Deliberate Self-Harm

Question 1

Do all people who commit suicide have a psychiatric illness?

Answer 1

No

Question 2

Which relationship status is associated with the lowest suicide risk?

Answer 2

Marriage

Question 3

Which professions have the highest rates of suicide?

Answer 3

doctors, farmers, vets

Question 4

Why do doctors, farmers and vets have a higher risk of suicide?

Answer 4

Conferred by access to means - drugs, shotguns etc.

Question 5

Does integration in society play a part in suicide risk?

Answer 5

yes - greater sense of integration, lower risk

Question 6

What is seen in prefrontal cortex activity in DSH patients?

Answer 6

reduced activity

Question 7

Is there a genetic link between suicide?

Answer 7

yes - monozygotic twins are higher than dizygotic, are higher than single.

Question 8

What is the ratio of deliberate self-harm to suicide?

Answer 8

10-20:1

Question 9

Is DSH more common in females/males?

Answer 9

females

Question 10

Which socio-economic status has higher rates of DSH?

Answer 10

low

Question 11

What percentage of suicides have a history of DSH?

Answer 11

40%

Question 12

What is the single greatest risk factor for suicide?

Answer 12

history of DSH

Question 13

who suicides after DSH?

Answer 13

older
male
unemployed 
single/separated/divorce
isolated 
poor health 
psychiatric history 
suicide note 
history of DSH

Question 14

What are some possible motives?

Answer 14

to die 
escape anguish 
escape a situation 
display desperation/get help 
influence others/get back at others 
roll the dice...

Question 15

What significance is hopelessness in DSH/suicide?

Answer 15

a robust predictor of eventual fatal self-harm

include hopelessness in your MSE

Question 16

What is the immediate management in DSH/suicide?

Answer 16

calm the patient
crisis cannot usually be resolved without some emotional release
be firm but supportive
direct the interview - privacy, distract, deep breathing.

Question 17

What is it important to ask about?

Answer 17

antecedents - what led up to the event

the episode of self-harm

mental state then and now

Question 18

How can you bolster self-esteem and help problem solving?

Answer 18

look for past episodes and use as a template

use family and friends

Question 19

How can manipulative patients use the threat of suicide?

Answer 19

to change their environment

1 Dependent clingers
2 Entitled demanders
3 Manipulative help-rejecters
4 Self-destructive deniers

compromise, boundaries

Question 20

What is suicidal ideation vs suicidal intention?

Answer 20

A patient can think about suicide but will never do it, whereas intention implies wanting to take ones life.