Self-Harm and Suicide

Question 1

What is the Relationship between Parasuicide (DSH) and Suicide?

Answer 1

DSH is a behavioural analogue of suicide but without a psychological orientation towards death being in any way essential to the condition.

Question 2

What was the commonest type of DSH in the past in the UK?

Answer 2

Overdose - Antidepressants.

Question 3

What is the commonest type of DSH in the UK now?

Answer 3

Overdose - Paracetamol (you can only buy a maximum of 32 pills at one store and it takes 4 to kill you).

Question 4

Give 2 demographic factors associated with DSH.

Answer 4

1. Female Sex.

2. Lower Socio-Economic Class.

Question 5

Give 3 social factors associated with DSH.

Answer 5

1. Unemployment.
2. State of Social Disorganisation.
3. Social Isolation.

Question 6

What is the biggest risk factor for DSH?

Answer 6

History of DSH.

Question 7

How is DSH important in the context of Acute Medical Admissions? (2)

Answer 7

1. 10% of Acute Medical Admissions.

2. Commonest Cause in Women (peak age 15-30).

Question 8

What are the 5 main forms of DSH?

Answer 8

1. Overdose (Self-Poisoning - 90%);
2. Self-Cutting.
3. Self-Poisoning & Self-Cutting;
4. Hanging.
5. Burns.
   * If the use of a method is likely to be fatal e.g. jumping, hanging - indicative of clear intent to die.

Question 9

Give 3 important questions to ask in a History of DSH.

Answer 9

1. Is there ongoing suicidal intent?
2. Is there evidence of mental illness?
3. Are there any non-mental health issues to be addressed?

Question 10

What is the management plan in a DSH patient?

Answer 10

1. Specialist Toxicologists (Activated Charcoal, Antidotes) or General Medical/Surgical (Plastic Surgery, Sutures).
2. Risk Assessment.
3. Discharge and Follow-Up within 1 Week.

Question 11

Give 3 alternatives that you can suggest to a DSH patient.

Answer 11

1. Squeezing Ice Cubes.
2. Snapping Rubber Bands around the Wrist.
3. Putting Red Food Dye on the Blunt Side of a Knife.

Question 12

What is Suicide?

Answer 12

A wilful, self-inflicted, life-threatening act that results in death.

Question 13

Give 5 important Risk Factors of Suicide to identify in the emergency Room.

Answer 13

1. Male Sex;
2. History of DSH;
3. Alcohol/Drug-Abuse;
4. History of Mental Illness (10% of Schizos);
5. Older Age Group.

Question 14

What can indicate an increased risk of completed suicide at a later date?

Answer 14

Planning e.g. efforts to avoid discovery, leaving a written note, sorting out finances, violent method.

Question 15

Give 3 Protective Factors of Suicide.

Answer 15

1. Family Support.
2. Having Children at Home.
3. Religious Belief.

Question 16

Give 4 Epidemiological Facts about Suicide.

Answer 16

1. Most Prevalent in Teenage Girls.
2. 4th Commonest Cause of Death in 15-44s.
3. 2nd Commonest Cause of Death in 15-30s (after RTAs).
4. 1% of all Deaths (13th worldwide, 4th in developed countries).

Question 17

Give 2 Individual Measures of Prevention of suicide.

Answer 17

1. Better detection.
2. Better management.
   These apply to patients who attend medical services with Depressive Disorders, Substance Misuse, Suicidal Intent.

Question 18

What is the most obvious warning sign?

Answer 18

A direct statement of intent - asking does not make the suicidal behaviour more likely so always ASK!

Question 19

What are the 4 Steps in Assessing a Suicide Attempt/Considering Patient?

Answer 19

1. Story i.e. Stressors (including planning, method and discovery).
2. NOW i.e. how do they feel now e.g. regret, disappointment.
3. Future i.e. how do they perceive their future e.g. repeats.
4. Risk Factors (Other Risk Factors).