Self-Harm and Risk Assessment

Question 1

What are the neurochemical differences in the prefrontal cortex between direct-self-harm (DSH) patients and non-DSH patients?

Answer 1

Reduced 5-HT binding
Lower CSF 5-HIAA
Basically, decreased activity in the prefrontal cortex

Question 2

What percentage of suicides have a history of DSH?

Answer 2

40%

Question 3

List risk factors for repeated DSH

Answer 3

Previous DSH
Unemployment
Personality disorder
Alcohol/drug abuse
Low socio-economic group
Criminal record
Single/separated/divorce
Previous psychological treatment

Question 4

Which group of people tends to suicide more commonly after DSH?

Answer 4

Older males

Question 5

All patients suspected of future suicide need immediate psychiatric assessment. True/False?

Answer 5

True

Question 6

List other risk factors for suicide

Answer 6

Socio-economic status
Living in an urban area
Spring season
Occupations with access to means
Chronic illness
Genetics

Question 7

What is the single strongest risk factor for suicide?

Answer 7

History of deliberate self-harm

Question 8

What group of people have the greatest risk of self-harm?

Answer 8

Young females (15-30)

Question 9

How can a suicide attempt be described?

Answer 9

Suicide ideation vs. intention
Mild/ moderate/ severe
Fleeting/ intermittent/ constant

Question 10

Outline the 5 step management plan for a patient who has self-harmed or attempted suicide

Answer 10

1. Calm patient
2. Ask about antecedents, episodes of self-harm, mental state then and now
3. Examine immediate problems
4. Bolster self-esteem and problem solving
5. Make a safety plan and arrange follow up

Question 11

List options for follow up in a DSH or suicidal patient

Answer 11

Psychiatry/ psychology
Counselling (cruse, rape crisis, women's refuge)
Social work
Addictions
Samaritans