Suicide Statistics and Terminology Quiz

Suicide

• Suicide is the intentional taking of one's own life.
• A suicide attempt is an act on suicidal thoughts to die.
• Suicidal behavior includes actions leading to a suicide attempt.
• Avoid using "commit" suicide, as it implies criminality.
• Avoid using "successful" or "failed" suicide—suicide is never a success.
• Use precise language like "completed," "attempt," or "died from acting on suicidal thoughts."
• Suicide is preventable.
• Vulnerable, marginalized, and discriminated people are at higher risk due to feelings of isolation and lack of support.
• Suicide rates are higher for women than men.
• 8 women per 100,000 commit suicide.
• 50% of male violent deaths, 71% of female violent deaths are related to suicide.
• Suicide rates peak in those aged 70+.
• It's the second leading cause of death in 15-29 year olds globally.
• Common suicide methods include pesticide ingestion, hanging, and firearms.
• Suicide statistics are challenging to collect due to low reporting rates and reluctance to discuss.
• Previous suicidal behavior provides valuable insights for prevention.
• Creating a supportive environment fosters open discussions regarding past suicidal thoughts. This involves reducing stigma, changing language, and correcting myths about suicide.
• Canada's average suicide rate in 2013 was 11.5/100,000.
• Approximately 4,000 suicides occur in Canada annually, with ~500 in BC.
• Health system and societal risks impacting suicide include barriers to accessing healthcare, access to means (guns), inappropriate media representation, and stigma.
• Community and relationship risks include disasters, wars, stress from immigration, discrimination, trauma, isolation, relationship conflicts, and loss.
• Individual risks include previous suicide attempts, mental disorders, substance abuse, job/financial loss, hopelessness, chronic pain, family history of suicide, and genetic predisposition (least likely).
• Verbal warning signs include direct statements ("I'm thinking of dying") and indirect hints ("I'm tired, I need to get away"). Follow up with questions if needed.
• Behavioral warning signs include altered work performance, mood changes, social withdrawal, discussing exit strategies, acquiring weapons/stockpiling pills, organizing affairs, gifting possessions, altered interest in religion, substance abuse/relapse, visiting dangerous locations, unusual appearance, and prior attempts.
• Situational warning signs include firings, moves, relationship deaths, serious diagnoses, loss of freedom, anticipated financial losses, feeling like a burden, fear of non-acceptance, and recent tragedies.
• Protective factors include strong relationships, religious/spiritual beliefs, and positive coping mechanisms.
• 3-Step Suicide Theory: Identifies pain and hopelessness, pain exceeding connectedness, and ability to attempt as cues.

Violence

• Violence is the exertion of power and control.
• Anger is a normal emotion—a reaction to provocation; frustration, hurt, or fear.
• Aggression is negative anger. It's a progression, not an on/off switch.
• Types of violence include physical, sexual, emotional, psychological, spiritual, cultural, verbal abuse, financial abuse, and neglect.
• Workplace violence: physical force to cause injury.
• Types of bullying include horizontal/lateral and vertical.
• Risk factors for violence include history of violence, abuse, trauma, medical conditions, substance abuse, communication difficulties.
• Stressors that can lead to violence: pain, lack of sleep, unmet needs, lack of control, disruption, new environments, and external factors (lighting, noise).
• Avoid focusing on the person, entering personal space, medical jargon, arguing, or reacting with fear, frustration, or anger.
• Non-verbal communication cues include personal space, body language, eye contact, touch, and posture.
• Vocal and verbal communication must be simple, empathetic, caring, positive, validating feelings, using their own language, paraphrasing, and clarifying.
• Avoid phrases like "calm down," "relax," "I understand," "I know how you feel," "Don't you remember?" and others.

De-escalation Strategies

• De-escalation techniques include offering time/space, redirection, distractions, providing options, and support from co-workers.

