Self harm and Suicide

Question 1

What are the motives for deliberate self harm?

Answer 1

• Emotional relief
• Self punishment
• Attention seeking
• A way of self help by channeling intolerable emotional experiences into a discrete physical sensation

Question 2

What are the epidemiological risk factors for self harm?

Answer 2

• Men are more likely to complete suicide but women engage in more parasuicidal activity
• Divorced > widowed > single
• Social classs V
• Living alone

Question 3

What are the clinical risk factors for self harm?

Answer 3

• Psychiatric illness
• Previous deliberate self harm
• Alcohol dependence
• Physical illness, especially terminal illness and debilitating or chronically painful conditions
• Family history of depression, alcohol dependence or suicide
• Recent adverse life events

Question 4

Psychiatric illness
-What % of pts who commit suicide have a diagnosable psychiatric disorder?
What % of these are in contact with services?

Answer 4

-90% but only 25% of these are in contact with services

Question 5

What is the % of completed suicide in the following groups of illness;

• Depression
• Schizophrenia
• Alcohol dependence
• Personality disorders
• Organic brain disease
• Anxiety and eating disorder

Answer 5

Depression; most common (50-80% of completed suicides with a 15% lifetime risk

• Schizophrenia; 10% lifetime risk, but higher in young, intelligent, unemployed males with good insight
• Alcohol dependence; 3-4% lifetime risk
• Personality disorder; high risk
• Organic brain disease; 5% of all suicides
• Anxiety and eating disorders; increased risk

Question 6

What are the aspects of a suicide attempt that indicate the person has a serious wish to end their life?

Answer 6

1. The attempt is planned in advance
2. Precautions were taken to avoid discovery or rescue
3. A dangerous method was used e.g. firearms
4. No help was sought after the act

Question 7

Management 
-What exam should be performed initially? 
-What else should be carried out extensively?
Why is it important to assess
-Current mood state?
-Ascertain protective factors
-Social support?
-Check for an undiagnosed mental illness

Answer 7

• A mental state exam should be carried out in a calm, quiet and confidential setting
• An extensive risk assessment should be performed
• Current mood state; is there any regret or ongoing suicidal ideation. Features of hopelessness or worthlessness are associated with a higher suicide risk
• Protective factors; anything to stop the pt doing it again i.e not wanting to leave the kids alone
• Social support; what do they have available to them if discharged, do they have the ability to cope

After initial management it must be considered whether an inpatient stay is needed or if they can be released back into the community and followed up by a CPN

Question 8

Prevention

What can be done long term to help reduce the risk of suicide ?

Answer 8

• Eating healthy and exercising regularly
• Avoid alcohol or stick to your recommended units
• Don’t use drugs to cope (unless prescribed)
• Avoid isolation
• Stay positive