Deliberate Self Harm

Question 1

Factors affecting suicide (7)

Answer 1

Gender: more common amongst males

Geography

Affluence: higher affluence countries have lower suicide rates

Age: middle age in high affluence, lower in low affluence countries

Season: higher in spring time

Marriage: lower rate of suicide

Occupation

Question 2

Which methods of suicide are more common in Scotland?

Answer 2

Hanging amongst men

Poisoning amongst women

Question 3

Affect of seasonality on suicide

Answer 3

Relationship between season of birth and suicide

If born in spring - 17% more likely to commit suicide later in life

Question 4

Which occupations are associated with a greater risk of suicide? (4)

Answer 4

Dentists

Doctors - GPs and Anaesthetists

Unskilled Labourers

Farmers

Question 5

What factors cause suicide amongst doctors?

Answer 5

Access to means - most important

Diligent, perfectionist characteristics

Question 6

What determines the method of suicide used?

Answer 6

Availability/access to one particular method

Question 7

Patients suffering from which diseases have the highest risk of suicide?

Answer 7

Neurodegenerative disease

Question 8

Significance of suicide notes

Answer 8

Proves that it was deliberate

Shows reasons for the suicide

Shows the psych ache or mental pain

Question 9

What is a suicide pack?

Answer 9

2 or more people agree to dies together

Question 10

Family annihilation and suicide

Answer 10

Kill everyone in their family and then themselves

Question 11

Role of alienation in suicide

Answer 11

The greater the alienation, higher the suicide

A person well integrated in society is less likely to commit suicide

Question 12

Neurobiology of suicide

Answer 12

Lower CSF 5-HIAA than Ψ controls

Anomalies in their serotonin system - Reduced binding to 5-HT transporter sites in Ventral PreFrontal Cortex

Increased post-synaptic 5-HT1a receptors

Question 13

Neuroimaging in suicide

Answer 13

High-lethality DSH patients have different PFC activity to low-lethality DSH patients

SPECTS of 2 patients who self-harmed soon after (coincidence) showed ↓ frontal activity

Question 14

Does genetics play a role in suicide?

Answer 14

Yes - MZ twins show concordance of 13.2%

Question 15

Is there an association between smoking and suicide?

Answer 15

Yes

Question 16

True or false - no relationship between psychiatric illness and suicide

Answer 16

False

Question 17

Does Lithium treatment (used for bipolar disorder) have an effect on suicide risk?

Answer 17

Yes, reduces the risk

Question 18

Suicidal mind

Answer 18

Ambivalent - any change in circumstance will change their outcome

Question 19

Why is suicide more common against men?

Answer 19

1. Men choose more violent methods - ex. hanging

2. Social networks - women have better and wider social networks

Question 20

Which is more common - suicide or deliberate self harm?

Answer 20

Deliberate self harm

Question 21

What is NSSI?

Answer 21

Non suicidal self injury

Question 22

Epidemiology of DSH

Answer 22

Northern Europe > Southern Europe
• Females > males (Except Finland)
• Low socio-economic status

Question 23

Role of cholesterol in self harm and suicide

Answer 23

LOW cholesterol increases risk

Question 24

Profile of DSH patients

Answer 24

Older
• Male
• Unemployed, N.E.E.T or retired
• Single, separated or divorced
• Isolated
• Poor health
• PsychDx
• ViolentDSH
• Suicide note
• Hx of DSH

Question 25

DSH is the single strongest risk factor of eventual suicide

Answer 25

TRUE

Question 26

Predictors of suicide

Answer 26

a) major mental illness
b) male
c) Substance abuse
d) Hopelessness

Question 27

Management (read slides too)

Answer 27

1. Calm the patient
   - encourage release of emotion but not attention
   - Be supportive but firm
2. Ask about:
   a) antecedents
   b) episode
   c) mental state then and now
3. Examine immediate problems
4. Bolster self esteem and problem solving
5. Arrange and explain follow up (if indicated)

Question 28

Manipulative patients and suicide

Answer 28

Use threat of suicide in order to produce a change in their environment