综合护理干预对妄想性抑郁症自杀行为的影响

目的探讨综合护理干预对妄想性抑郁症自杀行为患者的积极作用。方法选取收治的妄想性抑郁症患者70例,随机分为对照组和实验组,每组35例。对照组给予常规护理干预,实验组患者给予综合护理干预。观察两组患者护理干预后10d出现的不良事件,包括自杀行为、自杀准备行为和自杀念头的情况,对患者家属进行满意度调查,比较两组患者家属对护理工作的满意度。结果护理干预后实验组患者无自杀行为、自杀准备行为、自杀念头,与对照组比较有明显差异（P〈0．05）,患者家属对护理工作的满意度高于对照组（P〈0．05）。结论对妄想性抑郁症自杀行为患者给予临床综合护理可以更好地避免患者出现的自杀行为和自杀心态,是一种有效的护理措施,值得临床推广。     

综合护理干预在抑郁症伴自杀行为患者中的应用

目的探讨综合护理干预在抑郁症伴自杀行为患者中的应用效果。方法选取我科2017年1—12月抑郁症伴自杀行为患者30例作为研究对象,采用综合护理干预对患者进行护理,比较干预前、干预后1,2个月后患者的汉密尔顿抑郁量表(HAMD)、自尊量表(SES)、贝克自杀意念量表(SSI)和健康调查量表(SF-36)评分情况。结果护理干预后1,2个月患者的HAMD,SSI评分均低于干预前,SF-36,SES均高于干预前,差异有统计学意义(P 0. 05)。结论对抑郁症伴自杀行为患者进行综合护理干预可有效改善患者的抑郁程度,减少其自杀意念,提高其总体健康水平,值得临床推广应用。     

具有自杀危险的抑郁症住院患者的护理

目的 对具有自杀危险的抑郁症住院患者的相关护理干预效果进行分析,并对具体护理措施和体会进行总结.方法 选取2006年3月至2010年3月,在我院就诊的患有抑郁症且具有自杀危险的住院患者68例,对这些患者的自杀危险性因素和原因进行系统归类并予以护理干预,对护理干预后的效果进行分析,并总结具体护理措施.结果 经过对患者实施积极的治疗和精心的护理,68例患者无一例出现自杀行为.结论 对具有自杀危险的抑郁症住院患者进行护理干预,对于预防患者出现自杀行为有着极其重要的作用,对抑郁症患者症状的减轻和恢复也有着积极的促进作用,值得在今后的临床护理工作中予以推广和普及.     

护理干预对降低住院抑郁症患者自杀风险的效果评价

目的探讨护理干预对住院抑郁症患者自杀风险的影响。方法对符合纳入标准的47例有自杀风险的抑郁症患者于入院当天及护理干预后第6、12天采用住院患者自杀风险评估表进行评估,并将干预前后评估结果进行统计学分析。结果干预后第6、12天,全组患者自杀风险总分比干预前均明显下降,差异具有统计学意义(P0.05)。结论对住院抑郁症护患者进行自杀风险评估,并加强相应的护理干预措施,对降低自杀风险有较好的效果,能减少自杀行为的发生。     

产后抑郁症36例原因分析与防范措施

我们对36例产后抑郁症患者的自杀意念和自杀行为产生的原因进行分析,并采取相应的防范与干预措施.结果避免了自杀意外的发生.我们认为良好的护理干预措施能有效减少产后抑郁症患者出现自杀的比率,对抑郁症患者的针对性护理具有重要意义.     

住院抑郁症病人自杀未遂情况调查

[目的]探讨住院抑郁症病人自杀发生率、性别差异、自杀因素及护理干预对策。[方法]利用问卷调查表对150例自杀未遂的抑郁症病人自杀相关资料进行回顾性调查。[结果]住院抑郁症病人出现自杀意念、自杀意图、自杀行为较高;女性病人自杀行为明显多于男性,但男性自杀行为的后果更为严重;精神病家族史、自杀家族史、家庭环境等均与自杀行为密切相关。[结论]住院抑郁症病人存在较多的自杀问题,特别是病程长、多次住院、具有精神病家族史和自杀家族史者是自杀预防的重点人群。     

