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Psychiatry > Self harm and Suicide > Flashcards

Self harm and Suicide Flashcards

1
Q

Define Self Harm

A

Intentional act of self poisoning/self injury irrespective of the motivation or apparent purpose of the act

Usually as a form of emotional distress

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2
Q

Describe some potential methods of self-injury

A

Cutting, Burning, Hanging, Stabbing, Swallowing Objects

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3
Q

Describe some potential methods of self-poisoning

A

Medication, Illicit Drugs, Household Substances

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4
Q

Name 5 risk factors for Self Harm (DSH Largely Comes Via Self-Poisoning)

A
  • Divorced
  • Severe life stressors
  • Harmful drug/alcohol use
  • Less than 35 yo
  • Chronic physical health problems
  • Violence - domestic or child abuse
  • Socioeconomic disadvantage
  • Psychiatric Illness
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5
Q

What is the link between alcohol and suicide?

A

1/2 men and 1/4 women who self harm have taken alcohol in the last 6 hours

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6
Q

Describe some potential motives for Self Harm (DRIPS)

A
  • Death Wish
  • Relief (eg being unconscious)
  • Influencing others (guilt tripping them)
  • Punishment
  • Seeking Attention
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7
Q

Name the 2 commonest complications of Self Harm

A
  • Permanent scarring/damage to tendons and nerves
  • Acute Liver Failure
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8
Q

Name three investigations you could do in a patient that has self harmed

A

Bloods (Toxin levels, U&Es, LFTs, Clotting)
Urinalysis (Tox Screen)
CT Head

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9
Q

Name the antidote for Paracetamol

A

N Acetyl Cysteine

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10
Q

Name the antidote for Opiates

A

Naloxone

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11
Q

Name the antidote for Benzodiazepines

A

Flumazenil

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12
Q

Name the antidote for Warfarin

A

Vitamin K

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13
Q

Name the antidote for Beta Blockers

A

Glucagon

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14
Q

Name the antidote for Tricyclics Antidepressants

A

Sodium Bicarbonate

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15
Q

Name the antidote for Organophosphates

A

Atropine

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16
Q

What is the window in which you can give activated charcoal and what does it do?

A

One hour

can prevent or reduce absorption of the drug

17
Q

general management points for self harm

A
  • risk assessment in mandatory
  • refuse treatment = mental capacity assessment
  • consider safety of overdose of antidepressants - TCA most dangerous as can cause arrhythmias and convulsions in OD
  • 1 in 6 people admitted to A&E following act of self harm will harm again in next year
18
Q

what is the biological management of self-harm?

A

appropriate antidote

suturing/tetanus treatment for deep lacerations

19
Q

Describe the psychological management options for self harm patients

A

Counselling and CBT for depressive illness
Psychodynamic Psychotherapy for Personality Disorder

20
Q

describe the social options for management of self-harm?

A

social services input and voluntary organizations

21
Q

How soon after discharge should a self harm patient be followed up?

A

48hrs

22
Q

Define Suicide and attempted suicide

A

suicide - The fatal act of self harm with the intention of ending ones own life

attempted suicide - act of intentionally trying to take one’s own life with the primary aim of try, but failing to succeed

23
Q

Give risk factors for Suicide (IM A SAD PERSON)

A
  • institutionalized
  • mental health disorder
  • alone
  • sex - male
  • age - middle aged
  • depression
  • previous attempts
  • ethanol
  • rational thinking lost
  • sickness
  • occupation
  • no job
24
Q

Give three protective factors against Suicide

A
  • Children at home
  • Religious Beliefs
  • Fear of the act
  • Strong social support
  • positive coping skills
  • positive therapeutic relationships
  • supportive living arrangements
  • life satisfaction
  • fear of disapproval by society
  • responsibility of others
  • hope for future
25
Q

Name three ways someone who has attempted Suicide may present

A
  • preoccupation with death
  • sense of isolation and withdrawl from society
  • emotional distance
  • distraction and lack of pleasure
  • focus on past
  • feelings if hopelessness and helplessness
26
Q

Name some typical features of a Suicide History

A
  • Note left behind
  • Planned attempt of suicide
  • Attempts to avoid discovery
  • Afterwards help was not sought
  • Violent method
  • Final acts: Sorting out finances/changing will
27
Q

Name the questionnaire used in attempted Suicide patients

A

Tool for assessment of Suicide Risk

28
Q

Describe the 7 OSCE steps for suicide attempt history taking

A

1) Explore ideation (how do they feel?)
2) Explore Suicide Intent (Methods, Was it planned)
3) Exploring risk factors (PMH, FH)
4) MSE
5) Explore protective factors
6) Explore risk to others and risk from others
7) Formulate Management Plan

29
Q

Name three reasons you would admit someone who has attempted Suicide to secondary care

A
  • Suicidal Ideation clearly stated
  • Lack of social support
  • Underlying psychiatric illness is severe
  • Presentation change for an individual who has repeatedly self harmed
30
Q

management of suicide

A
  • ensure safety - removing means for suicide
  • medically stabilised - ie od
  • risk assess
  • admission to hospital generally indicated if individual pose high and immediate risk of suicide
  • ref to secondary care
  • treat underlying mental health conditions
  • crisis team and home treatment team
  • outpatient and community team
  • prevention strategies
31
Q

How would you manage someone with chronic suicidal thoughts but no action?

A

Outpatient and community treatment

32
Q

Name three ways of preventing Suicide in the population

A
  • Public education and discussion
  • Reducing access to means of Suicide
  • Easy rapid access to psychiatric care
  • Decreasing societal stressors ie unemployment and DV
  • Reduce substance misuse
33
Q

name some ways of preventing individual suicide?

A

detect and treat psychiatric disorders

urgent hosoitalisation under MHA

involve crisis resolution and home treatment team

Psychiatry (18 decks)

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