Deliberate Self Harm Flashcards
Factors affecting suicide (7)
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
Which methods of suicide are more common in Scotland?
Hanging amongst men
Poisoning amongst women
Affect of seasonality on suicide
Relationship between season of birth and suicide
If born in spring - 17% more likely to commit suicide later in life
Which occupations are associated with a greater risk of suicide? (4)
Dentists
Doctors - GPs and Anaesthetists
Unskilled Labourers
Farmers
What factors cause suicide amongst doctors?
Access to means - most important
Diligent, perfectionist characteristics
What determines the method of suicide used?
Availability/access to one particular method
Patients suffering from which diseases have the highest risk of suicide?
Neurodegenerative disease
Significance of suicide notes
Proves that it was deliberate
Shows reasons for the suicide
Shows the psych ache or mental pain
What is a suicide pack?
2 or more people agree to dies together
Family annihilation and suicide
Kill everyone in their family and then themselves
Role of alienation in suicide
The greater the alienation, higher the suicide
A person well integrated in society is less likely to commit suicide
Neurobiology of suicide
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
Neuroimaging in suicide
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
Does genetics play a role in suicide?
Yes - MZ twins show concordance of 13.2%
Is there an association between smoking and suicide?
Yes
True or false - no relationship between psychiatric illness and suicide
False
Does Lithium treatment (used for bipolar disorder) have an effect on suicide risk?
Yes, reduces the risk
Suicidal mind
Ambivalent - any change in circumstance will change their outcome
Why is suicide more common against men?
- Men choose more violent methods - ex. hanging
2. Social networks - women have better and wider social networks
Which is more common - suicide or deliberate self harm?
Deliberate self harm
What is NSSI?
Non suicidal self injury
Epidemiology of DSH
Northern Europe > Southern Europe
• Females > males (Except Finland)
• Low socio-economic status
Role of cholesterol in self harm and suicide
LOW cholesterol increases risk
Profile of DSH patients
Older • Male • Unemployed, N.E.E.T or retired • Single, separated or divorced • Isolated • Poor health • PsychDx • ViolentDSH • Suicide note • Hx of DSH
DSH is the single strongest risk factor of eventual suicide
TRUE
Predictors of suicide
a) major mental illness
b) male
c) Substance abuse
d) Hopelessness
Management (read slides too)
- Calm the patient
- encourage release of emotion but not attention
- Be supportive but firm - Ask about:
a) antecedents
b) episode
c) mental state then and now - Examine immediate problems
- Bolster self esteem and problem solving
- Arrange and explain follow up (if indicated)
Manipulative patients and suicide
Use threat of suicide in order to produce a change in their environment
