Psych - Deliberate Self Harm Flashcards
What is the average annual death toll from suicide?
800,000
What phrase should you use rather than ‘Attempted Suicide’?
Non-fatal deliberate self harm
What is Rational Suicide?
Proportion of people who decide to commit suicide in absence of psychiatric illness or deliberate self harm
True or False:
The vast majority of people who deliberately self harm do NOT suffer from a psychiatric illness
TRUE
What is the World suicide rate?
10.7 per 100,000 pa (2015)
Do males or females generally have a higher rate of suicide worldwide?
Males
M - 15.0 per 100,000
F - 8.0 per 100,000
How do the peaks of suicide rates differ between low-income and high-income countries?
Low-income - lower peak (15-25) and larger % of suicides (75.5%)
High-income - older peak (50ish yrs) and smaller % of suicides (14.5%)
Is the suicide rate higher in England or Scotland?
Scotland
S - 21.9 (M), 7.3 (F)
E - 14.8 (M), 4.6 (F)
True or False:
The suicide rates in Scotland are 3 times higher in most deprived
True
How can you track the fluctuations in suicide rates over years?
5 year rolling average
e.g. In Scotland there was an 18% reduction from 01/05 to 11/15
Which of the EU countries have the highest and lowest suicide rates (2014)?
Highest:
- Lithuania
- Latvia
- Hungary
- Slovenia
Lowest (Mediterranean countries):
- Cyprus
- Greece
- Italy
- United Kingdom
What is a theory for the considerable drops in suicide rates during WW1 and WW2?
Greater sense of national cohesion
Less alienation and greater unity as a country
Give an example of when affecting the modality of suicide method has an overall effect on suicide rate
1960’s - change in domestic gas supply from toxic goal gas to less toxic sea gas
By 1973 putting head in oven would cause a bad headache but not death
Massive reduction in number of suicides by gassing
Give an example of when a public figure death affected the rates of suicide
1) 1997 Princess Diana’s death
Increased by 17% (33% in women) in months after her death
This was an excess above what was expected
2) Robin Williams
Was reported in detail in media and lead to increased (EXCESS) suicides by hanging in the States
Traditionally which suicide modalities are favoured by each gender?
Males - Hanging (generally more violent methods)
Females - poisoning, overdose
Why was it important when Barbituates were switched to Benzodiazepines as sleeping tablets?
Benzodiazepines are far less likely to cause overdose in your sleep
Barbituate overdose can lead to unconsciousness and breathing difficulties
True or False:
Suicide rates higher in rural areas compared to urban areas
FALSE
Rates higher in urban (city) areas
More marked in women even though smaller contribution to overall death toll
Which seasonality has a higher rate of suicide?
Spring (lower in Autumn)
What is a theory behind why suicide rates are lower in Autumn and higher in Spring?
Autumn - easier to be mentally ill and less isolated from people when days are shorted and generally people are more subdued + more clothes
Spring - people are being cheerier and shedding layers, more alienating to be mentally ill
What affect does being born in the Spring have on your risk of suicide?
Increases risk of suicide by 17% (compared to being born in Autumn)
(stronger risk in women)
What percentage of doctors reported that they would not seek help or treatment if they had a mental health disorder?
41%
DON’T BE PART OF THIS 41%
Which medical specialities have a higher rate of suicide?
GP
Psychiatrist
Anaesthetist
ACCESS TO MEANS
(Paediatricians have the lowest rate)
What general findings did the Hawton 2004 study on 38 doctor suicides find?
25 had psychiatric illness
Most died from self-poisoning
15 received treatment
21 left a note (higher than average rate of leaving suicide notes)
Give examples where it has shown access or restriction to firearms affects suicide rate
UK - tighter gun laws after mass shootings showed reduced suicide by firearm
Switzerland - Swiss Army put new legislation in place that distributed firearms are stored at home while ammunition stored centrally (has shown reduction in suicide rate)
USA - person most at risk from legally held firearm is owner themselves
83% suicide, 12% shooting spouse, 3% children, 2% intruder (the reported purpose of the firearm)
Give examples of when media coverage influenced suicide rates
Hong Kong - suicide by CO (Charcoal-burning) majorly reported by media and romanticised (‘died with rosy cheeks’) showed rapidly increasing deaths by Carbon Monoxide in Hong Kong
Very suddenly become substantial death toll
What changes could neuroimaging potentially show us in high-lethality or low-lethality DSH patients?
High-lethality patients have different PFC (pre-frontal cortex) activity to low-lethality DSH patients
SPECTS of 2 patients who self-harmed showed decreased frontal activity
What is the Werther-effect?
