Self harm and suicide Flashcards

Question

Features of activated charcoal

Answer 1

for the majority of drugs taken in overdose, early use of activated charcoal (within one hour of ingestion) can prevent or reduce absorption of the drug

Answer 2

Suicide: A fatal act of self-harm initiated with the intention of ending one’s own life. Attempted suicide: The act of intentionally trying to take one’s own life with the primary aim of dying, but failing to succeed in this endeavour. Risk assessment: In a psychiatric context, it is assessing the risk of self-harm, suicide and/or risk to others.

Answer 3

Children at home Pregnancy Strong religious beliefs strong social support Positive coping skills Positive therapeutic relationship life satisfaction Fear of suicide Fear of disapproval by society Hope for the future

Answer 4

IM A SAD PERSON Mental health disorders, Alone (lack of social support), Sex (male), Age (middle aged), Depression, Previous attempts, Ethanol use, Rational thinking lost, Sickness, Occupation , No job (unemployed)

Answer 5

Suicide is the 13th leading cause of death worldwide, with about 1 million deaths every year due to self-inflicted violence. In 2012, in the UK there were 18.2 ♂ suicides per 100 000 population, and 5.2 ♀ suicides per 100 000 population. The most common methods of suicide are hanging, strangulation and suffocation (58% of ♂ suicides and 36% of ♀ suicides), followed by poisoning (43% of ♀ suicides and 20% of ♂ suicides).

Answer 6

History of DSH or attempted suicide The rate of suicide in people who have self-harmed increases and is 50–100 times greater than in the general population. Psychiatric illness Including depression, schizophrenia, substance misuse, alcohol abuse and personality disorder. Childhood abuse History of childhood sexual or physical abuse. Family history Family history of suicide or suicide attempt in first-degree relatives increases the risk. Medical illness Physically disabling, painful or terminal illness

Answer 7

Male gender Males are 3x more likely than females. Male suicide attempts are more likely to be violent and therefore successful. Age Highest in the age group 40 to 44 in men. Employment and financial status Those unemployed and who have low socioeconomic status are at higher risk. Occupation Vets, doctors, nurses and farmers are at higher risk of suicide. Access to lethal means The most lethal means of suicide are firearms, followed by hanging, strangling, and suffocation. Social support Low social support, living alone, institutionalized, e.g. prisons, soldiers. Marital status Those that are single, widowed, seperated or divorced Recent life crisis e.g. Bereavement, family breakdown.

Answer 8

Preoccupation with death: Thoughts, fantasies, ruminations and preoccupations with death, particularly self-inflicted death. Sense of isolation and withdrawal from society. Emotional distance from others. Distraction and lack of pleasure: Often are ‘in their own world’ and suffer from anhedonia. Focus on the past: They dwell on past losses and defeats and anticipate no future; they voice the notion of Beck’s cognitive triad (see Section 3.2, Depressive disorder) that the world would be better off without them. Feelings of hopelessness and helplessness.

Answer 9

Low mood Hopelessness, Helplessness, Worthlessness Loss/ Not seeking support/pillars ‘It is better to be dead than suffering this’ Death wishes (I wish I had died) Plan Attempt – self Harm Suicide

Answer 10

1. Note left behind: usually written. 2. Planned attempt of suicide. 3. Attempts to avoid discovery. 4. Afterwards help was not sought. 5. Violent method. 6. Final acts: sorting out finances, writing a will.

Answer 11

1. Exploring suicidal ideation: ‘How do you feel about your future?’ ‘Do you feel that life is worth living?’ ‘Have you ever thought about taking your own life?’

Answer 12

What precipitated the attempt? Was it planned? What method did they use? Was a suicide note left? Did they make any other preparations before acting? e.g. writing a will. Was the patient intoxicated with drugs or alcohol? Was the patient alone? Were there precautions taken to avoid discovery (e.g. they waited until the house was empty, locked doors, timed so that intervention would be highly unlikely)? Did the patient think that they were certain to die even if they received medical attention? What was the degree of premeditation? How long had they been contemplating suicide for? What plans had they made before acting? Did the patient seek help after the attempt or were they found and brought in by someone else? How does the patient feel about it now? Do they regret it or do they wish that they had succeeded? How do they feel about being found? Are they relieved or are they angry?

