Deliberate Self Harm Flashcards
Non-fatal deliberate self-harm is more common than suicide. TRUE/FALSE?
TRUE
What phrase should not be used in relation to non-fatal deliberate self-harm?
“attempted suicide”
Describe the difference of psychiatric illness in patients who die from suicide and those who deliberately self-harm?
vast majority of those who die from suicide DO have a psychiatric illness
majority of those who deliberately self-harm do not have a true psychiatric illness - often due to other causes
What is the gender ratio of suicide almost everywhere in the world?
Males>females
except certain parts of China
HOw many deaths do the WHO claim are due to suicide each year?
800,000
Describe the difference in suicide age peaks between high and low income countries
High income countries = less suicide overall, and age peak is middle age
Low income countries = more suicide overall and age peak is late adolescence/young adult
Scotland has the highest suicide rates in the UK. TRUE/FALSE?
FALSE
higher than England and Wales BUT lower than Northern Ireland
What are the preferred methods of suicide in Scotland and the rest of the Western World?
Hanging (males)
Poisoning (females)
In countries with high suicide rates, both the male and female suicide rates are markedly above that of the UK and other countries. TRUE/FALSE?
FALSE
Many countries with high suicide rates have normal female rates of suicide, yet male suicide is significantly high
What area of Europe is thought to have lower suicide rates than others?
Mediterranean
What time periods in history showed lower rates of suicide and why?
WWI and WWII - due to sense of community and purpose
1960s - change of toxic gas ovens to North Sea gas => less suicide by carbon monoxide poisoning (head in oven)
Rates of suicide increase after coverage of a celebrity dying or committing suicide appears in the media. TRUE/FALSE?
TRUE
e. g. Diana Princess of Wales (mainly affected women her age)
e. g. Robin Williams
What theory of suicide relates to Generation X? (i.e. Babies born between 1965 and 1980 - after the baby boomers)
The peak age of suicide is following the age which Generation X are becoming each year
- is this just a more suicidal generation?
- did something in their adolescence contribute to this?
What change caused a reduction in suicide by poisoning from the 1960s to 70s?
Change of sleeping tablets from barbiturates to benzodiazepines
=> patients much less likely to overdose on benzodiazepines
Are suicide rates higher in urban or rural areas?
Urban
What season has the highest rates of suicide and why is this thought to be the case?
Spring
- due to alienation of vulnerable patients as everyone else is going outside again and getting ready for summer
Being born in what season can increase the risk of suicide in later life?
Babies born in Spring months
especially females
Marriage is a protective factor from suicide. TRUE/FALSE?
TRUE
- those who are married have lower suicide rates than patients who are single, separated, divorced or widowed
What occupations are more at risk of suicide?
Unskilled labourers Construction workers Doctors Dentists Farmers
What sub-specialities of Doctor are more at risk of suicide than others?
GPs
Anaesthetics
Public Health
Psychiatry
Why are Doctors, Dentists and farmers more likely to commit suicide than other occupations?
These groups have access to the means to carry out a suicide
What features of a doctor make them more susceptible to suicide?
- culture of hiding mental illness/ feeling of shame
- High stress work environment
- Qualities of diligence, self-efficacy and perfectionism
Describe the EU suicide rates during and after 2008?
Suicide rates crashed in 2008 and then began rising again after this
Accessibility of a method of suicide will increase the rate of its use. TRUE/FALSE?
TRUE
e. g. jumping from height in NYC or Hong Kong due to frequency of multistory buildings
e. g. Switzerland access to guns and ammunition during cold war
Who is most at risk from a legally held firearm in America?
Owner (even though many people claim it is to protect them from an intruder)
- many suicides occur as a result of possession of firearm
What methods of suicide are prominent in Asian countries?
Asia in general - pesticide suicide is common
Hong Kong - charcoal-burning causing CO poisoning
What physical health problems can increase the likelihood of suicide?
Chronic pain
Neurodegenerative conditions
Only a minority of suicide cases leave a note. TRUE/FALSE?
TRUE
doctors are more likely than most to leave a note
What is a suicide pact?
More than one person arranging to commit suicide together or help one another commit suicide.
2/3 of these cases are incomplete and at least ONE person lives
What is family annihilation?
Suicidal act where patient kills family (their own or other) and then themself afterwards
Explain how patients with a history of deliberate self-harm have abnormal neurobiology
They have less serotonin (5HT) breakdown products in their CSF
=> serotonin system dysfunction
What does neuroimaging show in patients with a high lethality deliberate self harm VS a low lethality deliebrate self harm?
High lethality = more prefrontal cortex activity
Suicide rates increase dramatically in ALL twins. TRUE/FALSE?
FALSE
Mono-zygotic twins = 13.2% increase
Di-zygotic twins = 0.7% increase
Adverse childhood events such as sexual abuse can increase suicide rates. TRUE/FALSE?
TRUE
Why is smoking not always a useful predictor of suicide?
Suicide rates are increased in patients who smoke BUT psychiatric patients are MORE likely to smoke than patients with other health conditions
What mood stabiliser has a reduced risk of suicide compared to others?
Lithium (compared to Valproic Acid/ carbamazepine etc)
What are suicide hot-spots?
places where many patients choose to commit suicide
e.g. bridges
Why are suicidal prevention messages usually put on bridges/ suicidal hotspots?
Many patients are ambivalent on decision to commit suicide => posters for prevention could change their mind
What is meant by an Alcoholic Myopia?
a “pseudo” vision issue where patient’s can only see their problems and nothing past them
What is NSSI?
Non-suicidal self injury
- patient is confident in that they do not wish to die
- injuring themself to deal with increased emotins
What gender is more likely to deliberately self-harm?
Females > males
Low cholesterol causes what effect on suicide risk?
LOW cholesterol increases the risk of suicide
What is meant by the “ejector seat” motive?
Patients want to get out of the distressing situation as quickly as possible
How should you manage a patient with deliberate self harm?
Calm patient
Let them vent emotions in a controlled way
Ask about suicide (as this cannot cause it)
Involve family and friends as support
Make action plan on suicide help app for any further situations
