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Y4 Psychiatry: Conditions > Self-Harm > Flashcards

Self-Harm Flashcards

1
Q

What is deliberate self-harm (DSH)?

A

Deliberate self-harm (DSH) refers to an intentional act of self-poisoning or self-injury, irrespective of the motivation or apparent purpose of the act. It is usually an expression of emotional distress.

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2
Q

Give examples of methods of DSH

A
  • Methods of self-injury
    • Cutting, burning, hanging, stabbing, swallowing objects, shooting and jumping from heights or in front of vehicles
  • Methods of self-poisoning
    • Medication (prescribed or OTC), illicit drugs, household substances (e.g. washing liquid) and plant material
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3
Q

What are the risk factors for DSH?

A
  • Divorced/single/living alone
  • Severe life stressors
  • Harmful drug/alcohol use
  • Less than 35 (age)
  • Chronic physical health problems
  • Violence (domestic) or childhood maltreatment
  • Socioeconomic disadvantage
  • Psychiatric illness e.g. depression, psychosis
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4
Q

How common is DSH?

A

DSH affects 2 in 1000 people in the UK.

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5
Q

Who is commonly affected by DSH?

A

It is more common in ♀ at a ratio of 1.5:1, but this varies greatly with age.

DSH is more common in adolescents and young adults.

Incidence peaks in ♀ aged 15– 19 years and in ♂ aged 20– 24 years.

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6
Q

Which is more common DSH or suicide?

A

It is 20– 30 times more common than suicide.

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7
Q

How is DSH linked to suicide?

A

The rate of suicide in people who have self-harmed increases to between 50– 100 times greater than that of the suicide rate in the general population.

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8
Q

How does DSH present?

A

DSH can take the form of:

  1. Self-poisoning in the form of overdose
  2. Self-injury in the form of cutting, burning and slashing

In the UK, 90% of DSH cases are a result of drug overdose.

10% of DSH cases are due to self-injury.

Other less common methods of self-injury include jumping in front of moving vehicles or from great heights and attempting to drown oneself.

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9
Q

What medications are commonly used for DSH by overdose?

A

Commonly ingested medications are non-opioid analgesics including paracetamol and salicylates (aspirin), anxiolytics (including benzodiazepines) and antidepressants (self-harmers are commonly depressed).

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10
Q

Where on the body is DSH by self-injury common?

A

Common locations for cuts with razors or glass are the forearms and wrists.

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11
Q

How does alcohol influence DSH?

A

About half the men and a quarter of women who self-harm have taken alcohol in the 6 hours prior to the act, indicating that alcohol is a key risk factor.

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12
Q

What are the 2 most common complications of DSH?

A

The two commonest complications of DSH:

  1. Permanent scarring of skin and damage to tendons and nerves as a result of self-cutting
  2. Acute liver failure due to paracetamol overdose
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13
Q

Give examples of motives behind DSH

Note: DRIPS

A
  • Death wish: genuine wish to die
  • Relief: seeking unconsciousness or pain as a means of temporary relief and escape from problems
  • Influencing others: trying to influence another person to change their views or behaviour (e.g. making a spouse feel guilty for not caring enough)
  • Punishment: to punish oneself
  • Seeking attention: trying to get help or seek attention (expression of emotional distress).
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14
Q

Briefly describe the MSE of DSH

A

Obvious self-inflicted injuries may be seen.

The patient may be tearful or exhibit signs of neglect.

Behaviour may reflect an underlying mental disorder (depression, schizophrenia).

Thoughts may include feelings of guilt, worthlessness or helplessness.

Hallucinations may be present in cases of schizophrenia and depression with psychosis where DSH is triggered by command hallucinations.

Concentration is often impaired and insight can vary.

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15
Q

What investigations should be ordered for DSH?

A

Bloods including:

  • Paracetamol levels (accurate between 4 and 15 hours after ingestion)
  • Salicylate levels if suspected overdose
  • U&Es (renal function)
  • LFTs and clotting (synthetic hepatic function)

Urinalysis for possible toxicological analysis.

CT head if an intracranial cause for altered consciousness is suspected (in self-poisoning).

Lumbar puncture if intracranial infection (e.g. meningitis) suspected (in self-poisoning).

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16
Q

Briefly describe the bio-psychosocial model of managing DSH

A

Biological

  • Includes treating any overdose with the appropriate antidote and suturing (and anti-tetanus treatment if appropriate) for deep lacerations

Psychological

  • Includes counselling and CBT for underlying depressive illness
  • Psychodynamic psychotherapy may be appropriate if the individual has a personality disorder
    • However, this is a long term treatment and needs appropriate assessment

Social

  • Social services input and voluntary organisations (e.g. the Samaritans, Mind)
17
Q

What is essential in managing a patient who presents with DSH?

A

Risk assessment is mandatory as there is an immediate risk of suicide and risk of repeat acts of self-harm. Need for hospitalization should be assessed ± use of the MHA Section 2.

There is often involvement of the Crisis team in the community as an alternative to hospital admission.

If the patient refuses medical treatment for the consequences of self-harm (e.g. acute liver failure, deep lacerations) a mental capacity assessment will be required.

18
Q

Briefly describe the principles of managing DSH

A
19
Q

Following discharge of DSH, when should patients be followed up?

A

Ensure that the patient is followed up within 48 hours of discharge.

20
Q

What is the likelihood that following DSH a patient will present again?

A

Approximately 1 in 6 people who attend A&E following an act of self-harm will selfharm again within a year.

21
Q

What is the antidote for the following drugs?

  • Paracetamol
  • Opiates
  • Benzodiazepines
  • Warfarin
A
22
Q

What is the antidote for the following drugs?

  • Beta-blockers
  • TCAs
  • Organophosphates
A
23
Q

Briefly describe the role of activated charcoal in treating an overdose

A

Activated charcoal: for the majority of drugs taken in overdose, early use of activated charcoal (within one hour of ingestion) can prevent or reduce absorption of the drug.

24
Q

Briefly describe the role of TOXBASE in treating an overdsose

A

TOXBASE can be viewed for information on rarer poisons. The UK National Poisons Information Service (NPIS) can also be contacted for further information.

25
Q

What differentials should be considered for DSH?

Note: for self-poisoning and self-injury

A

For self-poisoning: head trauma, intracranial haemorrhage, intracranial infection (e.g. meningitis, encephalitis), metabolic abnormalities (e.g. hypoglycaemia), liver disease.

For self-injury: clotting disorders (causing significant bruising or bleeding).

Y4 Psychiatry: Conditions (23 decks)

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