An initial suicide evaluation should include
Interview should include current suicidal ideation, available means
Determine lethality of intended action
Contract for safety
Substance abuse/impulsivity
Determine history of psychiatric disorder, previous attempt of suicide or family history
All of the above
Covert statements to look out for in a suicidal patient include, "It's okay now. Everything will be fine" and "I won't be a problem much longer".
What are some overt statements made by a suicidal patient? Select all that apply.
"I can't take it anymore"
"Life isn't worth living anymore"
"I won't be a problem much longer"
"I wish I were dead"
"It's okay now. Everything will be better"
"Everyone would be better off if I died"
What are some behavioral clues in a suicidal patient?
Giving away prized possessions, making out a will, and exhibiting an unexpected and sudden improvement in mood after being depressed or withdrawn
Sleeping well, being compliant with medications and attending support or group therapy
Showering daily
What are the safety procedures and nursing interventions for an acutely suicidal individual who is hospitalized?
Follow institutional protocol for suicide regarding creating a safe environment - take away potential weapons
Keep accurate and thorough records of patient’s behavior – both verbal and physical – as well as all nursing and physician actions
Put on either suicide precaution (one-on-one monitoring at arm’s length away) or suicide observation (q 15 minute visual checks), depending on level of suicide potential
Keep accurate and timely records and document patient’s activity (usually q 15 min), including what patient is doing and with whom, etc. – FOLLOW INSTITUTIONAL PROTOCOLS
If accepted at your institution, construct a no-suicide contract with the suicidal patient. Use clear, simple language. When contract expires, it is renegotiated.
Encourage patients to talk about their feelings and problem-solving alternatives
What are the positive symptoms of schizophrenia?
Hallucinations
Blunted affect
Delusions
Disorganized speech
Bizarre behavior
Poverty of thought
What are the negative symptoms of schizophrenia?
Loss of motivation (avolition)
Inability to experience pleasure or joy (anhedonia)
The following are neurocognitive impairments of a person who has schizophrenia. Select all that apply.
Inattention, easily distracted
Impaired memory
Good problem-solving skills
Poor decision-making skills
Rational and logical thinking
Impaired judgement
Schizophrenia most likely occurs as a result of inherited genetic factors and extreme non-genetic factors (virus infection, birth injuries or nutritional factors).
What is the dopamine hypothesis in schizophrenia patients?
The theory that there is hyperactivity of the neurotransmitter dopamine in the limbic regions of the brain.
Suggestion that there is hypofunction in the N-methyl-D-aspartate (NMDA) receptors in the glutamate system that leads to a combination of excitotoxin toxicity and impaired neural plasticity.
Disruptions in the connections and communication within the neural circuitry.
Non-genetic risk factors for developing schizophrenia include a history of perinatal complications, viral infection, poor nutrition or starvation, exposure to toxins, and lack of oxygen during birth.
One theory of the etiology of schizophrenia is there is a strong genetic component.
The glutamate hypothesis suggests that there is hyperactivity of the neurotransmitter dopamine in the limbic regions of the brain.
Serotonin doesn't play a role in causing some of the symptoms of schizophrenia.
Meaningless rhyming of words in a forceful manner, in which the rhyming is often more important that the context of the word
clang association
neologisms
waxy flexibility
word salad
Voices that command the person to hurt self or others
Command hallucinations
Echolalia
Illusions
False fixed beliefs that cannot be corrected by reasoning
Clang association
Pathological repeating of another's words by imitation and is often seen in people with catatonia.
Echopraxia
Thought insertion
Mimicking of movements of another person
Paranoia
Sensory perceptions for which no external stimuli exists.
Neologisms
Frequently misinterpreting messages of others or giving private meaning to the communication of others
Ideas of reference
Thought withdrawal
Waxy flexibility
Misperceptions or misinterpretations of a real experience
Word salad
Made up words that have special meaning for a person
Thought broadcasting
Belief that one's thoughts can be heard by others
Belief that thoughts of others are being inserted into one's mind
Belief that thoughts have been removed from one's mind by an outside agency
When a leg or arm is placed in an awkward position by someone else and the patient holds that position for an uncomfortable length of time
A jumble of words that is meaningless to the listener and perhaps to the speaker as well
Which of the following describes the purpose of Program for Assertive Community Treatment (PACT)?
Aim is to prevent relapse, maximize social and vocational functioning and to keep the individual in the community
Emphasizes the patient's strengths in adapting to the community, provides support and assertive outreach, and involves almost all aspects of the patient's life
Provides mobile crisis intervention, supportive cognitive and behavioral therapy, and substance abuse training
Program for Assertive Community Treatment (PACT) is designed for the well adjusted and well functioning patients.
Describe appropriate psychoeducational strategies for patient with schizophrenia and their families.
Learn all you can about the illness
Develop a relapse prevention plan
Take advantage of all psychoeducational tools
Comply with treatment
Take long walks by the beach
Avoid alcohol and drugs
Keep in touch with supportive people
Keep healthy
Go on a long extended vacation to Europe
Describe appropriate ways to communicate with a patient who is hallucinating. Select all that apply.
Try to understand what the voices are saying or telling the patient to do
Don't make eye contact
Approach the patient in a nonthreatening and nonjudgmental way
Call the patient by another person's name
Speak simply but louder than usual
Describe appropriate communication strategies for a patient exhibiting delusions. Select all that apply.
Clarify the reality of the patient's experience
Don't empathize with the patient's apparent experience and feelings
Validate the delusions
Identify the feelings the patient is experiencing.
Clarify misinterpretations of the environment.
Describe communication techniques that appropriate for patient with paranoia. Select all that apply.
React to offensive criticism made by the person with anxiety and rejection
Approach the patient in a nonjudgmental, respectful manner
Explain procedures ahead of time
Be honest and consistent
Laugh, whisper, and talk quietly when the patient cannot hear what is being said
Use clear and concise language