团队工作模式在抑郁症患者自杀干预中的应用Δ

目的：探讨团队工作模式对开放精神科病房住院的抑郁症患者自杀干预效果。方法将400例在开放病房住院的抑郁症患者随机分为两组,均予以抗抑郁药物治疗及常规护理干预,干预组在此基础上运用团队工作模式进行自杀干预,观察8周。于干预前后采用汉密顿抑郁量表及自杀态度问卷评定干预效果。结果干预8周末两组汉密顿抑郁量表总分均较干预前显著下降（P＜0.01）,干预组较对照组下降更显著（P＜0.01）;自杀态度问卷各维度分均较干预前显著升高（P＜0.01）,干预组较对照组升高更显著（P＜0.01）。干预组自杀行为发生率显著低于对照组（ P＜0.01）。结论在精神科开放式管理病房运用团队工作模式对抑郁症患者实施自杀干预,能有效缓解患者的抑郁症状,改善患者的自杀态度,减少患者自杀行为的发生。     

精神科住院抑郁症患者自杀预防及护理干预措施专家共识

目的 形成《精神科住院抑郁症患者自杀预防及护理干预措施专家共识》,规范精神科住院抑郁症患者自杀护理干预措施。 方法 运用循证方法及文献分析法提取住院抑郁症患者自杀护理干预措施推荐建议和研究结论,形成共识初稿,通过2轮专家函询及2次专家论证会,结合专家意见,对初稿进行调整、修改和完善,形成共识终稿。 结果 2轮函询专家积极系数均为100%,专家权威系数均为0.924,各指标重要性赋值均数均>3.5分,且变异系数均<0.25,专家肯德尔和谐系数分别为0.182和0.260（均P<0.01）。最终对精神科住院抑郁症患者自杀护理干预操作性定义、自杀风险评估、干预形式、干预时间、干预理论基础、干预一般原则、自杀意念的干预措施、自杀行为的干预措施、特殊人群自杀护理干预要点、干预效果评价及出院后的健康教育计划共11个部分的内容达成一致意见。 结论 该共识为精神科住院抑郁症患者自杀护理干预措施提供指导依据,使精神科住院抑郁症患者的自杀护理干预更规范。     

抑郁症患者自杀行为危机干预观察

抑郁症是一种高患病率、高致残率及高自杀率的精神疾病.有文献报道,90%的自杀者患有精神疾病,其中抑郁症自杀行为的发生率为28.5%-63.7%[1].流行病学资料显示,50%抑郁症有自杀行为,其中25%自杀未遂,15%最终死于自杀[2].自杀是抑郁症患者主要死亡原因,也是精神科危机干预的重要内容,了解患者自杀行为的临床特征对提高临床危机干预效果具有重要意义.为此,我们对抑郁症伴有自杀行为患者开展危机干预,并取得了较满意的效果,现将结果报告如下.     

住院精神病患者自杀原因分析及护理干预

目的：了解住院精神病患者自杀的相关因素和行为干预的有效性。方法：利用交谈、问卷等方法分析31例精神病患者自杀的原因，针对性开展护理干预。结果：31例有自杀倾向的患者均痊愈出院。随访2年6个月，无1例自杀。结论：有自杀倾向的精神病患者，采取相应的护理干预，可减少或杜绝自杀行为的发生。     

开放病房抑郁症自杀行为分析与对策

目的：探讨开放心理病房抑郁症自杀行为的对策。方法：对2006年10月8日至2008年4月30日收住的195例抑郁症患者进行回顾性分析。结果：经治疗和干预后自杀意念明显下降,而自杀未遂在治疗好转时有所增加,治疗4周时自杀意念和自杀未遂明显下降：入院前与第一周比较自杀意念没有统计学差异,而自杀未遂则有统计学差异,和第二周及第四周比较自杀意念、自杀未遂有统计学差异。结论：开放式心理病房采取综合的治疗和护理措施可有效地预防抑郁症患者的自杀行为。     

精神分裂症患者的自杀倾向相关因素分析

目的探讨精神分裂症患者自杀倾向及危险因素,为制订相应的护理措施提供依据。方法抽取2010年8月至2012年11月在某医院住院的精神分裂症患者228例,根据患者是否有自杀倾向,分为有自杀倾向组和无自杀倾向组。采用Logistic回归分析,探讨精神分裂症患者自杀倾向的危险因素。结果精神分裂症患者有自杀倾向的占42.98%;家族自杀史、患者服药依从性、照护人员文化水平、照护人员收入状况、照护人员对疾病了解程度是主要影响因素。结论对存在自杀倾向的精神分裂症患者需要特别关注,及时加强患者及照护人员的健康教育,提高患者服药依从性,降低自杀率。     

