Mental Health- Test 2 Chapter 24

Front 1

-Suicide is not a psychiatric disorder, it is the manifestation of (3) suffered by a person

Back 1

inner pain
hopeless
helplessness

suffered by persons experiencing suicidal ideation

Front 2

Risk factors for suicide
-what kind of disorder (2)?
-what 3 other things are associated with suicide?

Back 2

-have a psychiatric disorder is a risk factor –half the people who commit suicide have an illness.

-medical illness

- loss of mobility disfigurement, and chronic pain are associated with suicide)

Front 3

Risk factors for suicide
-why is psychosis a problem?
-when are they more vulnerable?

Back 3

-psychosis is a problem (impulse control and judgment are impaired. )

more vulnerable when depressed or having command hallucinations)

Front 4

Risk factors for suicide
-depression w/ ____
-2 problems?

Back 4

-depression with hopeless is a problem
-mania is a problem
-anxiety (panic problem)

Front 5

highest risk for suicide?
-adolescence (what age)
-why?

Back 5

15-19

their impulse control is not great, frontal lobe is not mature…


Frontal lobe: emotional control center and home to our personality.
The frontal lobes are involved in motor function, problem solving, spontaneity, memory, language, initiation, judgement, impulse control, and social and sexual behavior)

Front 6

what strongly influences suicide in adolescent?

Back 6

impersonal conflicts
–self image and how others are and also with parents (kids OD after having a fight with parent) teens can’t deal with conflict.

-copy cat influences teen suicide –it’s contagious

Front 7

high risk for suicide

-veterans diagnosed with (2)

Back 7

PTSD and substance abuse

Front 8

high risk for suicide

what kidn of illnesses? (2 ex)

Back 8

-affective illnesses (like major depression and bipolar, schizophrenia) have a 50% suicide attributable to psychiatric disorders

Front 9

risk factor for suicide:
-what age for the elderly?

Back 9

-65+ is a risk factor (retirement, illness, loss of spouse) also they lived a good part of their life.

Front 10

what is true about elderly and suicide attemps?

Back 10

-elder adults attempt less often but are successful at more effects

Front 11

-risk factors for suicide

-what race is at a high risk?

-divoced men are (more or less) likely to kill themselves than are divorced women

Back 11

-white race

divorced men are more likely to kill themselves than are divorced women

Front 12

-risk factors for suicide

what is the difference in men and women (who does it more)

Back 12

-men take their own lives 4x more than women (chose more of a lethal method)

Front 13

-risk factors for suicide

men vs women
-who attempts suicide more often?

Back 13

-women attempt suicide about 2 to 3 times more often than men

Front 14

among males, adults aged ___ years and older have the highest rate of suicide

-among females, those in their ____ have the highest rate of suicide

Back 14

among males, adults aged 75 years and older have the highest rate of suicide
-among females, those in their 40s and 50s have the highest rate of suicide

Front 15

______ are the most commonly used method of suicide among males

-______is the most common method of suicide for females

Back 15

-firearms are the most commonly used method of suicide among males
-poisoning is the most common method of suicide for females

Front 16

-for men, suicide rates peak after age __

-for women, rates peak after ___

Back 16

-for men, suicide rates peak after age 45
-for women, rates peak after 55

Front 17

-childhood abuse
-history of suicide attempt
-unemployment
-isolation
-panic attacks
-low frustration tolerance
-sexual orientation issues
-humiliation

Back 17

risk for suicide

Front 18

Protective factors for suicide
-religion (what 2 religions has a higher rate of suicide than catholics)
-family?
-pregnancy?
-access to...
-effective ____ _____ skills?
-intact ___ ____

Back 18

-religion decrease rates of suicide (protestants and jews have a higher rate of suicide than the roman catholics)
-being married, esp with children in the home, reduces the risk of suicide
-pregnancy
-access to health care
-effective problem solving skills
-intact reality testing

Front 19

etiology of suicide:

-biological :

-does suicide run in families?

