Improve coding practices for patients in suicidal crisis

BMJ ◽  
2021 ◽  
pp. n2480
Author(s):  
Molly McCarthy ◽  
Pooja Saini ◽  
Rajan Nathan ◽  
Jason McIntyre
Keyword(s):  
Suicidal Crisis

Suicide Attempts During Adolescence: Systematic Hospitalization and Crisis Treatment

Crisis ◽  
1999 ◽  
Vol 20 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Jérôme Ottino
Keyword(s):  
Attempted Suicide ◽  
Suicide Attempts ◽  
Psychiatric Treatment ◽  
Health Workers ◽  
Inpatient Unit ◽  
Theoretical Hypothesis ◽  
Initial Resistance ◽  
Provision Of Care ◽  
Suicidal Crisis

This paper deals with an inpatient unit that recently opened in Geneva, specializing in the treatment of patients aged 16-21 years who had attempted suicide or felt the desire to commit suicide. This particular center was established because of the significant weaknesses found in the provision of care to adolescents who had attempted suicide. Despite the growing interest of health workers in this area of study over recent years, the frequency of suicide among the young has not decreased and there are numerous recurrences of the suicide attempts. Further, all efforts to improve the adolescents' compliance with psychiatric treatment have failed to date. The number of drop-outs from treatment is still very high. Thus, the objectives of our inpatient unit are as follows: (1) to overcome initial resistance to treatment and to improve long-term compliance; (2) to decrease the number of recurrent attempts as a consequence of the above, thus increasing life expectancy; (3) to offer the adolescents who have tried (or have contemplated) committing suicide an improved quality of life, after first helping them overcome the suicidal crisis. To achieve these goals, the therapeutic team of the unit proposes short stays during which the work with the adolescents consists of a very intensive psychoanalytic-oriented crisis intervention. Numerous practical aspects of our therapeutic approach in the inpatient unit are related here in detail, always with reference to our theoretical hypothesis.

Which Patients Reject Help Following A Suicidal Crisis?

1995 ◽  
Author(s):  
M. D. Rudd ◽  
T. E. Joiner ◽  
M. H. Rajab
Keyword(s):  
Suicidal Crisis

Progression from interpersonal problems to suicidal ideation and suicidal behavior in borderline personality disorder

2020 ◽  
Author(s):  
Timothy Allen ◽  
Michael Hallquist ◽  
Aidan G.C. Wright ◽  
Alexandre Dombrovski
Keyword(s):  
Borderline Personality Disorder ◽  
Suicidal Ideation ◽  
Personality Disorder ◽  
Negative Affect ◽  
Structural Equation ◽  
Suicide Attempts ◽  
Borderline Personality ◽  
Equation Modeling ◽  
Interpersonal Dysfunction ◽  
Suicidal Crisis

Importance: Clinicians treating borderline personality disorder (BPD) are often faced with the difficult challenge of assessing when, and for whom, risk for suicide is greatest. Addressing this dilemma requires longitudinal, prospective data from high-risk samples with an elevated base rate of suicide attempts.Objective: To test whether dispositional characteristics modulate the pathway from interpersonal dysfunction to suicide in BPD. Design: This longitudinal, observational study was conducted between 1990 and 2020. Data were analyzed between April and July 2020. Participants were assessed annually for up to 30 years (mean number of follow-ups = 7.82). Setting: Participants were recruited from inpatient, outpatient, and community referral sources.Participants: 458 individuals (Mean age = 28.59, 77% female) diagnosed with BPD.Main Outcomes and Measures: Presence or absence of a suicide attempt within one year of each follow-up assessment. Multilevel structural equation modeling was used to 1) examine longitudinal, within-person transitions from interpersonal dysfunction to suicidal ideation to suicide attempts (i.e., the [I]nterpersonal-[I]deation-[A]ttempt pathway); and 2) evaluate whether two maladaptive personality dimensions, negative affect and disinhibition, moderated these transitions.Results: At the within-person level, there was support for the I-I-A pathway: suicidal ideation accounted for the association between interpersonal dysfunction and suicide attempts. Personality further moderated each component of the I-I-A pathway: negative affect was associated with a stronger coupling between interpersonal dysfunction and ideation; and disinhibition was associated with a stronger coupling between ideation and attempts. Conclusions and Relevance: The escalation from interpersonal difficulties to a suicidal crisis in BPD involves two psychologically distinct process. An internalizing process links interpersonal dysfunction to suicidal ideation and is facilitated by trait negative. An additional externalizing process links suicidal ideation to suicide attempts, and is facilitated by trait disinhibition. Assessment of these intra- and interindividual risk factors may inform clinical decisions about when, and for whom, crisis intervention is necessary.

