Deliberate Self Harm Flashcards
What is the epidemiology of suicide?
Poor countries contribute over 75% to global rates
Peak incidence is mid 20s in poor countries and middle age in affluent countries
Suicide rates higher in men in most parts of the world
Rates are higher in urban areas than in rural areas
What are suicide rates like in Scotland?
Scotland has highest rates in Britain
Hanging and poisoning are most common methods
What effect does restricting access to a method of suicide have?
Reduces overall rates of suicide, especially for high lethality methods
What are some protective factors of suicide?
Marriage and lithium are protective
Those who attend church > once a fortnight have half the rates of suicide
What are some patterns seen in methods of suicide?
Most suicides in China are by pesticides
Suicide by firearms is rare in UK outside farmers, but is common in Switzerland and USA
How common are chronic illnesses in suicides?
10% of suicides have longterm or chronic illness = particularly dignity limiting diseases (e.g Parkinson’s, MS)
How common are suicide notes?
Not very = only a minority of suicides leave a note
Are suicide pacts successful?
Not really = 2/3 go uncompleted
What changes are seen in the brains of patients with a history of high lethality self harm?
Lower CSF 5-HIAA
Reduced binding to 5-HT transporter sites in the ventral prefrontal cortex
What is the difference in brain activity between high lethality self harmers and low lethality self harmers?
High lethality self harmers have different prefrontal cortex activity to low lethality self harmers
Is there a genetic influence in suicide?
Yes = 43% of suicides may be explained by genetics
What effect does experiencing childhood sexual abuse have?
May influence epigenetic expression of glucocorticoid receptors in the hippocampus
What are some interventions that can reduces suicide rates from bridges?
Preventing pedestrian access and cars stopping on the bridge
How does brain activity change in people who are acutely suicidal?
There is cessation of frontal cortex function
What is the epidemiology of deliberate self harm?
More common in women aged 15-19
More common in Northern Europe
Associated with lower socio-economic class
What is the most common method of deliberate self harm?
Self-poisoning (e.g overdose using pills)
How common is repeated self harm?
Over 50% of those who deliberately self harm are repeat self harmers
How does the time of the year influence self harming behaviours?
Christmas time is protective against self harm in females, but rates increase on February the 14th
What is the association between cholesterol and deliberate self harm?
Low cholesterol is associated with higher rates of self harm
What is the link between deliberate self harm and suicide?
History of self harm is single strongest risk factor for suicide
1% risk of suicide in the 12 months following self harm
What effect does deliberate self harm have on mortality?
Patients are at increased risk of premature mortality = suicide, RTA, cancer, ischaemic heart disease
What is the actuarial approach towards suicide risk?
The closer someone comes to fitting the profile of a suicide completer, the higher their risk of suicide
What are some protective factors against deliberate self harm?
Religion, children, reasons to live
How successful is suicide risk assessment at identifying those at high risk of suicide?
Not very = 1/2 of suicide completers who were risk assessed previously were deemed to be at low risk for suicide
What are the motives for deliberate self harm?
To die, to escape anguish or situation, to display desperation or to get help
What is the biggest predictor for deliberate self harm?
Hopelessness
What is the management of deliberate self harm?
Calm patient and ask stock questions (e.g how close have you come before?)
Ask about the episode of self harm
Look at immediate problems and what can be done
Bolster self esteem and problem solving