Back 19

-biological :
- low levels of serotonin found in spinal cord (cerebrospinal fluid) and brain (frontal cortex and brainstem)


-in suicide victims (suicide tends to run in families)

Front 20

etiology of suicide:
-psychosocial factors:

-Freud said suicide results from

Back 20

unacceptable aggression toward another person that is turned inward

Front 21

etiology of suicide:
-psychosocial factors:

-Menninger added to Freud’s thought by describing 3 parts of suicidal hostility

Back 21

(the wish to kill,

the wish to be killed,

and the wish to die)

Front 22

etiology of suicide:
-psychosocial factors:

-Beck identified a central emotional factor underlying suicide intent:

Back 22

hopelessness

Front 23

etiology of suicide:
-psychosocial factors:

-cognitive styles that contributed to higher risk are *(3)

Back 23

“all or nothing thinking"

inability to see different options,

perfectionism

Front 24

etiology of suicide:
-psychosocial factors:

humiliation, job loss, overwhelming/intense emotions (rage, guilt)

Back 24

risks

Front 25

Culture / sucidie rates

-who has the highest rate? (2)

Back 25

-European Americans and native Americans have the highest rate followed by whites

Front 26

Culture / sucidie rates

youth - highest rate?

Back 26

-Latino youth, suicide is higher for both sexes

Front 27

what is parasuicide

Back 27

is self injury with clear intent to cause bodily harm or death

Front 28

parasuicide
-prevalent in what 2 populations?

-what is the common self injury performed?
-why is it done?

-is it done for attention?

Back 28

-prevalent in the adolescent and young adult population

- self injury (usually in the form of cutting)
-is most often done with the intent to either alleviate psychic pain or to pierce the psychic numbness these individuals describe.

-the do not engage in this behavior to seek attention and will go to great lengths to hide the evidence

Front 29

-SI is a normal thought with depression with is directly correlated to (2)

Back 29

hopelessness/worthlessness

-hopelessness (it’s black at the end of the tunnel)

-if a pt is expressing hopelessness or making comments about it, ask about suicide

Front 30

-ex: part of them wants to die, part of them does not.

-knowing that, as an nurse, what should she assess?

Back 30

ambivalence

being able to assess what part of them doesn’t want to die (children, pets, religion)

Front 31

passive and active thoughts of suicide

idc if I die in my sleep,

Back 31

-passive:

Front 32

passive and active thoughts of suicide

pray god takes me in my sleep

Back 32

passive

Front 33

passive and active thoughts of suicide

thinking about dying and how to die

Back 33

actively
-risk sky rockets them

Front 34

passive and active thoughts of suicide

run car into tree

Back 34

actively

Front 35

covert / overt verbal clues

obvious

Back 35

overt

Front 36

covert / overt verbal clues

hidden

Back 36

covert

Front 37

covert / overt verbal clues

“I can’t take it anymore”

Back 37

overt

Front 38

covert / overt verbal clues

“Life isn’t worth living anymore”

Back 38

overt

Front 39

covert / overt verbal clues

“Everyone would be better off if I died”

Back 39

overt

Front 40

covert / overt verbal clues

“I wish I were dead”

Back 40

overt

Front 41

covert / overt verbal clues

“It’s okay now.. Soon everything will be fine”

Back 41

-covert: hidden

Front 42

covert / overt verbal clues

“Things will never work out”

Back 42

-covert: hidden

Front 43

covert / overt verbal clues

“I won’t be a problem much longer”

Back 43

-covert: hidden

Front 44

covert / overt verbal clues

“Nothing feels good to me anymore and probably never will”

Back 44

-covert: hidden

Front 45

covert / overt verbal clues

“How can I give my body to medical science?

Back 45

-covert: hidden

Front 46

covert / overt verbal clues

“I won’t be around for that wedding”

Back 46

-covert: hidden

Front 47

true or false

if u ask them about suicidal thoughts u will get them thinking about it

Back 47

in the assessment, remember that a common fear is if u ask them about suicidal thoughts u will get them thinking about it (that’s a myth)

Front 48

suicide
-ask them directly if they have thoughts of killing themselves.
if they say yes, what does the nurse do?

