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MRCPSYCH_Paper B_MENTOR & More_Dr. ART > Self-Harm > Flashcards

Self-Harm Flashcards

1
Q

what is SCOFF?

A

used for to screen for eating disorder (ED)

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2
Q

what items are on SCOFF?

A

Sick —due to fullness of food
Control—lost control over eating
One stone—-Gained ONE stone in last three month?
Fat— feeling fat, when others say they’re not?
Food—does food dominate their life?

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3
Q

Specifity of SCOFF?

A

98%

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4
Q

Sensitivity of SCOFF?

A

84%

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5
Q

cutoff point on SCOFF

A

≥2

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6
Q

Safe sedatives for Liver impairment?

A

LOTZ
Lorazepam
Oxazepam
Temazepam
Z o p i c l o n e

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7
Q

self harm is referred to any act of self injury (poison or physical) regardless of……!!!

A

motivation

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8
Q

do overdose or overconsumption of alcohol constitute the concept of self-harm?

A

nope

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9
Q

is self harm more common in young or old?

A

young

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10
Q

is self harm more common in girls or boys?

A

girls (three times more)

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11
Q

has rate of self harm increase or decreased over past decade?

A

raised

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12
Q

Rate of self-harm for 15 year olds in HSBC study?

A

22%

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13
Q

rate of life time experience of self harm in adolescents in OECD countries?

A

13-18%

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14
Q

rate of self harm in Goth culture?

A

53%

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15
Q

most common age for self-harm?

A

12-15

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16
Q

self-harm annual prevalence for age groups?

A

0.5%

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17
Q

death by suicide among those how do self-harm compared to public

A

50-100 folds increase

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18
Q

rate of repeat in self harm after one year

A

16%

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19
Q

how often people who make self harm visit GPs in the previous month?

A

often (approx. half)

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20
Q

why self harm should be taken seriously?

A

coz there is usually intent to kill onself

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21
Q

how many people with self harm ever use health service to report it?

A

50% (6% at some point engage in self-harm)

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22
Q

Risk factors for suicide after self-harm?

A

Male
poor physical
suicide intent in self-harm
Previous episodes of self-harm

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23
Q

when can psychosocial assessment be postponed to after medical treatment?

A

only and only if :
a life saving medical Rx is needed
patient is unconcious
patient incapable for assessment

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24
Q

Breath or blood alchol levels in psychosocial assessment of self-harm cases

A

Do not use them to delay the assessment

They might not be accurate anyway (NICE says)

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25
Q

NICE stance on Risk assessment Tools?

A

they’re crude & Not recommended

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26
Q

what Risk assessment tools are not recommoned in

A
  • Predicting future suicide or repeating self-harm act
  • Who needs and who won’t need treatment
  • Risk stratification
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27
Q

NICE stance of mechanical restraint in emegency departments?

A

do not use them to prevent self-harm

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28
Q

NICE stance on children with self-harm

A

should be reviewed joinly daily by paediatrician and children and young mental health team

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29
Q

non-pharma management of self-harm

A

structured, person-centred CBT

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30
Q

what should be certain about non-pharma interventions in self-harm?

A

they should start ASAP
at least 4-10 session

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31
Q

examples of non-pharma intervention in self-harm cases?

A

CBT
Problem solving therapy

32
Q

how long follow-up should take place after discharging a case of self-harm?

A

within 24 hrs

33
Q

drugs poisonings that require serum concentration to be taken? 1

A

———–amzepine
Carb -
-oxyhaemoglobin

         -anol Eth     -
       -ylene glycol

      - anol Meth -
      - otrexate
34
Q

drugs poisonings that require serum concentration to be taken? 2

A

Digoxin
Iron
Lithium
Paracetamol
Aspirin
Theophylline
Valproate

35
Q

the ———- activated charcoal is give, the more affective.

A

sooner

36
Q

activated charcoal may be affective —— after ingestion.

A

1 hour

37
Q

when can activated charcoal be affective hours after ingestion?

A

when overdosed drug is in modified release preparation
or
medicines with antimuscarinic properties

38
Q

when activated charcoal use is even more important

A

when drugs overdosed are toxins even in small doses like an antidepressant

39
Q

when can activated charcoal be used in children?

A

1- A toxic amount is ingested within 1 hour
2- no contraindication
3- toxin can be removed by activated charcoal
4-risk benefit ratio is justified

40
Q

what substances activated charcoal won’t be able to remove?

