Avanthika.s Msc(N)., II year, ACON


Suicide: Introduction
Is not a diagnosis or a disorder, it¶s a behavior. The christians believe that life is gift of God & that taking it is strictly forbidden. Most of the 90% of suicides are by individuals who are psychiatrically ill at the time of suicide


Contemplator ± thoughts of self harm intended to end own life. Attemptor ± acts on thoughts and injures self. Completor ± ends own life. Survivor ± close personal relationship with a completor.


Historical perspectives
In ancient Greece, suicide was an offense against the state & the individual who committed suicide were denied burial in the community site (Minois, 1999) Most religions consider suicide as a sin against god.


In the middle age,  suicide was viewed as a selfish and criminal act (Minois, 1999)  Individual who commit suicide were often denied cemetery burial & their property was confiscated & shared by the crown & courts.(MacDonald & Murphy, 1990)


& only in 1993 was it decriminalized in Ireland. but some writer recognized a connection between suicide & melancholy or other sever mental disturbances (Minois.1999) 6 .Contd ««« Suicide was illegal in England until 1961. Most of the philosopher in 17th & 18th century condemned suicide.

(Medscape psychiatry.Contd«. & abortion as crime against life . Euthanasia. 2001a) 7 . Pope John II restated church opposition to suicide. not unlike homicide & genocide. In 1995.

Suicide meaning An act of self destruction Major components are :  An act to destroy on self which is consciously planned  The individual considers suicide is to be the best solution for the problem confronting him. 8 .

Definition It is the intentional taking of one¶s life in a culturally non. vague. Attempted suicide ( parasuicide. and ineffective.destruction. psuedocide.hearted. 9 . nonfatal deliberate selfharm) is defined as any act of selfdamage carried out with the apparent intention of self.endorsed manner. however half.

10 .000 population. Worldwide prevalence varies from 5 to 30/100.000 population in India.Epidemiology Suicide is a universal phenomenon & it is seen almost in all society. Highest rate is seen in Japan & former communist countries. Lowest rate in middle east countries. Actual suicidal rate would be around 1012/100.

Incidence of various types of suicide 1% 17% Firearm Cut/pierce Fall Suffocation MVC Poisoning Fire/burn 1% 21% 56% 2% 2% 11 .

12 .Risk factors Age Gender Marital status Religion Socioeconomic status Ethnicity Individual with mood disorder Psychoactive substance use Schizophrenia Personality disorders panic disorders Organic brain disorders.

13 .Etiology Suicidal act is a deliberate decision of an individual to end his life as the best course available to him under the existing circumstances.  Availability of the social support. Such decisions will depend on:  Personality of the individual and his level of frustration tolerance.  Religious beliefs  the type of stress will also influence the decision to commit suicide.

Predisposing factors: theories of suicide Biological theories:  Genetics: twin studies have shown much higher concordance rate between monozygotic twins than dizygotic twins. 14 .  Postmortem studies focusing on other neurotransmitters revealed increases in beta adrenergic receptor binding & reduction in corticotropin-releasing factor binding sites.  Neurochemical factors:  studies have revealed a deficiency of serotonin in depressed client who attempted suicide.

Psychological theories  Anger turned inward  Hopelessness  Desperation and guilt  History of aggression and violence  Shame and humiliation  Development of stressors.Contd«. 15 .

divorce. Sociological theories: Durkheim (1951) described three social categories of suicide:  Egoistic suicide: response of individual who feels separate & apart from the mainstream of the society.(e.g. Excessively integrated to the society or the group.Contd«. (Japanese soldiers committed suicide for the welfare of the country during II world war )  Anomic suicide: occurs in response to the change in an individuals life (e.g. elderly person. widow/widower)  Altruistic suicide: opposite of the above.) 16 . loss of job.

risperidone ) have both antidepressant and antipsychotic effects are useful. immediate hospitalization is indicated.Treatment Patient who is consider seriously suicidal and cannot make commitment .g. Some medication (e. Vigorous treatment for antidepressant or anti psychotic medication should be initiated. 17 . ECT may be required for some severely depressed patient.

Contd«« Supportive psychotherapy Individual or group therapy Family therapy 18 .

