Health and Healing Week 4

bipolar suicide

what can bipolar disorder cause

• extreme disruption to normal functioning

• chronic and recurring in nature

bipolar disorder

• a mood disorder that includes one or more episodes of mania or hypomania and usually one or more depressive episodes

• related to chemical imbalances in the brain

• genetically transferred

bipolar disorder percents

• 1% of Canadians experience Bipolar Disorder

• Suicide accounts of 5% of deaths among women, and 10% of death among men with Bipolar Disorder

presenting signs and symptoms

• Periods of hyperactivity

• Overconfident, exaggerated view of own abilities

• Decreased need for sleep, no acknowledgement of fatigue

• Increased energy

• Poor social judgement, engaging in reckless and self-destructive activities

• Rapid fire speech; pressured speech; loud, garrulous, rhyming and punning

• Brief attention span, easily distractible, flight of ideas, loosened associations, delusions

• Expansive, irritable or paranoid behaviours

• Impatient, uncooperative, abusive, obscene, manipulative

bipolar biological factors

• generic

• neurobiological

• brain structure

• neuroendocrine

bipolar - genetic

• familial, concordance rate among twins 70%

• higher IQs

• creative

bipolar - neurobiological

• norepinephrine, dopamine, and serotonin

  • having too few will result in depression

  • oversupply mania

• receptor site insensitivity,

  • likely result of interactions among various chemicals

  • neurotransmitters and hormones

brain structure and function - bipolar

• fMRI reveal dysfunction in prefrontal cortex, hippocampus and amyglada

neuroendocrine - bipolar

• hypothyroidism (HPTA)

• peripheral inflammation

• estrogen

bipolar etiology

• biological

• environmental

• psychological

bipolar - environmental factors

• upper socioeconomic class, children with genetic and biological disorder most vulnerable when social determinants of health are compromised

• stress

bipolar - psychological factors

• Stressful Life Events (-ve traumatic life events trigger mania; Low social support, low self-esteem trigger depressive)

bipolar assessment guidelines - danger to self or others

• Manic patients can exhaust themselves

• Might not eat of sleep for days at a time

• Poor impulse control could lead to harm of self or others

• Uncontrolled spending can leave individual, and families destitute

bipolar assessment guidelines

• Assess need for protection from uninhabited behaviour (Patients might give away all money or possession, might need controls to protect from bankruptcy )

• Assess need for hospitalization to safeguard and stabilize

• Assess medical status, determine if primary or secondary to another medical condition or substance induced

• Assess patient’s and families understanding of bipolar disorder, medications, support groups and community organizations

bipolar phases

• acute

• continuation

• maintenance

bipolar - acute phase

• well hydrated

• maintain stable cardiac status

• maintain tissue integrity

• sufficient sleep and rest

• demonstrate self control

• no attempts to self harm

continuation phase - bipolar

• knowledge of disease process

• knowledge of medication

• consequences of addiction in predicting future relapse

• knowledge of early signs and symptoms of relapse

• support groups or therapy communication and problem solving skills training

maintenance phase - bipolar

• participation in learning interpersonal strategies related to work interpersonal and family problems

• participation in psychotherapy group or other ongoing supportive therapy modality

interventions for acute mania

• use firm and calm approach

• short concise explanations and statements

• remain neutral - no power struggles

• consistent in approach and guidelines

acute mania physical needs

• decrease environmental stimuli (consistent, external controls)

• offer finger foods/high caloric foods

• encourage short rest periods

• maintain minimal standards of hygiene

• monitor meds

• monitor elimination

acute mania behavioral needs

• negotiate limits on demanding manipulative behaviors

• simple tasks that focus attention and yield success

• sedentary activities, motor activities in moderation

• define and explain acceptable behavior

• set limits

• seclusion may be necessary

  • decrease env stimuli protect pt from self or others and prevent destruction of property

acute mania cognitive needs

• discourage expensive purchases

• help identify behaviours that lead to manic episode

• help establish relistic goals

• explore effects of behavior on others

• increase self esteem

• intervene when has delusions

acute mania emotional needs

• help become aware of underlying anger

• help verbally acknowledge resistance to therapy

• help with decision making and accepting responsibility

• help to develop coping skills

mood stabilization

• lithium carbonate

  • indications: elation, grandiosity, expansiveness, flight of ideas, irritability manipulation, anxiety