Back 48

assess the plan “tell me exactly what you are thinking” – “tell me how your going to do that”

then you take it a step further in your head and assess what???


lethality factor

Front 49

the more details about the plan of how to die, the greater the risk….if the method they are thinking of is a fast way to die, risk goes up (2 ex)

Back 49

(like a gun, jumping off bridge

Front 50

-3 main elements when evaluating lethality

Back 50

1.is there a specific plan with details?
2.how lethal is the proposed method?
3.is there access to the planned method

Front 51

Lethality: (high or low risk)

using a gun

Back 51

higher/hard methods

Front 52

Lethality: (high or low risk)

jumping off a high place

Back 52

higher/hard methods

Front 53

Lethality: (high or low risk)

hanging

Back 53

higher/hard methods

Front 54

Lethality: (high or low risk)

poisoning with carbon monoxide

Back 54

higher/hard methods

Front 55

Lethality: (high or low risk)

staging a car crash

Back 55

higher/hard methods

Front 56

Lethality: (high or low risk)

slashing wrists

Back 56

lower/soft methods

Front 57

Lethality: (high or low risk)

inhaling natural gas

Back 57

lower/soft methods

Front 58

Lethality: (high or low risk)

ingesting pills

Back 58

lower/soft methods

Front 59

nonverbal cues for suicide:

Back 59

if someone’s mood changes suddenly from sad/anger to happy

–

Front 60

risk for suicide and antidepressants

Back 60

if they are taking an antidepressant and it starts working and they are energized, the risk for suicide increases cause they have the energy to act on the thought

Front 61

Sad persons scale assesses what?

-used to evaluate what?

Back 61

risk for suicide

-used to evaluate 10 major risk factors for suicide

-one point is assigned for each characteristic. the total point score for the person correlates with an action scale that helps health care workers determine whether hospital admission is advisable

Front 62

Sad persons scale

Back 62

SEX- 1 pt if male
AGE- 1 pt if 25-44 yrs or 65+
DEPRESSION- 1 pt if present
PREVIOUS ATTEMPT- 1 pt if present
ETHANOL USE -1 pt if present
RATIONAL TIHNKING LOSS- 1 pt if psychotic for any reason
SOSICAL SUPPORTS LACKING- 1 pt if lacking, especially recent loss
ORGANIZED PLAN- 1 pt if plan with lethal method
NO SPOUSE- 1 pt If divorced, widowed, separated, or single male
SICKNESS- 1 pt if severe or chronic

Front 63

Sad persons scale

-score 0-2:
-score 3-4:
-score 5-6:
-score 7-10:

Back 63

-score 0-2: send home with follow up
-score 3-4: closely follow up, consider hospitalization (it is necessary for a HCP to conduct a full MSE and interview)
-score 5-6: strongly consider hospitalization
-score 7-10: hospitalize or commit

Front 64

Sad persons scale

-what is a draw back?

Back 64

draw back: omits assessment parameters useful in determining suicide lethality (if person is taking elicit or prescription, OD) under the influence of drugs = act more impulsively, you can be psychotic from drugs. they are not assessed in the SAD persons scale but it is a risk factor to look at

Front 65

-what medication increase SI thinking and behavior in adolescents and young adults – need to be closely monitored when started on a dose or when dose is changed

Back 65

-SSRIs


use of SSRIs in pts with depression R/T undiagnosed bipolar can result in mania which carriers an esp. high risk for suicide

Front 66

-highest priority of a nursing diagnosis is:

Back 66

“risk for suicide related to” feelings of hopelessness, anger, frustration, abandonment, and rejection are common among people who are suicidal

Front 67

-anxiety and the nurse regarding suicide is normal and that you can decrease anxiety by:

Back 67

approaching the topic in a matter of fact way (don’t change tone, don’t change facial expression)

Front 68

-outcomes are short term esp for someone who is at high risk (give example)


what is the plan of care based no?

