Self-destructive behavior

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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. Image Upload
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  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
    Image Upload
  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:
    Image Upload
  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: Image Upload
  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
Author:
elmarsha
ID:
33701
Card Set:
Self-destructive behavior
Updated:
2010-09-09 21:34:40
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