Suicide by Self-Neglect?

  1. 1
    i need some words of wisdom on how to most effectively care for a new home-care patient. this individual is currently being treated for their second cabg (3 vessel) after second or third mi. diabetic, amputated toes, old cva, two episodes of dka that led to codes, smoker with etoh abuse, only in their mid-forties.

    i have a limited psych background, and am wondering if this person might be killing themselves the slow, painful way?? the patient is of normal intelligence, with a spouse who seems supportive and the support of out of town parents.

    i'm not sure that the usual teaching is appropriate here, or the usual cardiac rehab [phase ii] at home. i'd like some interventions that will keep them alive to see fifty, but am stumped. any insights gratefully accepted!:bowingpur
    lindarn likes this.
  2. 12 Comments so far...

  3. 3
    even though medical needs trump psychological needs, in this case i would r/o depression.
    it sounds like he has been neglecting himself for a while.
    i would try and get him on antidepressants, if he's not currently on them.
    w/an optimal outcome, he may be more motivated in caring for himself.

    leslie
  4. 2
    hmmmm...
    i just read about the etoh-abuse.
    that's a tough one.
    as is the smoking.

    if he agrees to antidepressants, i do know there are meds that cut cravings for food/smoking/drugs...

    i know this, because my psychiatric np, mentioned such a med, but it has se's.
    i believe lft's have to be wnl...which would likely rule him out.

    hmmmm (again)...:thnkg:

    ok, let's take one step at a time.
    let's see if addressing the (perceived) depression is of any benefit.
    encourage the cardiac rehab in the meantime.
    give him simple, written materials that he or his wife could read.
    elicit input from him, re his destructive habits:
    i.e., why does he partake in this/that, knowing the outcome?
    in the meantime, collaborate w/other members of the healthcare team, re getting him on a safer path.

    best of luck, esp to him.

    leslie
    BlueRidgeHomeRN and lindarn like this.
  5. 1
    There is such a thing as "passive suicide".

    I strongly suspect, as Leslie said above, that this fellow is depressed, and if truth be told, probably has a very low opinion of himself. I would also imagine that he is fairly typical of his gender and denies that he has any mental health issues---it still isn't considered 'manly' to admit to depression---while blaming all his medical problems on some external locus of control, e.g. "bad genes".

    However, self-abuse isn't something that can be fixed with pills and surgery; your patient will need long-term therapy and medical oversight to help him get a handle on why he is destroying himself by smoking, drinking, ignoring his diabetes etc. Good luck with this patient........he (and you) will certainly need it.
    BlueRidgeHomeRN likes this.
  6. 1
    It sounds like depression is a real possibility. Maybe since he has been through so many serious health problems at such a young age, he feels powerless and has given up on life. Has anyone actually addressed this issue with the patient? It's so sad to see this happen to people
    BlueRidgeHomeRN likes this.
  7. 1
    He enjoys playing the sick role?

    Passive agressive?

    Gets attention from spouse and parents (who maybe didn't have time for him earlier in life?)?

    Wife and parents enablers?

    Major depression?

    What kind of social outlet, if any, does he participate in? Watching Jerry Springer doesn't count. Can he read? Do crossword puzzles? Listen to soothing music? Have a cat? Paint, knit, take short walks to see and feel the great outdoors?

    All the above posters have some great ideas, and I think you are on the right track. Brainstorming here sure helps. Let us know how it goes...
    BlueRidgeHomeRN likes this.
  8. 2
    whoa, that is so difficult. i know exactly the type patient you're speaking of and of those i have seen in hh they are now deceased and at an early age. their spouses are powerless to make any changes. it reminds me of the morbidly obese person who can't get oob yet their cg brings them all the food that they request.

    you can beat your head against the wall but in the end they are going to do exactly what they want and will eat and drink exactly what they want. in that state of health there's not much that can be done. they more or less have themselves on what they consider to be "comfort measures". we have discharged patients such as these for non-compliance. a psychiatrist is the only doctor who should be prescribing an antidepressant to a patient with such severe health issues. it's very sad.

    Quote from blueridgehomern
    this individual is currently being treated for their second cabg (3 vessel) after second or third mi. diabetic, amputated toes, old cva, two episodes of dka that led to codes, smoker with etoh abuse, only in their mid-forties.
    it's amazing he survived the cabg
    Last edit by DutchgirlRN on Feb 25, '08
    BlueRidgeHomeRN and psalm like this.
  9. 2
    My hospital has several diabetic frequent flyers who are almost certainly "suicide by noncompliance."

    Diabetes seems to be a disease that many people think they can cure by blatantly disregarding even the most common sense, basic rules. :icon_roll
    Altra and BlueRidgeHomeRN like this.
  10. 1
    Quote from earle58
    hmmmm...


    i know this, because my psychiatric np, mentioned such a med, but it has se's.
    i believe lft's have to be wnl...which would likely rule him out.

    hmmmm (again)...:thnkg:
    leslie
    yup, i left out the pancreatitis and the almost total lack of viable liver tissue! no surprise there, i guess, between the diabetes and etoh!
    leslie :-D likes this.
  11. 1
    Think you have to start by figuring out how much he and wife know about why he went into dka x2. Make sure they know how to prevent that. Cardiac rehab education would be another priority. If he can get up and get moving that would be good. Evaluate where he is as far as being willing to try to stop smoking. Offer alternatives, chantix etc for this. Sounds like he has a lot of complications from his diabetes and don't know how long he has been diabetic. However, if he has been a diabetic for a long time his diabetic education may not be up to par. As professionals we have to realize that it has not been too many years ago that diabetics got little or no education about their disease. Even now doctors diagnose patients with diabetes, put them on a pill and tell them to take it, and don't see that they get any education about the disease. How they expect that some of these patients won't end up in this guys shape I don't know and by this time there isn't much you can actually do. Probably has nothing to do with suicide although, if I were in that condition you can bet I would be depressed.
    BlueRidgeHomeRN likes this.


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