A

ionized
polar
water-soluble

41
Q

what substances activated charcoal will be able to absorb?

A

nonpolar
unionized
poorly water soluble

42
Q

what drugs can’t be removed by charcoal?

A

Iron, Lithium, electrolytes and alcohol

43
Q

Contraindication to use Charchoal

A
  • patients with unprotected airways
    -Threat of GI performation or haemorrhage
    -When it might make visibility unclear in due endoscopy
    -Intestinal obstruction
    -Ingested toxin is alcohol, lithium, electrolytes or iron
44
Q

in which drug overdose can you repeat giving charcoal even after they’re absorbed?

A

carbamazepine
phenobarbital
quinine
theophylline
dapsone

45
Q

other options alternative to charoal?

A

alkalinisation of the urine for aspirin
haemodialysis for ethylene glycol, lithium, methanol, phenobarbital, aspirin and valproate

46
Q

when can we perform gastric lavage

A

over 1 hour of ingestion
the toxic can’t be removed by charcoal

47
Q

when lavage should never be done

A

if the ingested toxin is petroleum or a corrosive substance

48
Q

when can whole bowel irritation be used?

A

-Lithium and Iron
-sustained release or enteric-coated medicines
-only after discussion with National Poisons Information Service

49
Q

antidote for paracetamol?

A

acetylcysteine

50
Q

Antidote for digoxin

A

digoxin-specific antibody fragments

51
Q

Flumazenil antidote of ?

A

benzodiazepine

52
Q

when should flumazenil injection be done with caution

A

when there is TCA or epilepsy…it increases seizure and arrythmia

53
Q

Glucagon injection antidot of?

A

insulin, beta-blockers, calcium channel blockers

54
Q

naloxone antidot of

A

opioids

55
Q

when will we be sure opioid is the toxic agent?

A

when improvement achieved after naloxone injection within 2 mins

56
Q

Desferrioxamine antidote of

A

iron salts

57
Q

Fomepizole antidote of

A

methanol or ethylene glycol

58
Q

in whom paracetamol overdose will make more liver injury?

A
  • starving
    -alcoholics who have stopped drinking recentlyy
  • people on inducible drugs (phenytoin, carbamazepine, barbiturates, rifampicin, St John’s Wort)
59
Q

how is paracetamol toxic to liver?

A

its metabolite benzoquinonimine conjugates to glutathione.
less glutathione will lead to more free benzoquinonimine

60
Q

when should be paracetamol dose be measured?

A

after 4 hrs of ingestion

61
Q

when treatment is indicated

A

if paracetamol serum level on plot was above the line (measured after 4 hours)

62
Q

when do nomogram shows dotted on graph in case of paracetamol overdose and what it means?

A

after 15 hours
means it is less reliable

63
Q

BNF:
who should receive acetylcysteine?

A
  • who plama-paracetamol level is falls on or above line
    -who presented after 8-24 hours of ingestion of 150 mg/kg and graph is not ready for anther 8 hours
    -who presented after 24 hours with jaundice, high ALT or INR >1.3 (no other cause) or paracetamol is still detectable.
64
Q

over how long is acetylcysteine given?

A

over 21 hours

65
Q

rate of pseudo alergy in acetylcystiene?

A

5-10%

66
Q

how would you treat peudo alergy assoicated with acetylcysteine administration?

A

anti histamines

67
Q

common side effect with acetylcystiene?

A

nausea & Vomitting (25%)

68
Q

what if paracetamol is taken a staggered overdose (over a period of 1 hour or more)

A

give intravenous acetylcysteine (MHRA, BNF and SPC)

69
Q

Opioid overdose result in?

A

resp. depression
hypoxia
coma
bradycardia
hopo/hypertention
CNS depression

70
Q

what is a naloxone?

A

pure opioid competitive antagonist at all recepters (mu, kappa and delta)

71
Q

what does flumazenil do in benzodiazepine overdose?

A

reduce need for intesive care

72
Q

in whom should flumazenil be avoided?

A

hx of epilepsy
or dependent on benzo (it might induce seizure)

73
Q

How does flumazenil work?

A

GABA_ A inhibotor competitive

74
Q

does fulmazenil help with non-benzodiazepine like z-drugs?

A

yes

75
Q

when do skin laceration not need stiches?

A

≤5 cm

MRCPSYCH_Paper B_MENTOR & More_Dr. ART (62 decks)

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