Back 68

"pt will remain safe this shift”

-nursing outcomes include (suicide self-restraint, coping, hope, social support, spiritual health, and self esteem)



-plan of care is based on risk factors

Front 69

(ATTENTION FOCUSED ON ____________ INTERVENTIONS CAN IMPROVE OUTCOMES)

Back 69

primary

Front 70

primary, secondary, tertiary

-includes activities that provide support, information, and education to prevent suicide

Back 70

primary

Front 71

primary, secondary, tertiary

-develop broad support for suicide prevention

Back 71

primary

Front 72

primary, secondary, tertiary

prevention services

Back 72

primary

Front 73

primary, secondary, tertiary

-reduce access to lethal means and methods of self-harm

Back 73

primary

Front 74

primary, secondary, tertiary

-promote effective clinical and professional practices

Back 74

primary

Front 75

primary, secondary, tertiary

-train for recognition of at-risk behavior and delivery of effective treatment

Back 75

primary

Front 76

primary, secondary, tertiary

: majority of intervention and saving their life

Back 76

secondary intervention

Front 77

primary, secondary, tertiary

-treatment of the actual suicidal crisis (practices in clinics, hospitals, jails, telephone hotlines)

Back 77

secondary intervention

Front 78

primary, secondary, tertiary

-ambivalence on the pts part gives you leverage where you can work the part of them that wants to stay alive

Back 78

secondary intervention

Front 79

primary, secondary, tertiary

painful phase

Back 79

tertiary

Front 80

primary, secondary, tertiary

after someone who committed suicide, working with family/peers . maybe they didn’t commit it successfully but they attempted it. it’s a hard place for families to be in. we are intervening to reduce the trauma that they are in.

Back 80

tertiary

Front 81

______ is what is needed (fantastic intervention)

Back 81

saftey plan

Front 82

saftey plan
-what does it involve?

Back 82

what does it involve? similar to someone who is a victim of domestic abuse

-who can you call when your having SI thoughts and thinking your going to act on it? then you get permission to talk to that person and involve them in the safety plan. (could be a friend, going to someone house, adolescents sleep with parents)

Front 83

counseling
--key element is establishing a working alliance to encourage the patient to engage in

Back 83

more realistic problem solving

Front 84

-no-suicide contracts -also called a no harm contract…

-what is it??

Back 84

written contract in which the pt agrees not to harm him or herself but to take an alternative action if feeling suicidal (talk with staff, call a crisis line)
-overall effective

Front 85

counseling
-what should the nurse focus on?

Back 85

-focus on personal strengths and positive thoughts and emotions (hope) is essential

Front 86

counseling
-what should the nurse instill??

Back 86

-instill hope (the pt doesn’t have any hope but you can convey it. you can say” you will get through this crisis, we will help get you through this crisis” “you can survive this pain that is unbearable, there is help that is available, your not alone”

Front 87

Pharmacological
SSRIs
-what do they decrease?

Back 87

- decrease SI thinking (but in adolescents and young adults it can increase it at first but its monitored)

Front 88

-ECT should be considered if nothing else is working

-pregnant woman?

Back 88

-safe and effective for pregnant patients

Front 89

-long term ______ treatment for bipolar and depression reduce suicide and suicide attempts

Back 89

lithium

Front 90

-reduce suicide rate among patients with schizophrenia who are receiving clozapine (what are the 3 side effects)

Back 90

SE: agranulocytosis, myocarditis, altered glucose metabolism)

Front 91

A client on one-to-one supervision at arm's length indicates a need to go to the bathroom. She tells the nurse "I cannot 'go' with you standing there." The nurse should
A) say "I understand" and allow the client to close the door.
B) keep the door open, but step to the side out of the client's view.
C) leave the client's room and wait outside in the hall.
D) say "For your safety I can be no more than an arm's length away."

Back 91

D

This level of suicide watch does not make adjustments based on client preference. The explanation quoting the protocol and the reason (your safety) is appropriate.