Self harm and Suicide Flashcards
Define Self Harm
Intentional act of self poisoning/self injury irrespective of the motivation or apparent purpose of the act
Usually as a form of emotional distress
Describe some potential methods of self-injury
Cutting, Burning, Hanging, Stabbing, Swallowing Objects
Describe some potential methods of self-poisoning
Medication, Illicit Drugs, Household Substances
Name 5 risk factors for Self Harm (DSH Largely Comes Via Self-Poisoning)
- 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
What is the link between alcohol and suicide?
1/2 men and 1/4 women who self harm have taken alcohol in the last 6 hours
Describe some potential motives for Self Harm (DRIPS)
- Death Wish
- Relief (eg being unconscious)
- Influencing others (guilt tripping them)
- Punishment
- Seeking Attention
Name the 2 commonest complications of Self Harm
- Permanent scarring/damage to tendons and nerves
- Acute Liver Failure
Name three investigations you could do in a patient that has self harmed
Bloods (Toxin levels, U&Es, LFTs, Clotting)
Urinalysis (Tox Screen)
CT Head
Name the antidote for Paracetamol
N Acetyl Cysteine
Name the antidote for Opiates
Naloxone
Name the antidote for Benzodiazepines
Flumazenil
Name the antidote for Warfarin
Vitamin K
Name the antidote for Beta Blockers
Glucagon
Name the antidote for Tricyclics Antidepressants
Sodium Bicarbonate
Name the antidote for Organophosphates
Atropine
What is the window in which you can give activated charcoal and what does it do?
One hour
can prevent or reduce absorption of the drug
general management points for self harm
- 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
what is the biological management of self-harm?
appropriate antidote
suturing/tetanus treatment for deep lacerations
Describe the psychological management options for self harm patients
Counselling and CBT for depressive illness
Psychodynamic Psychotherapy for Personality Disorder
describe the social options for management of self-harm?
social services input and voluntary organizations
How soon after discharge should a self harm patient be followed up?
48hrs
Define Suicide and attempted suicide
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
Give risk factors for Suicide (IM A SAD PERSON)
- institutionalized
- mental health disorder
- alone
- sex - male
- age - middle aged
- depression
- previous attempts
- ethanol
- rational thinking lost
- sickness
- occupation
- no job
Give three protective factors against Suicide
- 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
Name three ways someone who has attempted Suicide may present
- 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
Name some typical features of a Suicide History
- 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
Name the questionnaire used in attempted Suicide patients
Tool for assessment of Suicide Risk
Describe the 7 OSCE steps for suicide attempt history taking
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
Name three reasons you would admit someone who has attempted Suicide to secondary care
- Suicidal Ideation clearly stated
- Lack of social support
- Underlying psychiatric illness is severe
- Presentation change for an individual who has repeatedly self harmed
management of suicide
- 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
How would you manage someone with chronic suicidal thoughts but no action?
Outpatient and community treatment
Name three ways of preventing Suicide in the population
- 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
name some ways of preventing individual suicide?
detect and treat psychiatric disorders
urgent hosoitalisation under MHA
involve crisis resolution and home treatment team
