The ppt covers suicide,etiology,predisposing factors,Assessment of risk factors and reventio of suicide in inpatient care

2. PRESENTATION ON:
PRESENTED BY :RAKHI S NAIR

4. WORLD STATISTICS OF
SUICIDE

5. Definition
Suicide is a type of deliberate
self harm and is defined as a
human act of self-intentioned
and self inflicted cessation
(death).

6. COMMON THEMES IN SUICIDE
It is a crisis that causes
intense suffering and feelings
of hopelessness and
helplessness.
There is a conflict between
survival and unbearable
stress

7. Continued…
 There is a narrowing of person’s
perceived options
 There is a wish to escape
 There is often a wish to punish
self or punish significant others
with guilt

8. METHODS OF SUICIDE

9. Ingestion of poison

10. Hanging

11. Drowning

12. Burning

13. METHODS OF SUICIDE
 Ingestion of poison (35%)
 Hanging (23%)
 Drowning (9%)
 Jumping in front of train (4%)
 Burning (12%)

14. ASESSING RISK FOR SUICIDE
BEHAVIOUR
LOW
MODERATE
HIGH
ANXIETY
MILD
MODERATE
HIGH OR PANIC
DEPRESSION
MILD
MODERATE
SEVERE
ISOLATION
SOME FEELING SOME
HOPELESS,HEL
OF ISOLATION FEELINGS OF
PLESS,WITHDR
HELPLESSNESS AWN AND SELF
DEPRICIATING
DAILY
FUNCTIONING
FAIRLY GOOD
IN MOST
ACTIVITIES
MODERAELY
GOOD IN SOME
ACTIVITIES
NOT GOOD IN
ANY
ACTIVITIES
RESOURCES
SEVERAL
SOME
FEW OR NONE
COPING
STRATEGIES
GENERALLY
CONSTRUCTIV
E
SOME THAT ARE PREDOMINANT
CONSTRUCTIVE LY
DESTRUCTIVE

15. RISK ASSESSMENT
BEHAVIOUR LOW
MODERATE
HIGH
SIGNIFICAN
T OTHERS
FEW OR
ONLY ONE
AVAILABLE
ONLY ONE
OR NONE
AVAILABLE
PSYCHIATRI NONE OR
C HELP IN
POSITIVE
PAST
ATTITUDE
TOWARD
YES AND
MODERAEL
Y
SATISFIED
WITH
RESULTS
NEGATIVE
VIEW OF
HELP
RECEIVED
LIFESTYLE
STABLE
MODERATE
LY STABLE
UNSTABLE
ALCOHOL
OR DRUG
USE
INFREQUEN FREQUENTL CONTINUAL
TLY TO
Y TO
ABUSE
EXCESS
EXCESS
PREVIOUS
SUICIDE
SEVERAL
WHO ARE
AVAILABLE
ONE OR
MORE OF
MULTIPLE
ATTEMPTS

16. Risk assessment for suicide
BEHAVIOUR
LOW
MODERATE
HIGH
HOSTILITY
SUICIDAL PLAN
LITTLE/NONE
VAGUE
FLEETING
THOUGHTS
BUT NO PLAN
SOME
FREQUENT
THOUGHTS,OC
CASIONAL
IDEAS ABOUT A
PLAN
MARKED
FREQUENT OR
CONSTANT
THOUGHT
WITH A
SPECIFIC
PLAN

17. Predisposing factors-Theories of
suicide
PSYCHOLOGICAL THEORY
 Anger turned inward
 Hopelessness
 Desperation and guilt
 History of aggression and violence
 Shame and humiliation
 Developmental stressors

18. SOCIOLOGICAL THEORY
 EGOISTIC SUICIDE
 ALTRUISTIC SUICIDE
 ANOMIC SUICIDE

19. BIOLOGICAL THEORIES
 GENETICS
 NEUROCHEMICAL FACTORS-

20. Risk assessment of suicide
 Age>40 years
 Male sex
 Staying single
 Previous suicidal attempts
 Depression (risk about 25 times
more than normal)

21. Risk assessment cntd…
 Suicidal preoccupation (eg: a
suicidal note)
 Alcohol or drug dependence
 Severe ,disabling ,painful or
untreatable physical illness
 Recent serious loss or major
stressful life event)
 Social isolation

22. PREVENTION OF SUICIDE

23. Prevention of suicide
 Take all suicidal threats, gestures or
attempts seriously and notify a
psychiatrist
 Psychiatrist should quantify the
seriousness of situation and take
remedial precautionary measures
 Inspect physical surroundings and
remove all means of committing suicide
like sharp objects, ropes, firearm sets
etc
 Surveillance depending on severity of

24. Cntd…
 Acute psychiatric emergency interview
 Counseling and guidance
To deal with the desire to attempt suicide
To deal with ongoing life stressors and
teaching coping skills and interpersonal
skills
 Treatment of psychiatric illness with
medication, psychotherapy and ECT

25. IN-PATIENT SUICIDE
PREVENTION
•More stringent monitoring of patients’
risk
•Better monitoring of behavioral signs
and symptoms
Improve staff communication of signs
and risk
•Wait for significant, stable, reliable
change before relaxing precautions

26. Cntd..
•Improve
suboptimal staff-patient
relationships
•Gather collateral information
•Do not rely solely on patient
self-report of no suicidal ideation
•Do not rely on “no suicide” contracts

27. CNTD…
 •Ensure
a safe physical environment
that is devoid of means to commit
suicide, access to hidden areas. Units
should be periodically checked to
ensure suicide-proof architecture.
•Avoid overconfidence in or overreliance
on 15-minute checks
•Avoid premature discharge.

28. Cntd..
Smooth, tight transition to
outpatient care
•Base suicide precautions on an
adequate risk assessment and
clinical rationale
•Document risk assessment and
clinical rationale
•Form a suicide prevention
committee
 •

29. Nursing management
Risk for suicide R/T feeling of hopelessness and
desperation
 Ask client directly-have you thought
about harming yourself in anyway?if so
what do you plan to do it?Do you have
the means to carry out this plan?
 Remove all potentially harmful objects
from clients access

30.  Formulate a short term verbal or written
contract that client will not harm
self.Secure a promise that client will
seek out staff when feeling suicidal.
 Maintain close observation of client
depending on level of suicide
precaution,provide one to one
contact,every 15 min checks.place room
close to nurses station.

31.  Maintain special care in adminstration of
medications
 Make rounds at frequent irregular
interval especially at night ,toward early
morning at change of shift or other
predictably busy times for staff
 Encourage client to express honest
feelings including anger.Provide hostility
release if needed.

32. Hopelessness related to absence of
support systems and perception of
worthlessnes
 Identify stressors in life that
precipitated current crisis
 Determine coping behavior
previously used and clients
perception of effectiveness then
and now

33.  Provide expressions of hope to client in
positive ,low-key manner.
 I know you feel that you cannot go on
,but I believe that things can get better
for you.what you are feeling is
temporary .it is okay if you don’t see it
just now.you are very important to the
people who care about you.

34. Information to family and friends of an
individual who is suicidal
-Take any hint of suicide seriously
do not keep secrets
-Be a good listener
-Emphasize in specific terms the ways in
which the person s suicide would be
devastating to you and others

35. Cntd..
 Show love and encouragement.hold
them hug them,touch them ,allow
them to cry and express anger.

36. DO NOT---- JUDGE SUICIDAL PEOPLE
 SHOW ANGER TOWARDS THEM
 PROVOKE GUILT IN THEM
 DISCOUNT THEIR FEELINGS

37. THANK YOU!!!