  • must reach therapeutic levels in blood in order to be effective (7-14 days)

  • Small window between therapeutic and toxic levels

  • Blood serum levels should reach 0.6-1.2 mEq/L

  • Should not exceed 1.5 mEq/L to avoid toxicity

anticonvulsant medications

• superior for continuously cycling patients

• more effective when no family Hx

• dampening affective swings in schizoaffective

• diminished aggressive and impulsive behavior in some non-psychotic PTs

• alcohol and benzodiazepine withdrawal

other bipolar interventions

• ECT

• milieu management

  • stimuli, risk, seclusion or restraint

• support groups

• psychotherapy

• CBT

• family therapy

suicide stats

• 83% who die by suicide have sought Tx within past year

• 45% consulting primary care physician within a month before death

death or death by suicide

• act of taking ones life

suicidal behavior

• potential self injurious actions with a non fatal outcome for which there is evidence that a person intended to kill themself

non suicidal self injury

• self harming behavior with no intent to die

suicide epidemiology

• third leading cause of death for people aged 12-29

• highest rate were among those 50-54

• numbers could be greater due to under reporting

• higher in indigenous populations

• 1.5% of deaths worldwide are due to suicide

suicide etiology

• biological

  • familial

• psychosocial

  • low income, poverty, chronic illness

• cultural

  • ancient Japan horror

  • Caribbean voodoo

  • king of Egypt - wife should kill herself to be with husband

  • many religions see it as a sin

• societal

  • social isolation

suicide risk factors

• 90% of people who die from suicide are experiencing depression another mental health illness or substance abuse

• 15% of people who have depression or bipolar will die by suicide

• bulling, pathological gambling, incarceration

SADPERSONS

• S - sex

• A - age

• D - depression

• P - prior history

• E - ethanol abuse

• R - rational thinking loss

• S - support system loss

• O - organized Plan

• N - no significant other

• S - sickness or terminal illness

ISPATHWARM

• I - ideation

• S - substance abuse

• P - Purposelessness

• A - anxiety and agitation

• T - trapped

• H - hopelessness or helplessness

• W - withdrawal

• A - anger

• R - recklessness

• M - Mood changer

assessing suicide risk

• verbal and no verbal cures

• overt and covert statements

• history of attempts

• substance use or abuse

• level of despair

• ability to control behavior

• behavioral clues

verbal and non verbal cues

• overt and covert statements

overt

• i cant take it anymore

• life isn’t worth living

• i wish i were dead

• everyone would be better off if i died

covert statements

• its okay now soon everything will be fine

• things will never workout

• i wont be a problem much longer

• nothing feels good to me anymore and probably never will

lethality of the plan

• presence of risk factors for suicide

• degree of suicidal ideation

• intent to carry out suicide plan

• means and availability of resources to carry out metho of suicide

• degree of hope for improvement of psychological state

discussion suicide intent

• Are you thinking of suicide?

• Have you tried to end your life before?

• Have you been feeling left out or alone?

• Have you been feeling like you’re a burden?

• Do you feel isolated and or disconnected?

• Are you experiencing the feeling of being trapped?

• Has someone close to you recently died by suicide?

• How are you thinking of ending your life?

• Do you have the means to do this (firearms, drugs, ropes)? Have you been drinking or taken any drugs or medications?

• How have you been sleeping

suicide interventions

• primary

• secondary intervention

• tertiary intervention

primary intervention - suicide

• provide support

• education and information to prevent suicide

• schools, home, churches, hospitals, hospitals

secondary intervention suicide

• Tx of acute suicidal crisis;

• clinics, hospitals, jails, telephone hotlines.

• Often determinants of life and death

tertiary (postvention) intervention

• interventions with the family and friend of a person who had died by suicide

• reduce traumatic effects, addressing survivor problems; refer, consult, collaborate

other interventions - suicide

• milieu precautions

• counselling

• support groups

• health teaching and health promotion

• case management

• pharm interventions

• postvention for survivors for suicide