Availability and accessibility of medications and toxic substances and suicidal behavior

2016 ◽  
Vol 33 (S1) ◽  
pp. S596-S596
Author(s):  
M. Arsenyan ◽  
S. Sukiasyan ◽  
T. Hovhannisyan
Keyword(s):  
Suicidal Behavior ◽  
Significant Influence ◽  
Crucial Role ◽  
Attempted Suicide ◽  
Conflict Situation ◽  
Toxic Substances ◽  
Suicide Method ◽  
Teenage Girls ◽  
Competing Interest ◽  
Suicidal Crisis

IntroductionScientific research indicates that accessibility of suicide means has a significant influence on the choice of method. Since the choice of suicide method largely depends on availability of suicide means, the lethality of method at hand plays a crucial role in a period of suicidal crisis.AimsWe aimed to reveal the associations between accessibility and availability of medications and toxic substances and suicidal behavior of teenage girls in Armenia.ObjectiveOur objectives were to determine whether accessibility and availability of medications and toxic substances have any impact on development of suicidal behavior among teenage girls in Armenia and whether toxicity and quantity of medications and toxic substances at hand or purchased by attempters are associated with severity of outcome.MethodsA qualitative analysis of patient histories of 26 teenage girls, hospitalized in the ICU, Toxicology Center “Muratsan”, Yerevan, RA, diagnosed as having acute deliberate self-poisoning was performed.ResultsIn majority of cases, conflict situation preceded suicidal behavior and decision on attempting suicide was impulsive. Being emotionally distressed teenage girls reached for medications and toxic substances readily available in the household or bought medications from a pharmacy.ConclusionThe vast majority of teenage girls attempted suicide by medications and toxic substances at hand. Admittedly, both, type of medication and quantity of pills or amount of toxic substances utilized, affected the severity of outcome. Hence, the availability and accessibility of medications and toxic substances played a crucial role in development of suicidal behavior and severity of outcome.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals The Impacts of Working with People Experiencing Suicidal Ideation: Mental Health Nurses Describe Their Experience

2021 ◽  
Author(s):  
◽  
Lynley Murtagh
Keyword(s):  
Mental Health ◽  
Suicidal Ideation ◽  
Mental Health Professionals ◽  
Qualitative Description ◽  
Work Place ◽  
National Guidelines ◽  
Graduate Studies ◽  
Mental Health Nurses ◽  
Suicidal Crisis ◽  
The Impact

<p>New Zealand has one of the highest suicide rates in the world and mental health nurses are the most likely professionals to assess a person presenting with suicidal ideation. Managing a suicidal crisis is acknowledged as being one of the most difficult and frightening challenges facing mental health professionals. This research aimed to have mental health nurses who work in acute mental health settings describe the impact that working with people experiencing suicidal ideation has on their personal and professional lives. This study followed the tenets of fundamental qualitative description as presented by Sandelowski (2000). Five mental health nurses participated in individual semi structured interviews. The data collected under-went systematic thematic analysis and the extracted findings were presented as a straight description. The findings from this study revealed that personal philosophies of care, the work place culture, organisational and professional expectations and their personal concepts about suicide all influenced the experiences of these participants. Mental exhaustion, tension and feelings of isolation and alienation from family and society were universal experiences. Two recommendations have been made based on the insights gained from this research. These are; tertiary institutions should offer post graduate studies on the subject of suicide as it relates to mental health nursing and national guidelines for the provision of supervision to mental health nurses need to be developed.</p>