Suicidal ideation, plans, and attempts in chronic pain patients: factors associated with increased risk

This study describes suicidal behavior in a cross-sectional sample of chronic pain patients and evaluates factors associated with increased risk for suicidal ideation. One hundred-fifty-three adults with nonmalignant pain (42% back pain) who were consecutively referred to a tertiary care pain center completed a Structured Clinical Interview for Suicide History, the McGill Pain Questionnaire, and the Beck Depression Inventory. Nineteen-percent reported current passive suicidal ideation (PSI), 13% had active thoughts of committing suicide (ASI), 5% had a current suicide plan, and 5% reported a previous suicide attempt. Drug overdose was the most commonly reported plan and method of attempt (75%). Thirteen-percent reported a family history of suicide attempt/completion. Pain-specific and traditional suicide risk factors were evaluated as predictors of current PSI and ASI. Logistic regression analyses revealed that a family history of suicide attempts/completions was associated with a 7.5 fold increase in risk of PSI (P=0.001) and a 6.6 fold increase in ASI (P=0.003), after adjusting for significant covariates. Having abdominal pain was associated with an adjusted 5.5 fold increase in PSI (P=0.05) and a 4.2 fold increase in ASI (P=0.10). Neuropathic pain significantly reduced risk for both PSI (P=0.002) and ASI (P=0.01). Demographics, pain severity, and depression severity were not associated with suicidal ideation in multivariate analyses. These findings highlight the need for routine evaluation and monitoring of suicidal behavior in chronic pain, especially for patients with family histories of suicide, those taking potentially lethal medications, and patients with abdominal pain.     

Assessing suicide risk in stroke patients: review of two cases

Poststroke depression can be accompanied by suicidal ideation, yet reports of suicide among stroke patients are rare. When untreated, depression can become prolonged and severe. Risk factors for suicide include depression, severe insomnia, chronic illness, and organic brain syndrome. Early clinical assessment of suicide risk factors is essential in the rehabilitation setting. Two patients who developed mood disturbances in the acute poststroke period and eventually committed suicide are presented. Neither patient openly expressed suicidal thoughts to staff or family members. Retrospective analysis of medical records was compared to established suicide risk factors reported in the medical literature. Indirect verbal cues and nonverbal behavior patterns indicating potential suicide risk may have been present. Strategies for evaluation and management of suicidal behavior are discussed. These cases emphasize the need for early assessment of suicide risk by the entire rehabilitation team.     

Factors that influence emergency department doctors' assessment of suicide risk in deliberate self-harm patients.

OBJECTIVES: To determine the patient factors influencing UK Emergency Department doctors' assessment of suicide risk. To establish whether immediate clinical management is consistent with perceived risk. METHODS: The Manchester and Salford Self-Harm project is a multi-centre deliberate self-harm monitoring study. Data collected were used to analyse risk assessments made by Emergency Department doctors between September 1997 and August 1999. We used univariate and logistic regression analyses to determine the factors Emergency Department doctors used to make suicide risk assessments. RESULTS: A total of 3220 deliberate self-harm assessment forms were completed in two years by Emergency Department doctors; 2922 (91%) included a clinical assessment of risk; 28 out of 48 variables were associated with perceived suicide risk. Multiple logistic regression analyses showed that current mental state, high suicidal intent (including medical seriousness of attempt), and male sex were the most important independent predictors of suicide risk. Being referred to psychiatric services directly from the Emergency Department or to surgical/medical services was also strongly associated with a perceived high risk. CONCLUSION: In contrast to the negative findings of previous research, we found that Emergency Department doctors were influenced by key risk factors for suicide in their assessment of deliberate self-harm patients. Emergency Department doctors' assessments reflected the immediate risk of suicide, indicated by factors such as current mental state and strong suicidal intent. Background risk factors such as social adversity and psychiatric history were less influential. We would recommend that training for emergency doctors should emphasize the importance of both immediate and background risk factors.     

Effectiveness of a community-based program for suicide prevention among elders with early-stage dementia: A controlled observational study

The purpose of this study was to develop a small-group-focused suicide prevention program for elders with early-stage dementia and to assess its effects. This was a quasi-experimental study with a control group pretest–posttest design. A total of 62 elders diagnosed with early-stage dementia who were receiving care services at nine daycare centers in J City Korea participated in this study. The experimental group participated in the suicide prevention program twice a week for 5 weeks with a pretest and two posttests The developed suicide prevention program had a significant effect on the perceived health status, social support, depression, and suicidal ideation of elders with early-stage dementia. Nurses should integrate risk factors such as depression and protective factors such as health status and social support into a suicide prevention program. This community-based program in geriatric nursing practice can be effective in preventing suicide among elders with early-stage dementia.     

