Communication of suicide intent ? vague/abstract ? direct ? behavior ? notes Suicide ideation ? frequency ? duration ? intensity Suicide Plans ? method ? specificity ? lethality ? availability Increased Risk ? non-communicative ? increased distance during interaction ? increased hostility/mistrust ? negative reaction to attempts to help ? negative reactions to helper Suicidal Behavior ? attempt to communicate ? result of previous failures of communication Characteristics of Note ? one-way mode of communication ? final communication of years of despair ? different from a threat ? maintain a connection to life ? banal to insightful Content of notes ? beg forgiveness ? incurable illness ? accusatory notes, triggering guilt ? instructional notes Motive of Suicide by suicide note ? reunion (wish to reunite with a loved one or deity and avoid physical/psychic pain) ? rebirth (desire to move from pain to hope) ? rage-revenge (great ambivalence about a relationship, anger turned inward) ? riddance (intense low self esteem, worthlessness, hopelessness) ? respite (death is a comfort from pain of physical illness, most common in older age) RIsk factors for suicide ? past attempts ? depression ? alcohol and drugs ? suicide ideation ? lethal methods ? isolation ? hopelessness ? older white male ? family history of mental illness ? work problems ? relationship problems ? stress ? anger ? physical illness Firearms characteristics ? wound location ? proximity of weapon to wound ? accessibility of wound location ? ipsilaterality of wound to handedness ? trace metal residue on hand ? single wound ? removal of clothing from wound area Hanging/strangulation characteristics ? blood flow obstruction in arteries of neck, blocked windpipe, cardiac arrest ? sitting, kneeling or lying down as well ? tensoin on rope as little as 7-8lbs ? loss of conciousness occurs rapidly ? death/brain damage in 4-5 minutes ? common in prisons and psychiatric hospitals Jumping characteristics ? most are older males ? younger males with psychiatric problems ? no reason to be at the site ? no history of reckless disregard of heights ? leave valuables behind, folded ? feet first, vertical, relaxed Factors influencing method ? availablility and accessibility ? knowledge, experience, and familiarity ? meaning, symbolism, and cultural significance ? suggestion ? state of mind Suicide increase in children due to: ? more accurate reporting ? access to guns, alcohol, and drugs ? earlier onset of puberty ? earlier onset of relationship issues ? earlier onset of mood disorders ? (controversial) neurological damage to fetus Characteristics of children who commit suicide ? depression and severity of depression ? conduct, adjustment, developmental disorders ? extent of preoccupation with death ? recent aggression ? previous stressful experiences ? family stress, chaos, unpredictablility ? loss of family contact with loneliness ? low self-esteem ? contact with family or friend who has threatened or committed suicide Contributing factors for adolescent/young adults ? interpersonal problems: family and romantic ? parental divorce ? family mobility ? isolation ? depression ? alcohol and drugs ? access to guns ? interpersonal arguments ? relative/friend with alcohol/drug problems ? relative/friend who attempted suicide ? adolescent moving away or leaving home Midlife suicide relating to: ? depression ? alcoholism ? life debris (aaccumulation of interpersonal losses, declining health, financial losses, reduced career opportunities) Theories of older adult suicides: ? Sociological Theory (Durkheim) ? Analytical Theory (Carl Jung) ? Modern Analytic Theory ? Developmental Theory ? Sociobiological Theory Child characteristics in family ? feel helpless ? fear parent rejection ? feels unloved and unworthy ? difficulty accepting change and separation ? cry for help Family characteristics:dysfunctional families ? disorganized ? rigid and inflexible ? unstable ? conflict avoidant Family characteristics: ? unclear boundaries and roles ? unbalanced intra-familial relationships ? excessive secretiveness ? poor communication ? lack of expressiveness ? lack of cohesion 5 risk factors for youth suicide/attempts 1. poor family communication and problem solving 2. scapegoating 3. threatened or actual loss of attachment figure 4. marital dysfunction/satisfaction 5. family psychopathology DSM: 5 axis classifications ? clinical disorder/condition focus of treatment ? personality disorder or mental retardation ? general medical condition ? psychosocial and environmental problems ? global assessment of functioning (0-100) Studies between mental illness and suicide acts: ? prospective studies ? retrospective studies ? concurrent studies ? methodological studies 5models: ? direct impact ? indirect impact ? complications of diagnoses ? mental illness and suicides share common origin ? independence between mental illness and suicide Substance abuse: (one or more to be clinically significant) ? failure in major role responsibilities ? hazardous situations ? legal problems ? recurrent social problems Substance dependence: (3 or more) ? tolerance ? withdrawal ? larger amounts over longer period than intended ? persistant desire or efforts to cut down ? great deal of time is spent on seeking or using ? giving up or reducing important social, occupational or recreational activities ? continued use despite persistant or reoccuring problems Direct affect of alcohol: ? reduces inhibition ? interacts with other drug(s) ? decreases problem solving skills ? increses impulsivity INdirect affect of alcohol: ? disrupts protective factors ? social relations ? impairs work ? social isolation ? depression ? low self-esteem Prevention types: ? primary ? secondary ? tertiary treatment issues: (patient compliance) ? ambivalence ? denial ? secondary gain ? sick role ? mental illness ? family dynamics ? negative expectatioins ? control and autonomy ? avoidance of effect ? prior treatment failure ? fear of exposure ? side effects of meds ? stigma (parent of patient compliance): ? denial ? fear of exposure ? refusal to face parental and marital issues ? refusal to face own hostility and detachment ? stigma ? ignorance Iatrogenic effects (treatment induced failures) reasons: -negative feelings of caregiver -negative countertransference Countertransference reactions to iatrogenic effects: feelings of: ? hoplessness ? helplessness ? inadequacy ? anger ? dislike lead to: ? wish they would not return ? desire to tease ? excessive confrontation Treatment perspective: ? inpatient or outpatient ? voluntary or involutary Specific outpatient treatments: ? crisis intervention ? CBT-cognitive behavior therapy ? Voice therapy ? DBT-dialectical behavior therapy ? RCT-randomized clinicla trials (treatment effectiveness)
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