6 - Self Harm and Suicide Flashcards

1
Q

How do you do a risk assessment for suicide?

A
  • When did you first want to harm yourself?
  • Any final acts?
  • What were the circumstances?
  • How do you feel about it now?
  • Who called for help?
  • Risk factors?
  • Protective factors?
  • Psychiatric history?
  • Full history?
  • Collateral history?
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2
Q

How do you do a risk assessment in a MSE?

A
  • Risk to self
  • Risk to others
  • Risk to children (even adult saying they were abused as child)
  • Drug use/Alcohol use
  • Forensic History
  • Driving
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3
Q

What is deliberate self-harm?

A
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4
Q

Does asking someone if they are suicidal increase the risk of them actually doing it?

A

No - if anything it decreases the risk

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5
Q

When is the risk of suicide highest?

A

As an inpatient or up to 14 days post-discharge

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6
Q

Should you start treatment after a suicide attempt in ED?

A

NO!

Start in GP or Crisis team as they can monitor

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7
Q

What is the definition of suicide and what is the epidemiology of this?

A

Intentional self-inflicted death

3rd biggest cause of death in UK

Hanging was main way followed by poisoning

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8
Q

What are some factors that increase a person’s risk of suicide?

(image is important)

A
  • Male
  • Age
  • PMHx: Bipolar, Depression, BPD, Anorexia
  • Substance abuse
  • No job
  • Occupation: Vets, doctors, nurses, farmers
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9
Q

What are some protective factors that lower the risk of suicide?

A
  • Marriage
  • Children
  • Religious belief
  • Responsibility for others
  • Supportive community
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10
Q

How may someone who is suicidal present?

A
  • Preoccupations with death
  • Emotional distance from others
  • Focus on the past and anticipate no future
  • Withdrawal from society
  • Feelings of hopelessness
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11
Q

How can you determine the risk of suicide following an attempt?

A

Note: Planned Attempt Are Very Frightening

  • Note left behind
  • Planned attempt
  • Attempt to avoid discovery
  • Afterwards help was not sought
  • Violent method
  • Final Acts e.g sorting finances and writing will
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12
Q

What are some questionnaires you can use for suicide risk?

A
  • Tool for Assessment of Suicide Risk (TASR)
  • Beck Suicide Intent Scale
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13
Q

How do you do a suicide risk assessment in an OSCE?

(important)

A
  • Explore ideation
  • Explore intent
  • Explore risk factors
  • Explore protective factors
  • MSE
  • Explore risk to others e.g children
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14
Q

After doing a suicide risk assessment who should you refer to secondary care?

A

SUSPicious

  • Suicidal ideation
  • Underlying severe psychiatric illness
  • Social support lack of
  • Presentation change for someone who has repeatedly self-harmed
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15
Q

How is suicide risk managed?

A
  • Ensure safety e.g remove means
  • Admit to hospital and consider using MHA
  • Crisis and Home treatment team
  • Treat any depression and psychosis
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16
Q

What are some of the differences in epidemiology between suicide and deliberate self-harm?

A
17
Q

What is the definition of deliberate self harm and some examples of this?

A

Intentional act of self-poisoning or self-injury irrespective of the motivation/purpose of the act

Often an expression of emotional distress. OD and cutting are most common

18
Q

What is the prevalence/epidemiology of DSH?

A

0.2-0.4%

More common in females and adolescents

Increases risk of suicide

19
Q

What are some risk factors for deliberate self-harm?

A

DSH Largely Comes Via Self Poisoning

20
Q

What are the top 2 causes of DSH?

A
  • Over dose (90%)
  • Self-Injury (8-10%)
21
Q

What are some complications of DSH?

A
  • Permanent scarring of skin
  • Damage to tendons and nerves
  • Acute liver failure from OD
  • Accidental death
22
Q

How can you work out the motive behind self-harm?

A

DRIPS

  • Death wish
  • Relief
  • Influencing Others
  • Punishment
  • Seeking attention
23
Q

What bloods should you do for an overdose?

A
  • Paracetamol levels t 4 hours
  • Salicyclate levels
  • U+Es
  • LFTs
  • Clotting profile
24
Q

What is the management for self-harm?

A

Biological: Treat any overdose with antidote and suture any injuries

Psycho: Assess risk of suicide. Counselling and CBT if depressed. Psychodynamic therapy if personality disorder

Social: Voluntary organisations e.g Mind, explore life stressors

CONSIDER USING MHA IF REFUSING TREATMENT. FOLLOW UP IN 48 HOURS

25
Q

What is the antidote for the following:

A
26
Q

What are some of the clinical features of paracetamol overdose?

A
  • No symptoms
  • Nausea and vomiting
  • Loin pain
  • Haematuria and proteinuria
  • Jaundice
  • Abdominal pain
  • Coma
  • Severe metabolic acidosis
27
Q

How does paracetamol overdose cause harm?

A

Metabolism of paracetamol results in a buildup of a toxic substance called NAPQI (N-acetyl-p-benzoquinone-imine).

NAPQI is inactivated by glutathione. In an overdose, glutathione stores are rapidly depleted, and NAPQI is left un-metabolised. It can cause liver and kidney damage.

28
Q

What questions do you need to ask if a patient presents with paracetamol overdose?

A
  • Timing of ingestion: single overdose or staggered
  • Time since last ingestion (even staggered)
  • Weight: if >110 kg, used 110 kg as the maximum weight for calculations.
  • Total amount ingested (mg/kg)
  • Current suicidal risk
29
Q

How is paracetamol overdose medically managed?

A
  • If ingestion less than 1 hour ago + dose >150mg/kg: Activated charcoal
  • If staggered overdose or ingestion >15 hours ago: Start NAC now
  • If ingestion <4 hours ago: Wait until 4 hours to take a level and treat then
  • If ingestion 4-15 hours ago: Take immediate level and treat based on level

Use nomogram and start NAC once over treatment line

If a patient presents after 16 hours, there is uncertainty about timing or has a staggered overdose then NAC should be started regardless of the nomogram

30
Q

What is an adverse effect of NAC?

A

Anaphylactoid reactions

Seen in up to 30% of patients treated with the 21-hour regimen

It usually occurs soon after the first infusion with features of nausea, vomiting, urticarial rash, angioedema, tachycardia, and bronchospasm.

Temporarily stop the infusion, consider chlorphenamine (anti-histamine) and nebulised salbutamol. Once the reaction has settled, restart the infusion

31
Q

What patients would you start NAC immediately on?

A