Nursing Process 19 .

 Psychiatric /medical/ family history  Coping strategies. diagnosis  Suicidal ideas or acts  Interpersonal support system  Analysis of suicidal crisis.Assessment: Items to be consider are:  Demographics. 20 .  Presenting symptoms/med-psych.

Mnemonic for assessing suicide risk SADPERSONS S = Sex (male) A= Age (elderly or adolescent) D= Depression P= Previous suicide attempts E= Ethanol Abuse R= Rational thinking (psychosis) S= Social Support Lacking O= Organized plan to commit suicide N = No spouse (divorced>widowed>single) S= Sickness (physical illness) 21 .

22 .Suicidal behavior Divided into categories: Suicide ideation: thought of self inflicted death. either self reported or reported to others. direct or indirect. Suicide threats: it is a warning. that a person is planning to take one¶s own life. verbal or non verbal. Suicide attempt: any self directed actions taken by a person that will lead to death if not stopped.

poisoning or suffocation where there is a evidence that the decedent intended to kill himself or herself. *** All the suicide behavior is serious whatever the intend thus suicidal ideation deserves the nurse¶s highest priority care. Complete suicide: death from self inflicted injury. 23 .Contd«.

withdrawn & selfdeprecating Not hood in any activity Predominantly destructive Unstable 24 Moderate Moderate Moderate Some feeling of helplessness. no withdrawal I ensi y isk High High or panic severe Hopeless. hopelessness & withdrawal Daily functioning Coping strategies used Lifestyle Fairly good in most Moderately good of the activities in some activity Generally constructive Stable Some that are constructive Moderately stable . helpless.Assessing the degree of suicidal risk Behavi Low Anxiety Depression Isolation Mild mild Some feeling of isolation.

Behavi Intensity Low Previous suicide attempt None. fleeting thought but no plan Some Some Marked Frequent thoughts. or of low lethality isk Moderate One or more of moderate lethality High Multiple attempts of high lethality Marked Disorientation None /disorganization Hostility Suicidal plans Little or none Vague. Frequent or occasional plans constant about a plan thought with a specific plans 25 .Contd«.

 Remarks about life being unbearable.  Reflection on the worthlessness of life 26 .Guidelines for assessment of suicide risk Verbal cues to suicide:  Pretty soon you won¶t have to worry about me.  I would be better off dead  I don¶t want to be a burden of others.  Expression of feeling hopelessness.

giving belongings away.  Frequent visit to the physicians  Excessive use of drug or alcohol. 27 .  Accumulation of prescription medication  unusual preoccupation with self & withdrawal from others. specially in people who have no cognitive impairement. preparing for own funeral.  Serious self neglect.Non verbal clues to suicide intent  Making a will.

28 .Nursing diagnosis Risk for suicide r/t feeling of hopelessness and desperations  Outcome criteria: client will not harm self.

Intervention  Ask the client directly ³have you thought about harming yourself in any way? If so what do you plan to do? Do you have any means to carry out this plan?´  Create a safe environment for the client.  Supervise closely during meals & medication administration.  Remove all the potential harmful objects.  Formulate short term contract that client will not harm self. 29 .

constant visual observation . towards early morning.Contd«. or other predictably busy times for the staff.  Provide one to one contact . at the change of shift.)  Encourage client to express honest feelings. irregular intervals (especially at night.  Maintain closed observation of client.  Make rounds at frequent. including anger 30 .

31 .Nursing diagnosis 2 Hopelessness r/t absence of support system & perception of worthlessness  Outcome criteria: Client will verbalize a measure of hope & acceptance of life & situation over which he or she has no control.

Intervention Identify the stressors in client¶s life that precipitate current crisis. Encourage client to verbalize feeling 32 . Determine coping behavior previously used & client¶s perception of effectiveness then and now.

Provide expressions of hope to client in positive. Identify sources that client may use after discharge when crises occur or feelings of hopelessness & possible suicidal ideation prevails.Contd«. Help clients identify areas of life situation that are under own control. 33 . low key manner.

