104; Suicide/Self Harm Flashcards
What is the ‘probable’ suicide rate?
Suicides + open verdicts
In the U.K. for coroner to return a verdict of suicide ‘clear evidence that injury was self-inflicted, and that the deceased intended to kill himself. If there is any doubt about the intentions of the deceased either an accidental or open verdict should be recorded’
Who has the highest suicide rate, Men or Women?
Men 3:1 Women
Males; 17.5/100000/year
Females; 6/100000/year
in UK
Which group of people has the suicide rate?
male/female/old/young…
Young Male; 15-44yrs
Which male age group has the highest suicide rate?
35-50
In terms of socioeconomic depravation, social isolation and social class, compare who has the highest suicide rate.
- Links with socioeconomic deprivation
- Inner city > suburbia
- unemployment
- Social isolation
- Living alone (single, divorced, separated, widowed)
- Social class I & V
- Particularly farmers, doctors, lawyers, dentists
- Spring peak
- Prison/Involvement with police
How many suicide victims expressed suicidal ideas beforehand?
2/3
What are the most common methods of suicide in males?
- Hanging
- Overdose
- CO poisoning
What is the most common method of suicide in Females?
Overdose
How is non-fatal self harm defined?
Intentional self-poisoning or self-injury, irrespective of the type of motivation or degree of suicide intent
Which gender has the highest rate of deliberate self harm (DSH)?
Female 1.2 : 1 Male
Which age groups in Females and Males have the highest DSH rates?
Females; 15-24
Males; 25-34
Following a DSH event, how much is the risl of suicide increased in a Pt?
100X higher risk of suicide
What is the most common mental disorder associated with DHS?
Depression, up to 70% of DSH pt
What percentage of people commit suicide following DSH episodes?
1-2% in 12months
3% in 8yrs
What percentage of people repeat DHS?
15% in 12 months
What behaviours suggest a person is at risk of suicide?
Attempted premeditated or actively prepared for
Precautions taken to avoid intervention
Attempt carried out in isolation
Attempt timed to minimise risk of discovery
Suicide intent communicated prior to attempt
Final acts in anticipation of death (i.e. will)
Suicide note
Violent methods
Person believed act would be irreversible or lethal
Person states that aim of act was to kill him/herself
Person regrets surviving the attempt
No action taken to gain help after the event
Numerous previous suicide attempts with intent to die
What are the 3 main issues to assess in a patient following DSH?
- The immediate risk of suicide
- The subsequent risk of further deliberate self-harm or suicide
- Any current medical or social problems (‘assessment of need’)
What are the most common drugs that cause death from poisoning?
- Heroin, morphine and methadone
- Antidepressants
- Carbon monoxide
- Paracetamol
- Benzodiazepines
Which gender has the highest rate of poisoning?
Females > Males
What is the most common age group for poisoning?
15 - 24
What are the steps in the management of poisoning?
- Resuscitation
- Supportive care
- Decontamination
- Identification
- Antidotes
- Enhance elimination
- Management of complications
- Psychosocial support
What drugs induce fits, and what is used to treat fits?
TCAs
Mefanamic acid
Theophiline
IV Lorazepam
What methods can be used to reduce the absorption of poisons?
Adsorption of toxins
Whole bowel irrigation
(Forced emesis)
(Gastric lavage)
What is activated charcoal?
Small carbonaceous powder containing extensive netwirk of pores.
- Most effective within 1 hour
- 1g/kg given orally
Ineffective in:
- Metals; iron, lithium, lead, cyanide, mercury
- Do not bind
- Hydrocarbons; methanol, ethanol
- They’re absorbed rapidly from the gut
- Contraindicated caustics/volatile; can cause vomiting
When may whole bowel irrigation be appropriate treatment of poisoning?
Slow-release preparations of drugs- theophylline, Bblockers, Ca chan blockers. Button batteries and body packers.
What are the 3 different methods of enhanced elimination (decontamination)?
- Urine alkalinisation
- Forced diuresis
- Renal dialysis/haemoperfusion
For what drug is urine alkalinisation useful against?
Aspirin (Acetylsalicylic acid)
How doe urine alkalinisation work with aspirin?
- Aspirin is a weak acid
- Alkalinisation of renal tubular fluid ionises the drug, making it less lipid-soluble
- This form is unable to diffuse back across and be reabsorbed
In alkaline diuresis urine pH is 7-8
How does haemodialysis work?
Enhances elimination of
- Ethanol
- Ethylene glycol
- Lithium
- Methanol
- Sialicylate
*This is the treatment of chioce in severe poisoning
How does haemoperfusion work?
Blood is passed through a membrane of charcoal
- Theophiline
- Carbamezapine
What is the likely poison causing the following symptoms:
- Coma
- Hypertonia, hyper-reflexia and extensor plantar responses
- Myoclonus
- Mydriasis (dilated pupils)
- Sinus tachycardia
TCAs
Amitryptaline, Ritalin
What is the likely poison causing the following symptoms:
- Coma
- Miosis
- Bradypnoea
Opiates
What is the likely poison causing the following symptoms:
- Nausea & Vomiting
- Tinnitus
- Deafness
- Sweating
- Hyperventilation
- Vasodilation
- Metabolic acidosis
Salicylates
ee aspirin
What What is the likely poison causing the following symptoms:
- Coma
- Hypotonia & hyporeflexia
- Hypotension
- Plantar response: extensor or absent
- Benzodiazepines
- Barbiturates
- Severe TCAs
What is the most likely poison causeing the following symptoms:
- Hyperthermia
- Tachycardia
- Delerium
- Agitation
- Mydriasis
MDMA
What are the 4 types of suicide identified by Durkheim?
- Egotistic
- Self-centred
- Alturistic
- For the good of others
- Anomic
- Social isolation
- Fatalistic
- No choice
Name one drug used as an antidote in ethanol poisoning
Fomepizole
Competitive inhibitor of alcohol dehydrogenase; no toxic metabolised produced, and NAD:NADH ratio normal so liver function not comprimised
