Harm

Question 1

On shift, when a person presents with an overdose, what do you do?

Answer 1

Check TOXBASE (for recommendatiosn about treating an overdose for any substance)

Give ACTIVATED CHARCOAL within 1 hour of overdose to reduce absorption (e.g. aspirin, SSRIs, TCAs, antipsychotic drugs, benzos, quinine

Question 2

Treatment of overdose / toxicity of paracetamol

Answer 2

Acetylcysteine

Question 3

Treatment of overdose / toxicity of opioids

Answer 3

Naloxone

Question 4

Treatment of overdose / toxicity of benzodiazepines

Answer 4

Flumazenil

Question 5

Treatment of overdose / toxicity of beta blockers

Answer 5

• Glucagon - for heart failure or cardiogenic shock
• Atropine - for symptomatic bradycardia

Question 6

Treatment of overdose / toxicity of calcium channel blockers

Answer 6

Calcium chloride or calcium gluconate

Question 7

Treatment of overdose / toxicity of cocaine

Answer 7

Diazepam

Question 8

Treatment of overdose / toxicity of cyanide

Answer 8

Dicobalt edetate

Question 9

Treatment of overdose / toxicity of methanol (e.g. solvents or fuels) and ethylene glycol (e.g. antifreeze)

Answer 9

Fomepizole or ethanol (alcohol)

Question 10

Treatment of overdose / toxicity of carbon monoxide

Answer 10

100% oxygen

Question 11

Define self-harm

Answer 11

Intentional self-injury without suicidal intent

Question 12

Epidemiology of self-harm and suicide in men and women.

Answer 12

Self-harm: More common in females under 25
Suicide: 3x more likely in men, especialy around 50 (increases with age)

Question 13

Cycle of self-harm

Answer 13

• Emotional suffering
• Emotional overload
• Panic
• Self-harming
• Temporary relief
• Shame and guilt

Question 14

Name some presenting features that increases the risk of suicide

Answer 14

• Previous suicidal attempts
• Escalating self-harm
• Impulsiveness
• Hopelessness
• Feelings of being a burden
• Making plans
• Writing a suicide note

Question 15

Name some background factors that increase the risk of suicide

Answer 15

• Mental health conditions
• Physical health conditions
• History of abuse or trauma
• Family history of suicide
• Financial difficulties or unemployment
• Criminal problems (prisoners have a high rate of suicide)
• Lack of social support (e.g., living alone)
• Alcohol and drug use
• Access to means (e.g., firearms)

Question 16

Name some protective factors that may help to reduce the risk of suicide

Answer 16

• Social support + community
• Sense of responsibility to others (e.g. children or family)
• Resilience, coping and problem-solving skills
• Access to mental health support

Question 17

Management for self-harm and suicide risk

Answer 17

• Safety-netting
• Safety plan
• Follow-up
• Consider safeguarding issues

Suicide attempt:
* Informal admission (patient agrees)
* Mental Health Act (1983) (admission against will)

Management considerations for self-harm include:
* Empathy, supportive communication and building rapport
* Identifying triggers for episodes
* Separating the means of self-harm (e.g., removing blades or medications from the environment)
* Discussing strategies for avoiding further episodes (e.g., distractions, alternative coping strategies and getting help)
* Providing details for support services in a crisis (e.g., mental health services, Samaritans and Shout)
* Treating underlying mental health conditions (e.g., depression and anxiety)
* Cognitive behavioural therapy

Question 18

What legal framework is used to admit patients to hospital against their wishes for a mental health disorder when required for treatment or safety?

Answer 18

The Mental Health Act (1983)