Deliberate Self Harm and Risk Assessment

Question 1

What is the gender ratio of suicide in Scotland?

Answer 1

M:F 26.8:7.4

Question 2

What difference in the brain is found in patients with a history of DSH than controls?

Answer 2

Lower CSF 5-HIAA
Reduced binding to 5-HT transporter sites in ventral prefrontal cortex
Increased post-synaptic 5-HT1a receptors
May lead to increased violence of method?
Decreased prefrontal cortex activity in high lethality PSH patients

Question 3

What is the twin suicide concordance rate?

Answer 3

MZ: 13.2%
DZ: 0.7 %

Question 4

What is the ratio of DSH: Suicide?

Answer 4

10-20:1

Question 5

What percentage of suicides have a history of DSH?

Answer 5

40%

Question 6

What is the single strongest risk factor for suicide?

Answer 6

History of DSH

Question 7

What is the risk of suicide in 12 months after DSH?

Answer 7

1%

Question 8

Who suicides after DSH?

Answer 8

Older
Male
Unemployed, N.E.E.T or retired
Single, separated or divorced
Isolated
Poor health
Psych Dx
Violent DSH
Suicide note
Hx of DSH

Question 9

Who repeats DSH?

Answer 9

Previous DSH
Personality disorder
-OH or other drug abuse
Previous Psych Rx
Unemployed (N.E.E.T)
Low Socio-economic group
Criminal record
25-54 years of age
Single, separated or divorceD

Question 10

What is a robust predictor of eventual fatal self harm?

Answer 10

Hopelessness

Include in MSE

Question 11

How should you initially manage a suicide intervention?

Answer 11

Calm the patient
Crisis cannot usually be resolved without some release of emotion
Crying yes, aggression no. Be supportive but firm
Direct the interview. Privacy. Distract. Deep breathing

Question 12

What should you ask about in DSH/suicide attempt?

Answer 12

Antecedents
The episode of self harm
Mental state then and now

Question 13

What options exist for follow up in DSH?

Answer 13

Psychiatry/psychology
Counselling: Cruse, Rape Crisis, Womens’ Refuge
Social Work
Addictions
Samaritans