Deliberate Self Harm, Overdose and Suicide

Question 1

Clinical features of depression in children

Answer 1

Apathy

Boredom

Anhedonia > Low Mood

Regression Separation Anxiety

Decline in School Performance

Social Withdrawal

Hypochondriacal ideas

Irritable Mood or Frank Antisocial Behaviour more common in Adolescents

Question 2

Investigations in depressed child

Answer 2

Interview adolescent alone

Ask about feeling alone

Ask about suicidal ideations/plans

Separate parent history

Question 3

Management of mild depression in children

Answer 3

Primary care

Many will recover spontaneously

Watchful waiting

Non-directive supportive therapy

Guided self-help

Follow up within 2 weeks is advised

Question 4

Management of moderate to severe depression in children

Answer 4

Referral to CAMHS

Full assessment to establish a diagnosis

Psychological therapyas the first line treatment withCBT,non-directive supportive therapy,interpersonal therapyandfamily therapy

Fluoxetineis the first line antidepressant in children, starting at 10mg and increasing to a maximum of 20mg

Sertralineandcitalopramare second line antidepressants

Question 5

Causes of self harm in children

Answer 5

Coping technique for dealing with negative feelings

Expressed wish to punish themselves

Feeling of control

Distraction from emotional stress

Question 6

Common methods of self harm

Answer 6

Cutting

Burning

Biting

Bruising

Scratching

Ligature

Punching walls (Boxer’s fracture - 5th metacarpal near knuckle)

Question 7

Examination in self harm

Answer 7

Full physical exam

Cutting to thigh often missed

Patients wearing long sleeves

Reluctance to show skin should raise concern

Question 8

Management of self harm in children

Answer 8

Setting rules about confidentiality clearly

History alone, in a safe environment

Sufficient time to conduct consultation sensitively, without interruption

Validate person’s distress, give assurance that they will be
supported

Normalisation of the problem is key

Ask questions directly but sensitively

Question 9

Assessing suicide risk in children

Answer 9

P – Problems longer than a month

A – Alone at the house at the time

T – Three hours or more spent planning overdose

HO – Hopeless about the future

S – Sad most of the time before overdose