Self-Harm Flashcards
what is SCOFF?
used for to screen for eating disorder (ED)
what items are on SCOFF?
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?
Specifity of SCOFF?
98%
Sensitivity of SCOFF?
84%
cutoff point on SCOFF
≥2
Safe sedatives for Liver impairment?
LOTZ
Lorazepam
Oxazepam
Temazepam
Z o p i c l o n e
self harm is referred to any act of self injury (poison or physical) regardless of……!!!
motivation
do overdose or overconsumption of alcohol constitute the concept of self-harm?
nope
is self harm more common in young or old?
young
is self harm more common in girls or boys?
girls (three times more)
has rate of self harm increase or decreased over past decade?
raised
Rate of self-harm for 15 year olds in HSBC study?
22%
rate of life time experience of self harm in adolescents in OECD countries?
13-18%
rate of self harm in Goth culture?
53%
most common age for self-harm?
12-15
self-harm annual prevalence for all age groups?
0.5%
death by suicide among those how do self-harm compared to public
50-100 folds increase
rate of repeat in self harm after one year
16%
how often people who make self harm visit GPs in the previous month?
often (approx. half)
why self harm should be taken seriously in elderly?
coz there is usually intent to kill onself
how many people with self harm ever use health service to report it?
50% (6% at some point engage in self-harm)
Risk factors for suicide after self-harm?
Male
poor physical
suicide intent in self-harm
Previous episodes of self-harm
when can psychosocial assessment be postponed to after medical treatment?
only and only if :
a life saving medical Rx is needed
patient is unconcious
patient incapable for assessment
Breath or blood alchol levels in psychosocial assessment of self-harm cases
Do not use them to delay the assessment
They might not be accurate anyway (NICE says)
NICE stance on Risk assessment Tools?
they’re crude & Not recommended
what Risk assessment tools are not recommoned in
- Predicting future suicide or repeating self-harm act
- Who needs and who won’t need treatment
- Risk stratification
NICE stance of mechanical restraint in emegency departments?
do not use them to prevent self-harm
NICE stance on children with self-harm
should be reviewed joinly daily by paediatrician and children and young mental health team
non-pharma management of self-harm
structured, person-centred CBT
what should be certain about non-pharma interventions in self-harm?
they should start ASAP
at least 4-10 session
examples of non-pharma intervention in self-harm cases?
CBT
Problem solving therapy
how long follow-up should take place after discharging a case of self-harm?
within 24 hrs
drugs poisonings that require serum concentration to be taken? 1
———–amzepine
Carb -
-oxyhaemoglobin
-anol Eth -
-ylene glycol
- anol Meth -
- otrexate
drugs poisonings that require serum concentration to be taken? 2
Digoxin
Iron
Lithium
Paracetamol
Aspirin
Theophylline
Valproate
the ———- activated charcoal is give, the more affective.
sooner
activated charcoal may be affective —— after ingestion.
1 hour
when can activated charcoal be affective hours after ingestion?
when overdosed drug is in modified release preparation
or
medicines with antimuscarinic properties
when activated charcoal use is even more important
when drugs overdosed are toxins even in small doses like an antidepressant
when can activated charcoal be used in children?
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
what substances activated charcoal won’t be able to remove?
ionized
polar
water-soluble
what substances activated charcoal will be able to absorb?
nonpolar
unionized
poorly water soluble
what drugs can’t be removed by charcoal?
Iron, Lithium, electrolytes and alcohol
Contraindication to use Charchoal
- 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
in which drug overdose can you repeat giving charcoal even after they’re absorbed?
carbamazepine
phenobarbital
quinine
theophylline
dapsone
other options alternative to charoal?
alkalinisation of the urine for aspirin
haemodialysis for ethylene glycol, lithium, methanol, phenobarbital, aspirin and valproate
when can we perform gastric lavage
over 1 hour of ingestion
the toxic can’t be removed by charcoal
when lavage should never be done
if the ingested toxin is petroleum or a corrosive substance
when can whole bowel irritation be used?
-Lithium and Iron
-sustained release or enteric-coated medicines
-only after discussion with National Poisons Information Service
antidote for paracetamol?
acetylcysteine
Antidote for digoxin
digoxin-specific antibody fragments
Flumazenil antidote of ?
benzodiazepine
when should flumazenil injection be done with caution
when there is TCA or epilepsy…it increases seizure and arrythmia
Glucagon injection antidot of?
insulin, beta-blockers, calcium channel blockers
naloxone antidot of
opioids
when will we be sure opioid is the toxic agent?
when improvement achieved after naloxone injection within 2 mins
Desferrioxamine antidote of
iron salts
Fomepizole antidote of
methanol or ethylene glycol
in whom paracetamol overdose will make more liver injury?
- starving
-alcoholics who have stopped drinking recentlyy - people on inducible drugs (phenytoin, carbamazepine, barbiturates, rifampicin, St John’s Wort)
how is paracetamol toxic to liver?
its metabolite benzoquinonimine conjugates to glutathione.
less glutathione will lead to more free benzoquinonimine
when should be paracetamol dose be measured?
after 4 hrs of ingestion
when treatment is indicated
if paracetamol serum level on plot was above the line (measured after 4 hours)
when do nomogram shows dotted on graph in case of paracetamol overdose and what it means?
after 15 hours
means it is less reliable
BNF:
who should receive acetylcysteine?
- 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.
over how long is acetylcysteine given?
over 21 hours
rate of pseudo alergy in acetylcystiene?
5-10%
how would you treat peudo alergy assoicated with acetylcysteine administration?
anti histamines
common side effect with acetylcystiene?
nausea & Vomitting (25%)
what if paracetamol is taken a staggered overdose (over a period of 1 hour or more)
give intravenous acetylcysteine (MHRA, BNF and SPC)
Opioid overdose result in?
resp. depression
hypoxia
coma
bradycardia
hopo/hypertention
CNS depression
what is a naloxone?
pure opioid competitive antagonist at all recepters (mu, kappa and delta)
what does flumazenil do in benzodiazepine overdose?
reduce need for intesive care
in whom should flumazenil be avoided?
hx of epilepsy
or dependent on benzo (it might induce seizure)
How does flumazenil work?
GABA_ A inhibotor competitive
does fulmazenil help with non-benzodiazepine like z-drugs?
yes
when do skin laceration not need stiches?
≤5 cm