Point of Care Risk Assessment (PCRA)

• PCRA factors include the person, the environment, the task, and the assessor.

Behavioral Emergency

• A behavioral emergency is a situation requiring immediate intervention to prevent danger or death to self or others.
• Removal from the situation may be needed beyond de-escalation.

Mental Disorders

• DSM-5: Diagnostic and Statistical Manual of Mental Disorders, version 5; used to diagnose mental illness.
• Mood is a longer duration and generalized feeling; not specific to anything.
• Emotions are fast, chemical reactions to situations; easily manipulated.
• Feelings are cognitive interpretations of emotions.
• Euthymic mood: normal mood.
• Mania: elevated, expansive, or irritable mood. It impairs function and has a short duration (days/weeks).
• Hypomania: similar to mania but allows for functioning.
• Major Depressive Disorder: Characterized by depressed mood and decreased interest/pleasure plus at least three of these: weight loss/gain, abnormal sleep, psychomotor retardation/agitation, fatigue, worthlessness, decreased concentration, recurrent suicidal thoughts.
• Other Depressive Disorders: Postpartum, premenstrual dysphoric, seasonal affective, dysthymia.
• Diagnosis of Bipolar Disorder: Mania/hypomania for at least one week, plus at least three of the following: elevated self-esteem, decreased need for sleep, pressured speech, flight of ideas, distractibility, increased goal-directed activity, psychomotor agitation, risk-taking behavior.
• Bipolar 1: One or more manic episodes and one or more major depressive episodes (e.g., meets all criteria).
• Bipolar 2: Hypomania and major depressive episodes (the mix between the two).
• Cyclothymic: Repeated hypomanic and depressive episodes. Not MDD.
• Rapid Cycling: Four or more mood episodes within a year.
• Anxiety: Vague apprehension and dread, can have behavioral, emotional, cognitive, and physiological symptoms.
• Trauma: Overwhelming, single or multiple experiences, causing the inability to cope or integrate emotions.
• Stress: Wear and tear on the body.
• General Adaptation Syndrome (stress): Alarm, Resistance, Exhaustion.
• Other disorders: Generalized Anxiety Disorder, Panic Disorder, Phobias, PTSD, OCD, Adjustment disorder, Acute Stress Disorder, Dissociative Disorder (multiple personality disorder), Agoraphobia.

Treatment

• Antidepressants (SSRI, tricyclic, atypical): Affect serotonin, norepinephrine, and dopamine.
• Mood stabilizers (lithium, anticonvulsants): Monitor lithium levels (therapeutic level is just below toxic). Lithium interacts with water balance.
• Anxiolytics (benzodiazepines): Addictive, some antidepressants.
• Electroconvulsive therapy (ECT): For non-responsive patients; involves seizures and brain changes.
• Talk therapies (CBT, Exposure, Adaptive Disclosure, Grounding, Mindfulness, Positive reframing, etc.).
• Light Therapy: Seasonal Affective Disorder (SAD).
• Transcranial Magnetic Stimulation (TMS): Similar to ECT but without seizures.

Mental Wellness Assessment

• Includes self-esteem, emotional regulation, support networks, resilience, spirituality.

Mental Status Exam (MSE)

• Includes appearance, behavior, cooperation, speech, mood, affect, thought process/content, insight, and judgment (e.g., a tool to assess)

HAMS assessment

• Hallucinations, Anxiety, Mood, Suicidal thoughts

Nursing Considerations

• Safety, non-judgmental approach, maintaining consistent energy, active listening, validation, encouragement, help regain control.

Psychosis

• Disruption of thought process, often includes delusions, hallucinations, and disorganized thinking.

Delusions

• False beliefs—paranoid, persecutory, idea of reference, religious, grandiose, bizarre, thought withdrawal/insertion/broadcasting.

Hallucinations

• Sensory perceptions in the absence of stimuli. (auditory, visual, audio-visual, tactile, olfactory, gustatory)

Disorganized Thinking

• Poverty of speech, tangential speech, illogical statements, preservation, thought blocking/loose association.