Despair

2017 ◽  
Author(s):  
Rebecca Krug
Keyword(s):  
Spiritual Experience ◽  
The Difference ◽  
Suicidal Crisis ◽  
Confessional Discourse ◽  
Damaging Effects

This chapter locates the Book's origins in the emotional/spiritual experience of intense isolation and speechlessness, conditions associated with despair and, if despair was left unchecked, with suicidal inclinations. It suggests that this “temptation” toward suicide was Kempe's “secret sin” and that her decision to write the Book is an attempt to replace the silencing of confessional discourse, which had led her to a moment of near-suicidal crisis, with self-expression. In struggling to “say what she felt,” Kempe responds to the advice found in books of consolation: these warned against the damaging effects of despair but did little to explain how to escape its destructive power. She thus represents her discovery of the difference between “telling”—the process of saying how the condition felt—and enumerative confession that silenced and defined without allowing such expression as a solution to the problem.

Suicidal Crisis in the Digital Age

2016 ◽  
pp. 63-73
Author(s):  
L. Jehel ◽  
R. Arnal ◽  
D. Carmelo ◽  
N. Howard
Keyword(s):  
Digital Age ◽  
Suicidal Crisis

scholarly journals The homeless mentally ill – an audit from an inner city hospital

2007 ◽  
Vol 24 (2) ◽  
pp. 62-66 ◽  
Author(s):  
Aoife O'Neill ◽  
Patricia Casey ◽  
Rose Minton
Keyword(s):  
Psychiatric Service ◽  
Primary Diagnosis ◽  
Homeless Population ◽  
City Hospital ◽  
Psychiatric Unit ◽  
Psychiatric Admission ◽  
Medical Needs ◽  
Outreach Work ◽  
Accident And Emergency ◽  
Suicidal Crisis

AbstractObjective: To determine the proportion of those that are homeless attending the Mater Misericordiae Hospital's (MUH) psychiatric service, including those presenting to accident and emergency who were homeless, and to compare the homeless group with the non-homeless so as to obtain a profile of this group.Methods: All adults over 16, referred for psychiatric assessment, attending A&E were included, as were those attending outpatient clinics, liaison consultations and inpatients in the psychiatric unit, in the six-month period from January to June 2003. Excluded were those who were under 16, who refused to participate, who did not speak English, those with a diagnosis of personality disorder and organic brain damage. Questionnaires were completed by psychiatric registrars and a community psychiatric nurse, with an ICD-10 diagnosis recorded on each individual, in consultation with the treating consultant psychiatrist.Results: A total of 628 patients were seen in MUH during the study period, and 13.8% were homeless. Of the homeless, 56.3% were seen as emergency referrals in the A&E, 23% were inpatients (including the psychiatric unit and consultations in medical/surgical wards) and 20.7% were seen in the outpatient department. Of all the A&E referrals to psychiatry, 34.8% were homeless. The homeless presented most commonly in suicidal crisis (26.6%) compared with 12.5% in the non-homeless group. Substance-abuse disorders were the primary diagnosis in 42.3% of the homeless group, accounting for 14.2% in the housed sample. Outcome for both groups was similar, with slightly more homeless being referred for psychiatric admission (17.8%), as compared to 12.0% in the nonhomeless group.Conclusions: Mental illness and the need for psychiatric services remain a serious issue for a significant segment of the homeless population. The homeless are overrepresented in our accident and emergency department, with their psychological and medical needs not being met in primary care. An integrated multi-disciplinary treatment approach, including outreach work, that addresses their many needs, appears to hold the greatest promise of success in this population.

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