Optimism Reduces Suicidal Ideation and Weakens the Effect of Hopelessness Among Military Personnel

Suicide risk is an issue of increasing concern among military personnel. To date, most studies have focused on identifying risk factors for suicide in military personnel, but have by and large overlooked possible protective factors that reduce suicide risk, such as optimism. In a clinical sample of 97 treatment-seeking active duty Air Force personnel, the protective effects of optimism on suicidal ideation was investigated by considering the direct effect of optimism on suicidal ideation as well as the possible moderating effects of optimism on several suicide risk factors: depression, posttraumatic stress, and hopelessness. When adjusting for demographic and clinical covariates, results of multiple regression indicated that optimism was significantly associated with less severe depression, hopelessness, and suicidal ideation, but not posttraumatic stress symptoms. The interaction of optimism with hopelessness was also significant, and indicated that severe hopelessness contributed to more severe suicidal ideation only among participants with low levels of optimism. Results suggest that optimism is associated with less severe suicidal ideation, and buffer the effects of hopelessness among military patients.     

不同性别双相情感障碍患者发生自杀行为的临床特征比较研究

目的:研究双相情感障碍患者自杀行为相关因素的性别差异。方法:依据ICD-10诊断标准入组有自杀行为的双相情感障碍患者1739例和无自杀行为的双相情感障碍患者3713例,进行不同性别间各项目的比较分析,通过Logistic回归分析男、女性双相情感障碍患者自杀行为相关的危险因素。结果:男、女性伴自杀行为双相情感障碍患者在年龄、婚姻状况、职业、吸烟史、饮酒史、重大精神创伤史、入院次数等方面差异有统计学意义(P<0.05)。男性伴自杀行为患者较无自杀行为者年龄更大、已婚者更多、独生子女较少、较多家族自杀史、家族精神异常史、既往自杀史,差异有统计学意义(P<0.01)。女性伴自杀行为者较无自杀行为者年龄更大、较多饮酒史、重大精神创伤史、家族自杀史、既往自杀史,差异有统计学意义(P<0.05)。Logistic回归分析显示,女性患者的重大精神创伤、家族自杀史、既往自杀史与发生自杀行为相关(P<0.05)。男性患者的既往有自杀史与发生自杀行为相关(P<0.01)。结论:男、女性双相情感障碍患者的自杀行为危险因素存在一定差异,区别化对待其危险因素对预防自杀有重要意义。     

Depression and suicide assessment

Depressed patients and suicidal patients are common Emergency Department patrons with the potential for serious morbidity or death. Dysphoric mood, vegetative symptoms, and negative perceptions of oneself, the environment, and the future are characteristic of depression. Often, the patient is unaware of the depression and presents with a variety of somatic complaints, chronic fatigue, or pain syndromes. In these instances, the physician must consider the diagnosis of depression and ask the patient about any history of depressive symptoms. In all depressed patients, a careful history and physical examination are needed to identify any drugs or concurrent medical illnesses which might cause or exacerbate the depression. If depression is suspected or if the patient presents after a suicide attempt, then a thorough evaluation of suicide potential is mandatory. Several risk factors for completed suicide exist. Male sex, age under 19 or over 45, few social supports, and a history of previous suicide attempts are all factors associated with increased suicide rates. Concurrent chronic or severe medical illnesses and certain psychiatric illnesses, notably depression, schizophrenia, and substance abuse, also increase an individual's risk for suicide. The method of suicide attempt and the chance for rescue must also be considered when determining risk as well as the presence of an organized plan. Acute psychosis in the suicidal patient is an ominous finding and these patients should be admitted to the hospital. The physician must adopt an empathetic and nonjudgmental attitude when caring for potentially suicidal patients. Disposition can be determined after careful evaluation of risk factors, circumstances surrounding the attempt, and the patient's current feelings. Consultation with a psychiatrist or another mental health professional is desirable for any potentially suicidal patient. Many such patients can be safely treated as outpatients with proper referral; certain high-risk individuals will need to be admitted to the hospital. The decision to either hospitalize or discharge can be difficult and the emergency physician should admit the patient if doubt exists.