CT 11 - Suicide And Self-harm

Question 1

What are the risk factors for repetition of non-fatal self harm

Answer 1

• mental health conditions like depression or EUPD
• alcohol misuse
• a lower SES
• social isolation
• previous self harm
• ACEs or trauma
• breakdown of relationship or bereavement

Question 2

What are the risk factors for people completing suicide

Answer 2

Male

Living alone

Being elderly

Previous self harm

Having a mental health condition and being on psychiatric medications

Being white

Having a criminal record

Bad family environment

Question 3

What questions to ask about a current self harm or suicide attempt

Answer 3

What triggered/precipitated it?

Was it planned or impulsive?

Were there any final acts like leaving a note?

Precautions to avoid discovery

If self harming ask about how they did it, how it made them feel afterwards, did they do it with intention to kill themselves. If cutting ask where and how many

If overdose ask about what they took, how much, where they got it from

Question 4

What is the epidemiology of self harm and suicide

Answer 4

1 in 10 young people are affected by self harm or suicide every year

F>M

2/3 are under 35

Also more common in teenage years, single or divorced people, gay or bisexuals

Overdoses more common in females whilst more violent methods are prevalent in men

Substance misuse, childhood abuse or traumatic life event substantially increases risk

Question 5

What sort of treatment is suggested for those who self harm or have previously tried to commit suicide

Answer 5

Referral to community mental health team for further assessment, treatment plan, plan for crises

CBT

May consider SSRI but these MAY increase suicidal ideation

Organisations like Samaritans, MIND, Harmless, Young Minds

Question 6

What are the most common diagnoses in patients that self harm

Answer 6

Acute stress reaction/adjustment disorder

Reactive depression

Alcohol problem

Panic disorder

Personality disorder especially EUPD