Suicidality

from Wikipedia, the free encyclopedia
This article or the following section is not adequately provided with supporting documents ( e.g. individual evidence ). Information without sufficient evidence could be removed soon. Please help Wikipedia by researching the information and including good evidence.
Health notice This article is about suicide. For those at risk, there is a wide network of offers of help in which ways out are shown. In acute emergencies, the telephone counseling and the European emergency number 112 can be reached continuously and free of charge. After an initial crisis intervention , qualified referrals can be made to suitable counseling centers on request.
Classification according to ICD-10
R45.8 Suicidality ; other symptoms related to mood
Z91.8 Suicide attempt ; Personal history of other specified risk factors, not elsewhere classified
ICD-10 online (WHO version 2019)
Weary of life , study by Ferdinand Hodler , 1882

Suicidality , also known as suicidal or, colloquially, fatigue , describes a psychological state in which thoughts , fantasies , impulses and actions are persistent, repeated or in certain critical escalations aimed at deliberately bringing about one's own death . The suicidology engaged as a scientific discipline with the study of suicidality and suicidal events.

There is a gradual differentiation between suicidal thoughts without the desire to commit suicide - which are also part of suicidality - and urgent suicidal thoughts with concrete intentions, plans and even preparations for suicide.

Suicidality is not a disease , but a symptom of an underlying problem . It can exist as an escalation of an emotional development in which despair and hopelessness have taken over. Suicidal people often experience themselves as torn inside out and are often ambivalent about their desire to die . On the one hand, those affected perceive their life as unbearably painful and therefore want to end it, on the other hand, many feel a kind of self-preservation instinct , fear of severe pain in the context of a suicide attempt and generally great uncertainty about the consequences of their actions. A possibility to change your current life, to start it again, cannot be recognized in the case of acute suicidality; suicide appears to this group of people as the only way out.

Since suicidality can express itself - or not express itself - very differently, the attempt to assess how acute the suicidality or how pronounced a person's tendency to suicide is often becomes a difficult and sometimes even hopeless endeavor, especially with those people who offer help - for whatever reason - are negative. In the case of acute suicidality, in which the person concerned may have already made specific plans and preparations, cannot distance himself from his intentions and cannot enter into agreements (e.g. assure that he will call the therapist the next day), there is an indication within the scope of the duty of care for compulsory admission to a psychiatric clinic .

When assessing and diagnosing suicidality, the following aspects are important:

  • Presuicidal syndrome : constriction, reversal of aggression, suicidal fantasies
  • Risk factors : Mental illness (especially depression , addiction or schizophrenia in the acute phase), psychosocial crises (separation, death of a loved one), few social relationships, previous suicide attempts, suicides in the family
  • Current state of mind : hopelessness, fear, insomnia, joylessness, impulsiveness and acute stresses in life: disturbed coping with illness, unbearable memories, negative assessment of living conditions, resignation
  • Separation experiences : failed partnership, death of a relative, injury, developmental crisis, discharge from inpatient psychiatric and psychotherapeutic treatment

As a special group of suicidal behavior can be the wish to die see of people who in the face of old age , age ailments want to die or fatal incurable disease. It is not uncommon for such people to refuse to eat and / or drink; their relatives and doctors are then faced with the question whether such a person is accountable (see also alleged will , living will , artificial nutrition ).

Questionnaires to assess suicidality

There are several questionnaires for self-assessment and external assessment:

  • NGASR - Nurses Global Assessment of Suicide Risk (16 questions)
  • SSF-II - Suicide Status Form
  • BSSI - (19 questions)
  • Beck scale for suicidal thoughts (SBQ-R | SBQ-R, questionnaire to record suicidal behavior (4 questions))
  • Reasons for Living Inventory (RFL)
  • Beck Hopelessness Scale (BHS)
  • INQ - Interpersonal Needs Questionnaire
  • ACSS - Acquired Capability for Suicide Scale
  • TASR - Tool for Assessment of Suicide Risk
  • SSI - Scale for Suicidal Ideation (19 questions)
  • SIS - Suicide Intent Scale (15 questions)
  • LSARS - Lethality of Suicide Attemt Rating Scale
  • LASPC - Los Angeles Suicide Prevention Scale
  • SDPS - Suicidal Death Prediction Scale
  • SD - SAD Persons Scale
  • SIQ - Suicidal Ideation Questionnaire
  • SRAS - Suicide Risk Assessment Scale
  • SASR - Scale for Assessing Suicidal Risk
  • SPS - Suicide Probability Scale