Answer 13

‘Is there anything in particular that is making you feel this way?’, ‘Can you tell me about it?’ (stress) ‘Have you ever tried anything like this before?’, ‘Can you tell me about it?’ (previous suicide attempts) ‘Are you aware if you are suffering from any mental health illness?’ (psychiatric illness) ‘Do you have any health problems that are bothering you at the moment?’ (medical illness) ‘Is there any family history of suicide, attempted suicide or self-harm?’ (family history)

Answer 14

‘Is there anything in particular that is making you feel this way?’, ‘Can you tell me about it?’ (stress) ‘Have you ever tried anything like this before?’, ‘Can you tell me about it?’ (previous suicide attempts) ‘Are you aware if you are suffering from any mental health illness?’ (psychiatric illness) ‘Do you have any health problems that are bothering you at the moment?’ (medical illness) ‘Is there any family history of suicide, attempted suicide or self-harm?’ (family history)

Answer 15

‘Is there anything that would stop you from carrying out this act?’ What are the positive things in their life? (general protective factors) ‘Do you have someone to confide in, close family or friends?’, ‘Who do you live with?’, ‘Do you have company at home?’ (establishing social support or lack of)

Answer 16

‘Do you ever have thoughts of harming others?’ Patients may have children/relatives that are in danger: ‘Do you have close contact with any children?’ Document the child’s name, DOB, place of residence and enquire as to the nature of the relationship. ‘Do you ever feel threatened or at risk from others?’

Answer 17

Determine whether the patient is low, medium or high risk and formulate a management plan accordingly, depending on the degree of planning, severity of the attempt and ongoing concerns about risk

Answer 18

Medical investigations according to the method, e.g. drug levels (see Section 9.1, Deliberate self-harm). Questionnaires - Tool for Assessment of Suicide Risk (TASR), Beck Suicide Intent Scale. Suicide can be confirmed by post-mortem

Answer 19

Self-harm (for attempted suicide)

Answer 20

Suicide: More common in males Risk increases with age Act may be planned meticulously Act is more often violent Physical and psychiatric illness is common Self-harm: More common in females More common in young people Act is impulsive Usually in form of overdose or cutting Physical and psychiatric illness is less common

Answer 21

Ensure safety: Immediate action should include removing means for suicide and ensuring the safety of the patient and others. Patients who have attempted suicide and failed, should be medically stabilized, e.g. management of drug overdose or treatment of physical injury. Risk assessment: The risk of further suicide should then be assessed. People with a high degree of suicidal intent, specific plans, or chosen methods (particularly if lethal) should be assigned a higher level of risk (see OSCE tips 3). Admission to hospital (or observation in a safe place) is generally indicated if individuals pose a high and immediate risk of suicide. The Mental Health Act might be required if the patient refuses help and there is evidence of a mental illness. Referral to secondary care (see OSCE tips 4). Psychiatric treatment: Depression or psychosis should be detected and treated accordingly. Involvement of the Crisis Resolution and Home Treatment team to provide support immediately following discharge can be instrumental. Outpatient and community treatment may be more suitable for patients with chronic suicidal ideation but no history of previous significant suicide attempts. For this to succeed, a strong support network and easy access to outpatient and community facilities are required. Prevention strategies

Answer 22

Manage immediate risk Plan for young people to tell parents if have further thoughts Manage any underlying mental health condition eg Depression If too severe – hospital/intensive home treatment If parents unable to work to protect young person – consider social care

Answer 23

Detect and treat psychiatric disorders Urgent hospitalisation under the Mental Health Act Involvement of the Crisis resolution and Home treatment team

Answer 24

Public education and discussion Reducing access to means of suicide Easy, rapid access to psychiatric care Decreasing societal stressors Reducing substance misuese

Answer 25

(SUSPicious) (1) Suicidal ideation clearly stated; (2) Underlying psychiatric illness is severe; (3) Social support (lack of); (4) Presentation change for an individual who has repeatedly self-harmed.

Answer 26

Low levels of blood tryptophan (source of serotonin) Low serotonin levels in brain and low receptor HPA dysregulation & elevated blood cortisol levels Low serotonin and 5HIAA (serotonin metabolite) in the CSF of suicide victims