Give support person the telephone number of the counselor or emergency contact person .Intervention of the suicidal client following discharge Person should not left alone. 34 . Establish no suicide contract with the patient Enlist the help of family and friends to ensure that the home environment is safe from dangerous item.

Don¶t lecture. or feelings are good or bad. Be direct. Talk openly and matter-of-factly about suicide Listen. 35 .Contd«. Establish rapport and trusting relationship. Allow expressions of feelings Be non-judgmental. Don¶t debate whether suicide is right or wrong.

‡Take action -educate. such as guns or stockpiled pills. Remove means.Contd«. ‡Get help from persons or agencies specializing in crisis intervention and suicide prevention/ give appropriate referrals 36 . Offer hope that alternatives are available but do not offer glib reassurance.

Nursing interventions for attempted suicide Do not panic or raise an alarm on being informed Act with speed in a coordinated manner Check vital signs Incase of drug over dose. concentrated salt solution 2 glasses for vommitting is given 37 .

. attempt to clear airway if necessary Turn client¶s head and neck to one side to prevent regurgitation and swallowing of vomitus 38 .Cont. If pulse is weak start I-v fluids and give injection decadron 4mg IV as ordered Check airway.

personal toileteries. 39 .Emergency nursing care in self inflicted burns Care of burns If client has lost consciousness. medicine box. initiate procedures for the management of an unconscious patient Tranfer the client to medical centre with 3 sets of clothes.

Adjunctive measures Other clients to be reassured and taken away from the scene of the attempt as quickly as possible. Clients to be engaged in some group activity like games. If possible the next meal to the client should be served earlier than scheduled 40 .

Cont.. Inform relatives 41 . The next dose of medication to the clients may be given earlier than scheduled All attendors and others. working staff to be reassured Visit all the patients in your ward at regular intervals and see that they appear to be calm.

Emergency nursing measures during suicide Check for evidence of life by feeling for pulse/ respiration If there is no evidence of life leave the body in the same position / room in which it was found except Incase of evidence by other clients in ward Incase client attempted suicide by jumping do not leave the body in a place visible to other clients 42 .

Move the patient who has committed suicide from a common living area exdining room or t-v room. tranfer the body to a private room Inform the local police after informing psychiatrist Contact relatives of client Keep other clients engaged in games 43 .

Serve food and medications to the clients earlier than scheduled Give increased medications to those clients who appear disturbed as ordered Follow up action  clean the place where the body was found with a strong disinfectant  carry out statutory regulations regarding institution of unnatural death and carry out formalities for death certificate 44 .

The senior nursing staff should discuss the incident in detail with other staff and reassure them Discuss preventive methods in future Keep resuscitation trolley in the ward containing medications for medical and psychiatric emergencies 45 .

status.Steps of crisis counseling with suicide client ( Macnab. Work towards the restoration of the client¶s self worth. note how appraisals are changing in the changing context. morale and control 46 . Note the clients reactivity to the crisis & how this can be changed.1993) Focus on the current crisis & how it can be elevated Identify the clients appraisal of how things are & things will be.

Identify experience & action that affirms self worth & self efficacy Encourage movement toward new reality .Contd«. 47 .. Be available for ongoing therapeutic support and growth. Rehearse cognitive reconstruction±more positive ways of thinking about the self. with the coping skills require to manage adaptively.

Suicide and Law Section 209 of Indian penal code considers suicide to be a crime.´ 48 . shall be punished by the simple imprisonment for a term which may extent to one year. or with a fine or with both. Section state that ³whoever attempts to commit suicide and does act towards committing such an offence.

49 . they will be held guilty and can be imprisoned for 3 years.Contd« Recent legislation on dowry death state that if a women commits suicide within seven years of marriage & in-laws found to be harassing her or torturing her .

50 .Summary Introduction Historical perspectives Definition Epidemiology Risk factors Predisposing factors Treatment Nursing process Intervention following discharge Crisis counseling Suicide & law.

9th edition. Townsend. page no.K. 4th edition. Psychiatric mental health Nursing Concepts of care. clinical psychiatry. Agarwal A.References Mary C. 51 . synopsis of psychiatry. 206-207. page 921. 255-266 Kaplan & Sadock's.

52 .