Etiology models

There are different models for generating suicidal thoughts or behavior:

  • Phase model of suicidal development (Pöldinger 1968)
  • Cubic Model of Suicide (Shneidman, 1989)
  • Escape Theory (Baumeister, 1990)
  • Cry of Pain model (Williams 2001)
  • Fluid Vulnerability Theory of Suicide (Rudd, 2006)
  • Cognitive model of suicidal acts (Wenzel and Beck, 2008)
  • Interpersonal theory of suicidal behavior (Joiner 2005): Passive suicidal desires could arise either from a lack of sense of belonging to a group or the assumption that one is a burden for others. If both components were present at the same time, active suicide desires could develop. The decisive factor for whether a suicide attempt is undertaken is whether the third component is fearlessness of pain, dying and death. This fearlessness of pain and death could possibly result from habituation to repeated painful or frightening experiences, such as self-harm, trauma or drug abuse.
  • Integrative motivational-volitional model of suicidal behavior (O'Connor, 2011)

therapy

There are various approaches to the psychotherapeutic treatment of suicidality:

  • Motivating conversation: The aim is to try to work out forgotten reasons for life or to develop new reasons. Britton, Patrick, Wenzel and Williams (2011) suggest first exploring the reasons for dying and against life in order to increase the patient's receptivity and only in the second step to inquire about the reasons for living and against dying. Complementary strategies can be used to develop reasons for life, such as asking what a good life would look like later or whether there were moments when life was more important. The question of how important life is on a scale from 0 (not important at all) to 10 (extremely important) can also be a starting point for exploring reasons to live. If a number greater than 0 is given, you can ask why no 0 was chosen. If 0 was mentioned, the question arises as to what would have to change in order to choose a higher value.
  • Cognitive therapy of suicidal behavior according to Wenzel, Brown and Beck (2009)
  • Behavioral therapeutic strategies such as contingency management or stimulus control: In the context of dialectical behavioral therapy , a behavior analysis first examines whether suicidal thoughts, the messages or the preparations for a suicide represent operant or respondent behavior. Often, in borderline patients, suicidal behavior is both respondent and operant. With regard to operant behavior, strategies such as contingency management are used. It should be noted that a certain reaction can reduce the short-term risk of suicide, but increase the likelihood of a future suicide through positive reinforcement in the long term. Therefore, the higher the risk of suicide, the more active the behavior. One difficulty would be that patients could always reinforce their behavior until the therapist intervened. Because it is not yet known in new patients whether the behavior is operant and what function it has, the approach must initially be much more conservative and active in order to keep the short-term risk of suicide low. In the case of respondent suicidal behavior, the therapist should end the triggering events and convey how the patient can avoid these events in the future (stimulus control) and reinforce alternative problem-solving behavior.

literature

  • T. Forkmann, T. Teismann, H. Glaesmer: Diagnosis of suicidality. Hogrefe Verlag , Göttingen 2016, ISBN 978-3-8017-2639-3 .
  • Thomas Bronisch, Paul Götze, Armin Schmidtke u. a. (Ed.): Suicidality. Causes, warning signs, therapeutic approaches. Schattauer, Stuttgart 2002, ISBN 3-7945-2008-4 .
  • Heinz Henseler, Christian Reimer (Ed.): Risk of suicide. On psychodynamics and psychotherapy. Stuttgart-Bad Cannstatt 1981.
  • Heinz Henseler: Narcissistic crises. On the psychodynamics of suicide. Wiesbaden 1974.
  • Walter Pöldinger: The assessment of suicidality. Huber, Bern 1969.

