Self harm and suicide Flashcards
Define suicide
A fatal act of self injury, undertaken with conscious self-destructive intent.
Define para-suicide
A conscious act of self-destruction, with fatal intent. However, this differs from suicide as the victim manages to survive the attempt.
Define deliberate self harm
An act of self harm without the intention of death.
Outline the worldwide epidemiology of suicide
1 million people commit suicide worldwide each year.
It is among the top 10 causes of death in most countries.
Which demographic is at highest risk of suicide?
Male (3:1), especially aged 45-59.
When in regards to healthcare services, are mental health patients at highest risk of suicide?
Inpatient stay
14-day post-discharge
List 4 risk factors for suicide
Male sex (3:1) Increasing age Unemployment or social isolation Divorced or widowed Hx of mental illness (especially depression, schizophrenia) Hx of deliberate self harm Alcohol or drug misuse
Name 3 factors associated with risk of suicide following deliberate self harm
Efforts to avoid discovery Planning Written note Final acts Violent method
What factors increase the risk of inpatient suicide?
Forensic Hx Previous suicidal behaviour Violence to property Recent bereavement Delusions
What factors increase the risk of post-discharge suicide?
Unplanned discharge
Lack of continuity of care
Unemployment
Previous suicidal behaviour
What is the impact of depression on lifetime risk of suicide?
Increase by 15%
What aspects of depression increase the risk of suicide?
Greater severity of depression Self neglect Hopelessness Alcohol abuse Impaired concentration History of suicidal behaviour
What is the impact of schizophrenia on lifetime risk of suicide?
Increase by 10-15%
What aspects of schizophrenia increase the risk of suicide?
Psychotic symptoms Post-psychotic depression Young male First decade of illness Relapsing illness pattern Good insight
What is the impact of alcohol abuse on lifetime risk of suicide?
Increase by 2-4%
What aspects of alcohol abuse increase the risk of suicide?
Male sex Longer duration of issues Single, divorced, widowed Multiple substance abuse Comorbid depression
What is the impact of personality disorders on lifetime risk of suicide?
<10% increase
EUPD has highest risk, commonly manifesting as accidental death.
How are suicide and chronic physical illness associated?
Increased risk in chronic neurological, GI, CV disorders, and cancer.
Severe chronic pain increases risk of depression.
Disfigurement, especially in women.
Effect on job, role, family, and finance.
What are the 2 main types of deliberate self-harm?
Self-poisoning
Self-injury
Outline the epidemiology of deliberate self-harm in the UK
150,000 new attendances at A&E per year
Higher rate in females
Peak age 15-44
What is the impact of deliberate self-harm on risk of suicide?
40-60% increase in risk of suicide
What is the risk of suicide within one year of deliberate self-harm?
- 7%
- 1% if male
- 5% if female
Name 3 risk factors for repeated self-harm
Previous self harm Psychiatric Hx Unemployment, low SE Hx trauma or abuse Forensic Hx or violence Single, divorced, separated Family Hx - 4x risk
List motives for acts of deliberate self-harm
Wish to die
Cry for help
Communication
Unbearable symptoms
What psychological characteristics contribute to deliberate self-harm?
Impulsivity
Cognitive rigidity
Problem-solving deficits
Hopelessness
Describe the association between substance abuse and deliberate self-harm
Substance abuse occurs commonly at the time or before DSH.
Alcohol can increase the dangers of overdose. It also increases the toxicity of psychotropic drugs,
Intoxication may result in unconsciousness and delayed treatment.
Outline the risk assessment of suicide
Risk factors: dynamic, static, modifiable
Specific suicide inquiry
Protective factors
What should be included in the specific suicide inquiry?
Triggers
Preparation:
planning, final acts
Circumstance:
precaution against discovery, alcohol, the suicide act, pt thought and desires of outcome
After act:
Sought help?, regret, intent, future plans
What risk management options exist regarding suicide?
Treat any underlying psychiatric disorders
Inpatient: closer supervision, Tx adherence, staff training, safer environment
Outline the association between psychiatric disorder and homicide (risk to others)
Delayed sleep phase disorder, substance misuse, and schizophrenia cause a small increase risk to others.
Mood disorders have no increased risk to others.
Psychotic disorders increase the risk to others by persecutory psychosis and command auditory hallucinations.
What information is required if child protection may be involved in psychiatry?
Child’s name, DOB, residence, relationship
