Self-Harm and Suicide Flashcards
What is self-harm?
Intentional act of self-poisoning or self-harm, irrespective of motivation or apparent purpose of the act
What are methods of self-injury?
Cutting
Burning
Stabbing
Hanging
Swallowing objects
Shooting
What are methods of self-poisoning?
Medication overdose
Illicit drug use
Ingesting household substances (eg. bleach)
What are RF’s for self harm?
Divorced
Severe life stressors
Harmful drug/alcohol use
Age < 35
Chronic physical health problems
Violence
Childhood abuse
Socioeconomic disadvantage
Psychiatric illness (eg. depression, schizophrenia)
What are complications of self-harm?
Permanent scarring of skin
Damage to tendons and nerves
Acute liver failure
What investigations may be done?
- Investigate reasons for self-harm
- MSE
- Bloods: paracetamol levels, salicylate levels, U&E, LFTs, clotting
- Urinalysis
- CT head
- Lumbar puncture (if suspected intracranial infection from poisoning)
What may be reasons for self-harm?
- Wish to die
- relief and escape from problems
- Attempt to influence others (eg. make someone feel guilty)
- Punishment
- Seeking attention either for help/emotional distress
What may an MSE show?
- Appearance
- Behaviour
- Thoughts
- Hallucinations
- Cognition
- Insight
How may self-harm be managed?
- Treat overdose with appropriate antidote
- Suture lacerations
- Counseling, antidepressants, CBT for underlying depressive illness
- Psychodynamic psychotherapy for underlying PD
- Social service input
- Refer to drug and alcohol services
- Remove access to means of self harm
- MUST do risk assessment (as immediate risk of suicide and repeat acts of self-harm)
What patients are at greater risk of suicide and self harm?
Men
What methods are men vs women more likely to use?
Men - violent methods (eg shooting, hanging)
Women - prescribed/OTC drug OD’s
What should suicide be differentiated from?
NSSI (non-suicidal self-injurious behaviour)
- intent to harm without attempt to end one’s life
What is the peak age of NSSI in women?
15-24
What is the peak age of NSSI in men?
25-34
What components should you ask about in a suicide risk assessment?
HEADSS
Home and environment
Education
Activities
Drugs and Alcohol
Sexuality
Suicide and Depression
What should you gauge in an acute presentation?
Collateral hx from friend or relative if present
What is used in adolescents who present with an OD?
Pathos Score
Problems (> 1 month)
Alone (alone at the time?)
Time (planned for > 3 hrs?)
Hopeless (feeling hopeless about future?)
Sad (feeling sad for most of the time before the OD?)
Each “yes” answer = higher risk of future harm and intent
What may an MSE show in suicide?
- Appearance
- Behavior
- Mood
- Thought
- Perception
- Cognition
What investigations may be done?
Bloods - paracetamol levels, U&E’s, LFTs
Urinalysis
Questionnaire - tool for suicide risk assessment
Note left behind, writing a will
What questions should be asked in a risk assessment?
How should suicide patients be managed?
Remove means for suicide
Medically stabilise
Risk assessment
Psychiatric tx
Involve Crisis Resolution and Home Tx team
What are population level suicide prevention strategies?
Public education
Reduce access to means of suicide (eg. safer prescribing)
Decrease social stressors
Reduce substance misuse
Easy, rapid access to psychiatric care
Self harm vs suicide
Read Geeky medics suicide risk assessment
https://geekymedics.com/suicide-risk-assessment-osce-guide/
