Deliberate self harm, acute stress reaction + adjustment disorders

Question 1

When should you consider admission to general hospital after an episode of self-harm?

Answer 1

concerns about safety of the person (eg. violence, abuse or exploitation) and psych admission not indicated

safeguarding planning needed and psych admission not indicated

person unable to engage in psychosocial assessment (eg. because too distressed or intoxicated)

Question 2

What would make a coroner deem death by suicide or death by misadventure?

Answer 2

death by suicide = deceased did the act which ended their life and intended by that act that their life would end

death by misadventure = similar to accidental death, misadventure implies that an individual deliberately undertook an action which results in death

Question 3

What is harm reduction with regards to self harm?

Answer 3

help to avoid, delay or reduce further episodes of self harm and reduce complications

• distraction techniques or coping strategies
• approaches to self care
• wound hygiene and aftercare
• information on potential complications

Question 4

Define acute stress reaction

Answer 4

transient disorder that develops in an individual without any other apparent mental disorder in response to exceptional physical and mental stress and that usually subsides within hours or days

Question 5

Management of acute stress reactions

Answer 5

safety (setting, pharmacology?)
management of distress (counselling, CBT, IPT and/or pharmacology)
drawing upon or learning coping mechanisms (relaxation, exercise, diet, reducing drugs and alcohol)

Question 6

Prognosis of acute stress reaction

Answer 6

may go on to:
- recover
- develop an adjustment disorder
- develop PTSD
- develop another mental illness

Question 7

Define adjustment disorder

Answer 7

symptoms are in response to an identifiable stressor
symptoms develop within 1 month of that stressor
symptoms of affective, conduct or neurotic/stress related/somatoform disorders not present
once stressor has terminated, symptoms do not persist for more than an additional 6 months
some degree of disability in performance of daily routines and usually interfering with social functioning
only includes grief if prolonged

Question 8

Presentation of adjustment disorder

Answer 8

predominantly affective symptoms
predominantly anxiety symptoms
mixed affective and anxiety symptoms
behavioural changes including suicidal behaviour

Question 9

Management of adjustment disorder

Answer 9

safety
management of distress (CBT, IPT, counselling, and/or pharmacology)
drawing upon or learning coping mechanisms (relaxation, exercise, diet, reducing drugs and alcohol)