Web links

Individual evidence

  1. ↑ Reinhard Lindner, Georg Fiedler, Paul Götze: Diagnostics of Suicidality . In: Dtsch Arztebl. Volume 100, Issue 15, 2003, pp. A 1004-1007.
  2. ↑ a b Tobias Teismann, tungsten Dorrmann: suicidality . Hogrefe, 2014, ISBN 978-3-8409-2436-1 , pp. 20–23, 49–52 ( limited preview in Google Book search).
  3. ↑ Heike Ulatowski: Care planning in psychiatry: A practical guide with formulation aids . Springer, 2016, ISBN 978-3-662-48546-0 , pp. 130 ( limited preview in Google Book search).
  4. ↑ Susanne Schewior-Popp, Franz Sitzmann, Lothar Ullrich: Thiemes Pflege (large format): The textbook for nurses in training . Georg Thieme, 2012, ISBN 978-3-13-152442-3 , p. 1146 ( limited preview in Google Book Search [accessed December 20, 2016]).
  5. ↑ Sonia Chehil, Stan Kutcher: The risk of suicide. Assessment of suicidality and dealing with suicidality . Hans Huber, Bern 2013, ISBN 978-3-456-85197-6 , pp. 99-103 .
  6. ↑ a b c d e f g h i j Frank M. Dattilio, Arthur Freeman: Cognitive-Behavioral Strategies in Crisis Intervention . 3. Edition. Guilford Press, 2012, ISBN 978-1-4625-0874-7 , pp. 38–39 ( limited preview in Google Book search).
  7. ↑ Thomas Forkmann, Tobias Teismann, Heide Glaesmer: Diagnostics of Suicidality . Hogrefe, 2015, ISBN 978-3-8444-2639-7 ( google.de ).
  8. ↑ Tobias Teismann, Christoph Koban, Franciska Illes, Angela Oermann: Psychotherapy for suicidal patients: Therapeutic handling of suicidal thoughts, suicide attempts and suicides . Hogrefe, 2017, ISBN 978-3-8444-2584-0 ( google.de ).
  9. ↑ Herry Zerler: Motivating conversation and suicidality . In: Hal Arkowitz, Henny A. Westra, William R. Miller, Stephen Rollnick (Eds.): Motivational conversation in the treatment of mental disorders . Beltz, Weinheim 2010, ISBN 978-3-621-27705-1 , pp. 183-204 .
  10. ↑ Suizidprophylaxe No. 167 - S. Roderer Verlag. Retrieved April 20, 2017 .
  11. ↑ P. Britton, H. Patrick, A. Wenzel, G Williams: Integrating Motivational Interviewing and Self-Determination Theory With Cognitive Behavioral Therapy to Prevent Suicide . In: Cognitive and Behavioral Practic . tape 18 , 2011, p. 16-27 ( PDF download ).
  12. ↑ Tobias Teismann, Christoph Koban, Franciska Illes, Angela Oermann: Psychotherapy for suicidal patients: Therapeutic handling of suicidal thoughts, suicide attempts and suicides . Hogrefe Verlag, 2017, ISBN 978-3-8444-2584-0 ( google.de [accessed April 20, 2017]).
  13. ↑ Jürgen Margraf (Hrsg.): Behavioral therapy: 2: disorders of adulthood . Springer, Berlin 2013, ISBN 978-3-662-08348-2 , pp. 138–148 ( limited preview in Google Book search).
  14. ↑ Birger Dulz, Otto F. Kernberg: Handbook of borderline disorders . Schattauer Verlag, 2011, ISBN 978-3-7945-2472-3 , p. 410 ( limited preview in Google Book search).
  15. ^ Marsha M. Linehan: Dialectical-Behavioral Therapy of Borderline Personality Disorder . CIP-Medien, Munich 2008, ISBN 978-3-932096-61-7 , p. 353-373 .