[15] Deliberate self-harm Flashcards
What is deliberate self-harm (DSM)?
An intentional act of self-poisoning or self-injury, irrespective of motivation or apparent pupose of the act. It is usually an expression of emotional distress
What forms can self harm take?
- Self poisioning
- Self-injury
Give 7 methods of self-injury
- Cutting
- Burning
- Hanging
- Stabbing
- Swallowing objects
- Shooting
- Jumping from heights or in front of vehicles
Give 4 methods of self-poisoning
- Medications, prescribed or OTC
- Illicit drugs
- Household substances, e.g. washing up liquid
- Plant material
What are the risk factors for DSH?
- Divorced, single, or living alone
- Severe life stressors
- Harmful drug/alcohol use
- Less than 35
- Chronic physical health problems
- Domestic violence
- Childhood maltreatment
- Socioeconomic disadvantage
- Psychiatric illness, e.g. depression, psychosis
Is DSH more common in men or women?
Women (ratio of 1.5:1), but ratio varies greatly with age
What is the peak age of incidence of DSH?
15-19 years in females, 20-24 years in males
How much more common than suicide is DSH?
20-30 times
By how much does DSH increase the rate of suicide?
50-100 times greater than the suicide rate in the general population
What % of DSH cases in the UK are a result of a drug overdose?
90%
What medications are commonly ingested in DSH?
- Non-opioid analgesics, e.g. paracetamol and salicylates (aspirin)
- Anxiolytics (including benzodiazepines)
- Antidepressants
What % of DSH cases in the UK are due to self-injury?
10%
What are the most common locations for self-injury in DSH?
Forearms and wrists
What proportion of people have taken alcohol in the 6 hours prior to the act?
About half the men and a quarter of women
What are the most common complications of DSH?
- Pernament scarring of skin, and damage to tendons and nerves as a result of self-cutting
- Acute liver failure due to paracetamol overdose
What questions should you ask when a patient presents with DSH?
- What were their intentions before and during the act?
- Does the patient now wish to die?
- Wha are the current problems in their life?
- Is there a psychiatric disorder?
- Collaterol history from relatives, friends, or the GP
What are the potential motives behind DSH?
- Genuine wish to die
- Relief - seeking unconscioussness or pain as a means of temporary relief and escape from problems
- Influencing others - trying to influence another person to change their views or behaviour, e.g. by making someone feel guilty
- To punish themselves
- To try and get help or seek attention
What investigations should be done in a patient who presents with DSH?
- History
- MSE
- Bloods
- Urinalysis for possible toxicological analysis
- CT head is an intracranial cuase of altered consciousness is suspected
- Lumbar puncture if intracranial infection e.g. meningitis is suspected
What bloods should be done in the investigation of DSH?
- Paracetamol levels
- Salicylate levels
- U&Es
- LFTs and clotting
When are blood paracetamol levels accurate?
4-15 hours after ingestion
What is the purpose of U&Es in investigation of DSH?
Assess renal function
What is the purpose of LFTs and clotting in investigation of DSH?
Synthetic hepatic function
What are the differential diagnoses for self-poisioning?
- Head trauma
- Intracranial haemorrhage
- Intracranial infection, e.g. meningitis, encephalitis
- Metabolic abnormalities, e.g. hypoglycaemia
- Liver disease
What are the differential diagnoses for self-injury?
Clotting disorders, which can cause significant bruising or bleeding
What is included in the biological management of self-harm?
- Treating any overdose with the appropriate antidote
- Suturing deep lacerations
- Anti-tetanus treatment if approrpriate
What is included in the psychological management of DSH?
- Counselling and CBT for underlying depressive illness
- Psychodynamic psychotherapy may be appropriate if an individual has a personality disorder, however this is a long term treatment and needs appropriate assessment
What is included in the social management of DSH?
- Social services inpur
- Voluntary organisations, e.g. Mind, Samaritans
Why is risk assessment mandatory in DSH?
- There is an immediate risk of suicide
- Risk of repeat acts of self-harm
What is often used as an alternative to hospital admission in DSH?
Involvement of the Crisis team in the community
What will be required if the patient refuses medical treatment for the consequences of self-harm?
A mental capacity assessment
What should be considered when giving medication to depressed patients?
The safety of the medication in overdose
Which antidepressants are most dangerous in overdose?
TCAs, as they cause arrhythmias and convulsions
Why can psychosocial assessment be useful in management of DSH?
Many patients have personal, relationship, or social problems for which they can be offered help, e.g. counselling and social service input
How long after discharge should DSH patients be followed up?
Within 48 hours
What antidote is given against paracetamol?
N-Acetylcysteine
What antidote is used in opiates?
Naloxone
What antidotes is used for benzodiazepines?
Flumazenil
What antidote is used for warfarin?
Vitamin K
What antidote is used for beta-blockers?
Glucagon
What antidote is used for TCAs?
Sodium bicarbonate
What is the antidote for organophosphates?
Atropine
What is the use of activated charcoal in overdoses?
For the majority of drugs taken in overdose, early use of activated charcoal (within 1 hour of ingestion) can prevent or reduce absorption of the drug