Goethe-effect
A spike of emulation suicides (copycat suicide) after a publicised suicide known as Werther effect.
The publicised suicide can serve as a trigger in a susceptible or suggestive person
Originates from Goethe’s novel about a young man who committed suicide after he was rejected by the woman he loved - showed a marked increase in suicide following publication
How many people are estimated to have died from jumping off the Golden Gate Bridge since it first opened?
Estimated 16,000
Fatality rate roughly 98% (die from impact with water)
Only 34ish people known to have survived the jump
True or False:
Suicidal people tend to be very ambivalent
TRUE
Putting restrictive methods in place may be enough to make them hesitate
Asking them what’s wrong or discouraging the act may be enough to change their plans
What was the affect of a bill in 1984 in Russia that restricted the sale and consumption of alcohol?
Had huge effect on alcoholism within the country
Rise in life expectancy
In following 4 years the rate of suicide reduced by 40%
Roughly how many people are found to have alcohol in their systems at time of death?
Over 1/3
True or False:
People who spend more than 5 hours per day on social media are found to have lower rates of suicidal thinking
FALSE
Found to have the highest rate of suicidal thinking
What are some possible reasons that male suicide is more common than female?
Men chose more violent methods so more likely to be successful
Less stigmatised for women to seek support
Women tend to have bigger, wider social networks and support
What is the incidence of DSH to suicide?
DSH:Suicide
10-20:1
(WHO 2004)
What is Non-suicidal self injury (NSSI)?
Defined as deliberate, self-inflicted destruction of body tissue WITHOUT suicidal intent (they don’t want to die)
What is the epidemiology of DSH?
Northern europe > Southern Europe
Females > Males
Low socio-economic status
True or False:
The rate of premature mortality in DSH patients increases for years via suicide, IHD, Ca, RTAs, homicide
TRUE
What percentage of suicide cases have a history of DSH?
40%
Hx of DSH single strongest risk factor for suicide
What is the risk of suicide in 12 months after DSH?
1%
Which groups/factors are more likely to suicide after DSH?
Older Male Unemployed, retired Single, separated, divorced Isolated Poor health Psych Dx Violent Dx Suicide note Hx of DSH
Who repeats DSH?
Previous DSH Personality disorder Alcohol/drug abuse Previous Psych Rx Unemployed Low socioeconomic group Criminal record 25-54 years Single, separated, divorced
What are some common motives for DSH?
To die To escape anguish To escape a situation To display desperation To influence others To get back at others To get help To repeat what has helped before To roll the dice
What is ‘Hopelessness’ a good marker of?
Robust predictor of eventual fatal self-harm
- Post DSH or in general
Include hopelessness in your MSE
What are some initial stages to take in management of DSH before taking a history?
Calm the patient (crisis cannot be resolved without release of emotion) Crying (yes), Aggression (no) Be supportive Privacy Deep breathing Direct the interview
Should you ask about suicidal thoughts in a history?
YES
Asking about it does not cause it
(Usually a relief for patient to talk about thoughts in a safe, non-judgemental environment)
What are some important stock questions to assess risk?
‘Have you ever thought life isn’t worth living?’
‘How close have you come before? What stopped you?’
‘What are things that keep you going?’
What comes under the Management of bolstering self-esteem & problem solving?
- Discussing personal things with stranger takes bravery
- Any relief from discussion is proof that further discussions might help even more
- Look for past episodes that have solved problems
- Friends or family
- Safety Plan
What is the idea around a Safety Plan?
Making a compulsory list of activities or tasks you have to complete before you self harm
This could be juvenile things with the last being calling for help before you DSH
Designed to distract mind and give something to focus on to lower risk of completing DSH
What follow-ups may be required for DSH?
Psychiatry/Psychology Counselling - rape crisis, womens refuge, cruse Social work Addictions Samaritans
How can you recognise manipulative DSH patients?
Using the threat of suicide in order to produce a change in their environment
What are the different types of ‘difficult’ patients?
- Dependent clingers
- Entitled demanders
- Manipulative help-rejecters
- Self-destructive deniers
What is meant by a dependent clinger patient?
Describe excessively needy patients who require endless attention and reassurance.
Regard themselves as having ‘bottomless needs’ and the physician as being able to provide inexhaustible stream of services
What is meant by Entitled demander patients?
Type of patient that will tell you what types of tests and medications to order (may threaten legal action if denied)
Patients often feel helpless and powerless so rather than argue they order
What is meant by Manipulative Help-rejecter patients?
Drags physician through endless cycles of help-seeking and help-rejecting
Nothing doctor does is satisfactory (but keep returning with new requests)
What is meant by Self-destructive denier patient?
Patient knowingly continues behaviours that area dangerous to their health
