Self-destructive behavior

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elmarsha
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33701
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Self-destructive behavior
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2010-09-09 17:34:40
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  1. SUICIDE


    øIdeation-


    øGesture-


    øAttempt-
    • -thinking about suicide ranging to planning eventually including intent
    • -an attempt in order to control the external environment, a cry for help
    • -a nonfatal self destructive, self inflictive act
  2. Examples of indirect self-destructive behavior, it ranges on a continuum
    • smoking, drinking, j walking, getting involved in a relationship right after another
    • relationship.
  3. dsfdafda
  4. Social variables for people not getting help when thinking about suicide
    øEthics

    øIgnorance

    øEmbarrassment

    øShame

    • øFear
    • of being labeled
  5. CLINICAL VARIABLES
    %of individuals who commit suicide have a psychiatric illness
    %are under active psychiatric or mental health care
    2 reasons for committing suicide
    ø90

    ø50


    • øLack
    • of close relationships

    • øLack
    • of personal freedoms
  6. Who is most at risk for suicide?
    Age group?
    Race?
    • YYoung
    • adults 20-24- 3rd
    • leading cause

    • YNon-Hispanic
    • whites twice as likely as blacks or hispanics


    • YAge
    • 65 and older

    • YNon-Hispanic
    • white men over 65

    • YDivorced
    • and widowed men more likely

    • YSingle
    • men twice as likely
  7. What are the different axises?
    Axis 1- clinical syndromes

    • Axis 2- learning disabilities, challenges in intellectual functioning, personality
    • disorders, chronic, maladaptive relationship

    • Axis 3-
    • medical problems… hypothyroid… diabetes

    • Axis 4-
    • stressor… lost job, move

    • Axis 5- global
    • assessment of functioning… scale from 0-100… the lower the score the more
    • likely to need inpatient care. <40= inpatient care
  8. Reasons for committing suicide:
    • øSecondary
    • to terminal illness

    • øFeeling
    • like a burden to others

    • øAn
    • untenable family situation

    • øAn
    • untenable personal situation

    • øSelf-punishment
    • for unacceptable behavior
  9. Relationship between depression and committing suicide?
    Higher risk as depression is lessening because you get more energy to actually do it.
  10. THEORIES


    Sociocultural-

    Interpersonal-

    Bioloogic

    Cognitive-
    • -loss of job, religion
    • -percieved or real rejection, abandonment, guilt
    • - hormones, serotonin
    • -black and white thinking, constriction of thought (narrow view of the world,
  11. less accomoadating, less
  12. flexible)
  13. SUICIDE ASSESSMENT
    Verbal:
    Bahavioral:
    Somatic:
    Emotional:
    • YOvert-
    • “I wish I were dead”, “life isn’t worth living”

    • YCovert-
    • “things are never going to work out for me”

    -giving away possessions, putting affairs in order

    • -social withdraw, then pulling away isolates them and
    • makes it more difficult to get better alone.

    -helplessness, hopelessness, irritability, exhaustion.
  14. When is the risk of a second suicide attempt highest?
    first 2 years, especially 3 months.
  15. What makes them more prone reguardless of the answer to any other questions?
    Psychosis and command hallucinations.
  16. Suicide scale
  17. Risk factors to assess when dealing with suicide:
    øGender; age

    øPrevious attempts

    øPresenting symptoms

    øPsychiatric illness

    øSevere life events

    øPoor impulse control

    øFamily history
  18. Risk factors in hospitalized depressed pts:
    • •High
    • levels of anxiety

    • •First
    • week of admission

    • •First
    • month after discharge
  19. Risk factors in older pts:
    Death of a loved one
  20. Minimum precautions:
    Moderate precautions:
    Maximum precautions:
    - someone in arms distance at all time

    - must be in your eyesight at all time

    see them every 15 minutes- this is if they say they will come find someone if they are feeling like doing something
  21. Risk factors for patients with alcoholism:
    • •Loss
    • of a close relationship in the previous 6 weeks

    • •Concurrent
    • use of other drugs

    • •Late
    • in the course of illness
  22. Risk factors in depressed adolescents:
    • •Comorbid
    • substance abuse

    • •Prior
    • suicide attempt

    • •Family
    • history of major depression

    • •Previous
    • antidepressant treatment

    • •History
    • of legal problems

    • •Handgun
    • available in the house
  23. Sample protocalls for suicide precaution:
  24. Suicide prevention
    • zTake any threat
    • seriously
    • zTalk openly and
    • directly
    • zInstitute appropriate
    • level of precautions
    • zBe mindful of objects
    • that can be used for self-harm
    • zDetermine if contract
    • is needed*
    • zConsistently observe
    • client
    • zDevelop a care plan
    • zEncourage hope and
    • self-care



    • zPerform
    • physical assessment- look for any other obvious injuries

    • zMindful
    • of family and client needs

    • zMonitor
    • personal feelings-

    • zHelp
    • client identify and develop protective factors*
  25. No suicide/harm contracts:
  26. Protective factors against suicide:
    • •Effective
    • and appropriate clinical care for mental, physical, and substance abuse disorders


    • •Easy
    • access to a variety of clinical interventions and support for help-seeking

    • •Restricted
    • access to highly lethal methods of suicide

    • •Family
    • and community support

    • •Support
    • from ongoing medical and mental health care relationships


    • •Support
    • from ongoing medical and mental health care relationships

    • •Learned
    • skills in problem solving, conflict resolution, and nonviolent handling of
    • disputes

    • •Cultural
    • and religious beliefs that discourage suicide and support self-preservation
    • instincts
  27. Possible nursing diagnoses:
    • øRisk
    • for violence, self-directed

    • øIneffective
    • individual coping

    øHopelessness

    øPowerlessness

    • øChronic
    • low self esteem

    • øSpiritual
    • distress
  28. Counceling- on the basic level
    effective intervention
    -
    -
    -
    Information to convey:
    -
    -
    -
    -
    • YEstablish
    • rapport

    • YProblem
    • solving

    • YReaffirm
    • hope



    • YCrisis
    • is temporary

    • YUnbearable
    • pain can be survived

    • YHelp
    • is available

    • YYou
    • are not alone

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