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SUICIDE
by Sara Toland (Definition (Suicide: the intentional act of…
SUICIDE
by Sara Toland
Definition
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Suicidal Ideation: thinking about personal death, wishing to be dead, considering how to accomplish death, and planning the act
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DSM-5
- Not a recognized disorder
- Under section called "Conditions for Further Study" (Halter, 2018)
- Proposed for inclusion to next DSM as "Suicidal Behavior Disorder"
Risk Factors
Family History: related to biological inheritance and exposure to suicidal behavior in others (Barlow & Durand, 2015)
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Existing Psychological Disorder: mood disorders, substance abuse, or impulse control disorders
Stressful Life Events: natural disasters, death, divorce, abuse (emotional or physical), perceived shame or humiliation
Nursing Process
Assessment: Suicide Assessment Five-step Evaluation and Triage (SAFE-T), Columbia-Suicide Severity Rating Scale (C-SSRS), verbal and nonverbal clues, and lethality of suicide plan
Nursing Diagnosis/Outcomes: Risk for Suicide - remains free from self-injury, Hopelessness - identifies people and professional support systems to contact during a crisis, Impaired Coping - demonstrates or describes positive coping mechanisms for use during crisis
Planning: based on assessment and presence of risk and protective factors. Comorbid psychiatric disorders increase risk and need for direct observation
Intervention: primary prevention is the focus, ie. education, awareness, support in the form of 24-hour hotlines
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Patient Safety Plan Template: Nurse can work with client to create this personalized six-step plan to identify a suicide crisis and seek help
Pharmacological: antidepressants, and/or second-generation antipsychotics
Somatic: electroconvulsive therapy (ECT)
Medications
Second-gen antipsychotics - risperidone, olanzapine
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Benzodiazepines - diazepam, lorazepam
SSRIs - sertraline, fluoxetine, or citalopram
References
Barlow, D. H., & Durand, V. M. (2015). Abnormal psychology: An integrative approach (7th ed.). Stamford, CT: Cengage Learning.
Halter, M. (2018). Varcarolis’ foundations of psychiatric-mental health nursing (8th ed.). St. Louis, MO: Elsevier Inc.