Schizophrenia

• Etiology: Unknown, but genetic factors, environmental conditions, and brain abnormalities are believed to play roles, along with dopamine and serotonin biochemistry.
• Prevalence: ~1.1% of the population over 18.
• Onset: Men (late teens/early 20s), Women (mid-teens/early 30s). Later detection makes treatment more difficult.
• DSM-5 Criteria: Two or more of these within a month, including delusions, hallucinations, disorganized speech, disorganized behavior, catatonic behavior, or negative symptoms. Impaired functioning below prior level for at least six months.
• Positive Symptoms: Symptoms seen in schizophrenia but not in general population.
• Negative Symptoms: Absences of typical behaviors in the general population.
• Cognitive Symptoms: Effects cognition.
• Phases: Prodromal, Active, Residual.
• Types: Paranoid, Disorganized, Catatonic, Undifferentiated, Residual.
• Treatment: Medication, ECT, talk therapy, and occupational therapy.
• Side Effects of Medications: Extrapyramidal symptoms (EPS), tardive dyskinesia (TD), neuroleptic malignant syndrome (NMS), seizure, anticholinergic symptoms.

Addiction

• Compulsive, excessive, and difficult to control substance or non-substance use.
• Misconceptions:
• Addiction isn't always a substance use problem. Addiction encompasses compulsive, pleasurable, difficult-to-control behavior that interferes with daily functioning.
• It's not a choice.
• It is a brain disease affecting the limbic system (reward center) which controls emotions and behavioral responses. Neurotransmitters (inhibitory and excitatory) are central, but also the interaction of body and environment.
• Hypofunctioning Reward System: Tolerance develops as the body compensates for substance overload, resulting in an increased need for the substance over time.
• Similar Chemical Structures: Heroin/opioids have similarities to endorphins; nicotine mimics acetylcholine thereby causing dopamine release; alcohol binds to dopamine and norepinephrine receptors.
• Why People Engage: Addiction soothes pain, offers a sense of control, peace of mind, connection, relaxation, and validation, potentially filling desires not being met through healthy avenues.

The Stages-of-Change Model

• Precontemplation, Contemplation, Preparation, Action, Maintenance. Patients can move between stages.

Ethics

• Autonomy: Independence; ensuring autonomy, but acknowledging potential limitations due to illness.
• Beneficence: Doing good; providing the best care.
• Non-maleficence: Do no harm.
• Confidentiality exceptions: when harm is imminent.
• Informed consent: patients must provide valid informed consent.
• Rights of voluntary/involuntary admissions (MHA) to be considered, as well as those with respect to their treatment and care.
• MHA: Provincial laws ensuring the treatment of people with mental illness.
• Criteria for involuntary treatment: Impairment, worsening condition, risk prevention (such as suicide, harm), and non-seeking help.
• Review of certification—re-evaluation and patient agency are necessary

Personality

• Personality: enduring patterns of thinking, feeling, and acting.
• Trait Theory: Stable enduring patterns, conscious motivation. CANOE (Conscientiousness, Agreeableness, Neuroticism, Openness, Extraversion).
• Social Cognitive Perspective: Observing/learning behaviors and how we think about situations influencing our reactions.
• Personal Control: Internal (cognition of impacting life/decisions) vs. external (others impact life/decisions).
• Personality Development (Adolescents/Toddlers): Social self, sexuality, relationships; developing how we view ourselves in relation to others.
• Incomplete Personality Development: trauma, emotional dysregulation, manipulation, or lack of empathy.
• Personality Disorders: Diagnosed when enduring patterns result in work/relationship issues, inaccurate world perception, and improper/intense emotional reactions and poor impulse control.
• Egosyntonic vs. Egodystonic: Egosyntonic: doesn't feel like a problem; Egodystonic: feels like a problem.