Blacks it was (5.5 per 100,000). - 7. Suicide risk increases when Depressed patients start getting better (3 months). - 8. Approximately 25% of patients diagnosed with schizophrenia and dysthymic disorder will attempt suicide. - 9. Approximately 25 - 30 % of those with an alcohol dependency diagnosis will attempt suicide. - 10. Approximately 45% of patients with an affective disorder/mood diagnosis will attempt suicide.

Suicide is the _______ leading cause of death in the United States. However, one must keep in mind that due to stigma surrounding suicide, it may be unreported.

- 10th

________ of those individuals who are "lifetime suicide ideators" will make a suicide plan, and that ________ with a plan attempt suicide.

- 34% - 72%

Homicidal Ideation:

- A common term for thoughts about homicide, ranging from vague ideas of revenge to detailed and fully formulated plans without the act itself. - It accounts for 10-17% about of patient presentations to psychiatric facilities in the United States. - It often results from other illnesses such as psychosis and delirium and even personality disorders and substance-induced psychosis.

Suicide Attempt:

- A non-fatal, self-directed potentially injurious behavior with an intent to die as a result of the behavior, might in result in injury.

Suicide Status Form (SSF):

- A prominent suicide risk assessment scale that has clients respond to questions regarding psychological pain, stress, perturbation, hopelessness, and self-hate. - The focus of SSF has been to measure social intent, potential, and prediction of possible attempts in persons with personality disorders and with substance abusers.

Cultural Humility:

- Allows counselors to practice cultural competence. - Thought of as having 3 dimensions according to the Social Work Practitioner: -- 1) Lifelong learning and critical self-reflection -- 2) Recognizing and challenging power imbalances for respectful partnerships - 3) Institutional unaccountably

Emic Issues Related to Asian American Families:

- Asian American Family Structure - Shame and Obligation in Asian American Culture - Communication Process in Asian American Culture

Structural Family Therapy:

- Attempts to help everyone in the family move through new developmental stages at the same time by learning new, more adaptive roles.

People and even clinicians often used the phrase ___________ ____________ when someone intentionally killed themselves; however, currently, the phrase _____________ __________ is considered a more sensitive term and does not imply things that are often associated with the word commit, such as commit a sin or commit a crime.

- Commit Suicide - Complete Suicide

Regardless of Culture, Three General Categories Prevail:

- Death Accepting - Death Defying - Death Denying

Suicide:

- Death caused by self-direct injurious behavior with an intent to die as a result of the behavior (complete/commit/did by suicide)

Non-Suicidal Self Injury/ Self-Mutilative Behaviors:

- Defined as deliberately damaging one's own body tissue without suicidal intent: -- Generally viewed as an impulsive disorder. -- Often the result of abuse, trauma, poor self-image, mood swings, and fear of abandonment. -- Seen in about 4% of the general adult population and 21% of adult psychiatric inpatient populations. -- Seen in 40-61% of adolescents in psychiatric inpatient settings. -- The top five methods of NSSI: cutting/carving one's skin, picking at a wound, hitting oneself, scraping one's skin to draw blood, and biting oneself. -- The top six reasons for NSSI: stop bad feelings, feel something, punish oneself, relieve feelings of numbness/emptiness, feel relaxed, and give oneself something to do when alone.

Scale for Impact of Suicidality-Management, Assessment and Planning:

- Developed by Shrivastava and Nelson; It was created to balance the risk and resilience factors, and it looks at factors that contribute to suicide from a variety of domains. - The standards of assessment used by the National Suicide Prevention Lifeline are consistent with the domains of the SIS-MAP. - The following are the types of questions used in this instrument, which includes items such as the protective factors that are not found in typical suicide assessment tools: -- 1) Demographics: age, gender, marital status -- 2) Ideation: thoughts of hurting oneself, worthlessness of Life -- 3) Management of Suicidal Ideation: Can you cope with those thoughts? Do you fear losing control and attempting suicide? Do you believe in seeking help for suicidal thoughts? -- 4) Current State of Suicidality: Do you currently feel suicidal? Worthless? Have you attempted suicide? -- 5) Planning for Subsequent Attempt: Do you think you will get suicidal ideas in the future? Will you be able to cope with these thoughts? Do you think you need treatment and help? -- 6) Comorbidities: alcohol or drug use, sexual abuse, emotional abuse -- 7) Family History: attempts by others mental illness, addictions -- 8) Biological: psychiatric illness, chronic mental illness, mood swings -- 9) Protective Factors: Is your family supportive of your problems? Have you succeed when faced with life challenges? Is home safe and stable? -- 10) Clinical Ratings: Personality Disorder, Psychosis, Impulsivity -- 11) Psychosocial Environmental Problems: primary support group, economic problems, problems with access to health care services.

