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3: Psych Y3 - Mental Health [10] > [15] Deliberate self-harm > Flashcards

[15] Deliberate self-harm Flashcards

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1
Q

What is deliberate self-harm (DSM)?

A

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

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2
Q

What forms can self harm take?

A
  • Self poisioning
  • Self-injury
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3
Q

Give 7 methods of self-injury

A
  • Cutting
  • Burning
  • Hanging
  • Stabbing
  • Swallowing objects
  • Shooting
  • Jumping from heights or in front of vehicles
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4
Q

Give 4 methods of self-poisoning

A
  • Medications, prescribed or OTC
  • Illicit drugs
  • Household substances, e.g. washing up liquid
  • Plant material
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5
Q

What are the risk factors for DSH?

A
  • 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
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6
Q

Is DSH more common in men or women?

A

Women (ratio of 1.5:1), but ratio varies greatly with age

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7
Q

What is the peak age of incidence of DSH?

A

15-19 years in females, 20-24 years in males

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8
Q

How much more common than suicide is DSH?

A

20-30 times

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9
Q

By how much does DSH increase the rate of suicide?

A

50-100 times greater than the suicide rate in the general population

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10
Q

What % of DSH cases in the UK are a result of a drug overdose?

A

90%

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11
Q

What medications are commonly ingested in DSH?

A
  • Non-opioid analgesics, e.g. paracetamol and salicylates (aspirin)
  • Anxiolytics (including benzodiazepines)
  • Antidepressants
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12
Q

What % of DSH cases in the UK are due to self-injury?

A

10%

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13
Q

What are the most common locations for self-injury in DSH?

A

Forearms and wrists

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14
Q

What proportion of people have taken alcohol in the 6 hours prior to the act?

A

About half the men and a quarter of women

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15
Q

What are the most common complications of DSH?

A
  • Pernament scarring of skin, and damage to tendons and nerves as a result of self-cutting
  • Acute liver failure due to paracetamol overdose
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16
Q

What questions should you ask when a patient presents with DSH?

A
  • 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
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17
Q

What are the potential motives behind DSH?

A
  • 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
18
Q

What investigations should be done in a patient who presents with DSH?

A
  • 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
19
Q

What bloods should be done in the investigation of DSH?

A
  • Paracetamol levels
  • Salicylate levels
  • U&Es
  • LFTs and clotting
20
Q

When are blood paracetamol levels accurate?

A

4-15 hours after ingestion

21
Q

What is the purpose of U&Es in investigation of DSH?

A

Assess renal function

22
Q

What is the purpose of LFTs and clotting in investigation of DSH?

A

Synthetic hepatic function

23
Q

What are the differential diagnoses for self-poisioning?

A
  • Head trauma
  • Intracranial haemorrhage
  • Intracranial infection, e.g. meningitis, encephalitis
  • Metabolic abnormalities, e.g. hypoglycaemia
  • Liver disease
24
Q

What are the differential diagnoses for self-injury?

A

Clotting disorders, which can cause significant bruising or bleeding

25
Q

What is included in the biological management of self-harm?

A
  • Treating any overdose with the appropriate antidote
  • Suturing deep lacerations
  • Anti-tetanus treatment if approrpriate
26
Q

What is included in the psychological management of DSH?

A
  • 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

​

27
Q

What is included in the social management of DSH?

A
  • Social services inpur
  • Voluntary organisations, e.g. Mind, Samaritans
28
Q

Why is risk assessment mandatory in DSH?

A
  • There is an immediate risk of suicide
  • Risk of repeat acts of self-harm
29
Q

What is often used as an alternative to hospital admission in DSH?

A

Involvement of the Crisis team in the community

30
Q

What will be required if the patient refuses medical treatment for the consequences of self-harm?

A

A mental capacity assessment

31
Q

What should be considered when giving medication to depressed patients?

A

The safety of the medication in overdose

32
Q

Which antidepressants are most dangerous in overdose?

A

TCAs, as they cause arrhythmias and convulsions

33
Q

Why can psychosocial assessment be useful in management of DSH?

A

Many patients have personal, relationship, or social problems for which they can be offered help, e.g. counselling and social service input

34
Q

How long after discharge should DSH patients be followed up?

A

Within 48 hours

35
Q

What antidote is given against paracetamol?

A

N-Acetylcysteine

36
Q

What antidote is used in opiates?

A

Naloxone

37
Q

What antidotes is used for benzodiazepines?

A

Flumazenil

38
Q

What antidote is used for warfarin?

A

Vitamin K

39
Q

What antidote is used for beta-blockers?

A

Glucagon

40
Q

What antidote is used for TCAs?

A

Sodium bicarbonate

41
Q

What is the antidote for organophosphates?

A

Atropine

42
Q

What is the use of activated charcoal in overdoses?

A

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

3: Psych Y3 - Mental Health [10] (21 decks)

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