Overdose & Self-Harm

Question 1

What is self-harm?

Answer 1

Self-poisoning or self-injury,

• Anything that causes harm to the body.

Irrespective of the apparent purpose of the act:

• Harming ourselves is relatively normal in different cultures.
  
  • Religious reasons, cultural reasons, aesthetic reasons, etc

Question 2

How common is self-harm?

Answer 2

1 in 15 people have self-harmed at some point in their life.

1 in 10 people think about self-harm / suicide on a daily basis.

Question 3

Non-fatal self-harm is a major risk factor for what?

Answer 3

Is the strongest risk factor for subsequent suicide;

• 1 in 25 patients presenting to hospital for self-harm will die by suicide within five years.
• Up to 16% of survivors of self-harm will try again within a year,
  
  • with 2% of repeat attempts being successful (fatal).

Question 4

What are some motivations between self-harm?

Answer 4

An attempt to end life.

Communication with others.

Secure help or care for others.

Obtaining relief from a difficult situation or emotional state.

Question 5

What is the most common drug used in overdoses?

(and what’s the close second?)

Answer 5

Paracetamol (39.8%)

Close second:

• Alcohol (32.7%)

3,4,5…

• NSAIDs, antidepressants and opioids.

Question 6

Go through the ABCDE(H) of an overdose.

Answer 6

• Triage:
  
  • Is the patient physically safe?

Airways,

• Is the airway compromised? (maybe not if they’re unconscious)

Breathing,

• Slow RR (e.g. benzos), Fast RR (NSAIDs)

Circulation,

• Most will cause hypotension.

Disability,

• How comatose they are, level of consciousness.
• Size of pupils.

Exposure / Examination,

History.

• What they’ve taken, how much have they taken, what timeframe they’ve taken it over (e.g. staggered).

Question 7

What is the treatment to give when someone is overdosed on paracetamol?

Answer 7

IV Acetylcysteine (NAC)

Question 8

What is the treatment to give when someone is overdosed on benzodiazepines?

Answer 8

Flumazenil:

• Competitive inhibition of GABA_A binding.

Question 9

What is the treatment to give when someone is overdosed on opioids?

Answer 9

Naloxone:

• Opioid antagonist

Question 10

What are some tips to maximise the success of a mental health assessment?

Answer 10

Have the assessment in a private environment.

See alone if possible.

• no audience.

Consider collateral history.

Establish Rapport.

Empathetic Approach.

Considered questions.

There is no evidence that enquiring about suicidal thoughts causes suicidal ideation.