Psychosocial Stages (Erikson):

- Each stage involves a crisis, and is viewed as a turning point for that stage. Ego strength develops from a crisis.

Manifestations of Normal Grief:

- Feelings - Physical Sensations - Cognitions - Behaviors

Aguilera (1990) offers some typical signs of a suicidal person:

- Giving things away - Putting things in order - Writing a will - Withdrawing from usual activities - Being preoccupied with death - The recent death of a friend or relative - Increasing drug and alcohol use - Displaying psychotic behavior - Giving verbal hints such as, "I am of no use to anyone anymore." - Showing agitated depression - Living alone and being isolated

What Is the Goal of the Crisis Intervention? (When Dealing with Suicide)

- Growth . . . ultimately coming to grips with one's mortality.

Disengagement:

- In a disengaged family, distance is the pattern.

Enmeshement:

- In an enmeshed situation, everyone in the family interferes and is overly involved in everyone else's decisions, feelings, wishes, and behaviors.

Life Cycle Crises:

- Infancy - Toddlerhood - Preschool and Middle School - Adolescence - Young Adulthood - Middle Adulthood - Maturity

The Beck Depression Inventory:

- Is a self-report consisting of 21 multiple questions, used widely for measuring depression. - Since suicide is closely related to depression, this tool may be useful in establishing suicide risk as well as understanding the thoughts that underlie the suicidal ideation.

Suicidal Risk Level:

- Low Risk: -- 1) No history of attempted suicide. -- 2) Have adequate support systems. -- 3) Concerned that they have suicidal thoughts/ideations. - Middle Risk (Most commonly seen by crisis workers): -- 1) Are functioning but not well. -- 2) Likely a history of threatening suicide. -- 3) Feelings of hopelessness. - High Risk: -- 1) Generally depressed/angry. -- 2) History of suicide attempts. -- 3) Have both a plan and means to kill themselves.

Job Loss:

- Often leads to feelings of depression and low satisfaction with life. One frequently grieves the loss of a job in much the same way one might grieve the loss of a relationship.

Norman L. Farebrow:

- One of the founding fathers of modern suicidology. - His pioneering contributions to suicide research, treatment, and prevention spans the last 50 years in the United States. - His work began after World War II when suicide rates began to increase due to the disappearing sense of unity and shared purpose that the war had created in society.

Emic Patterns Related to Latinos:

- Personalismo - Marianismo - Machismo - Catholicism - Familismo - Enshemed Family Structure - Emotionalism

Emic Issues Related to African Americans:

- Religion - Racism - Black Lives Matter

The purpose for assessing for signs of suicide is to determine the:

- Risk Level

Four Methods of Suicide Prevention:

- Shneidman and associates (1976) have identified four methods to affect a reduction in the suicide rate in this country: -- 1) Increase the acumen for recognition of potential suicide among all potential rescuers. -- 2) Facilitate the ease with which each citizens can access services/help. -- 3) Provide resources for responding to suicidal crises. -- 4) Disseminate the facts about suicide.

Because of the emergency nature of suicide, there is often not time to administer a:

- Test

Family Systems Theory:

- The idea that if a member in a family changes his or her behavior in a major way, others in the family will behave in ways to prevent the change from happening

Education for Prevention:

- The most effective means of suicide prevention appears to be education.

Interventions for NSSI:

- These range from creating a safe nonthreatening and structured environment and implementing cognitive-behavioral components to psychodynamic psychotherapy.

Suicidal Ideation:

- Think about, considering, or planning a suicide.

Suicidal Ideation:

- Thoughts about wanting to kill oneself. - Often results when a client feels totally overwhelmed because of his or her perception of a variety of precipitating events.

Factors associated with a high risk of suicide:

- Unemployment, Illness, Impulsivity, Rigid Thinking (Black and White, All or Nothing), Several Stressful Events, and Release from Hospitalization

Suicide/Homicide Clues:

- Verbal Clues are spoken or written statements, which may be either direct ("I'm going to do it this time - kill myself") or indirect ("I'm of no use to anyone anymore") - Behavioral Clues may range from purchasing a grave marker for oneself to slashing one's wrist as a "practice run" or suicidal gesture.

Suicide is usually preceded by a:

- Warning

Emergency Psychiatry:

- When services are provided in an emergency setting, such as a hospital, to people with serious suicide attempts, life-threatening substance-abuse conditions, vegetative depression, psychosis, and violence or other rapid changes in behavior

Some of the risk factors related to potential violence against others include:

- history of violence - thoughts of committing harm - poor impulse control and inability to delay gratification - impairment or loss of reality testing - delusions or command hallucinations - feelings of being controlled by an outside force - belief that other people wish to harm him or her - perception of rejection or humiliation at the hands of others - being under the influence of substances - past history of antisocial personality disorder - frontal lobe dysfunction or head injury