Self harm and suicide

Question 1

Define suicide

Answer 1

A fatal act of self injury, undertaken with conscious self-destructive intent.

Question 2

Define para-suicide

Answer 2

A conscious act of self-destruction, with fatal intent. However, this differs from suicide as the victim manages to survive the attempt.

Question 3

Define deliberate self harm

Answer 3

An act of self harm without the intention of death.

Question 4

Outline the worldwide epidemiology of suicide

Answer 4

1 million people commit suicide worldwide each year.

It is among the top 10 causes of death in most countries.

Question 5

Which demographic is at highest risk of suicide?

Answer 5

Male (3:1), especially aged 45-59.

Question 6

When in regards to healthcare services, are mental health patients at highest risk of suicide?

Answer 6

Inpatient stay

14-day post-discharge

Question 7

List 4 risk factors for suicide

Answer 7

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

Question 8

Name 3 factors associated with risk of suicide following deliberate self harm

Answer 8

Efforts to avoid discovery
Planning
Written note
Final acts
Violent method

Question 9

What factors increase the risk of inpatient suicide?

Answer 9

Forensic Hx
Previous suicidal behaviour
Violence to property
Recent bereavement
Delusions

Question 10

What factors increase the risk of post-discharge suicide?

Answer 10

Unplanned discharge
Lack of continuity of care
Unemployment
Previous suicidal behaviour

Question 11

What is the impact of depression on lifetime risk of suicide?

Answer 11

Increase by 15%

Question 12

What aspects of depression increase the risk of suicide?

Answer 12

Greater severity of depression
Self neglect
Hopelessness
Alcohol abuse
Impaired concentration
History of suicidal behaviour

Question 13

What is the impact of schizophrenia on lifetime risk of suicide?

Answer 13

Increase by 10-15%

Question 14

What aspects of schizophrenia increase the risk of suicide?

Answer 14

Psychotic symptoms
Post-psychotic depression
Young male
First decade of illness
Relapsing illness pattern
Good insight

Question 15

What is the impact of alcohol abuse on lifetime risk of suicide?

Answer 15

Increase by 2-4%

Question 16

What aspects of alcohol abuse increase the risk of suicide?

Answer 16

Male sex
Longer duration of issues
Single, divorced, widowed
Multiple substance abuse
Comorbid depression

Question 17

What is the impact of personality disorders on lifetime risk of suicide?

Answer 17

<10% increase

EUPD has highest risk, commonly manifesting as accidental death.

Question 18

How are suicide and chronic physical illness associated?

Answer 18

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.

Question 19

What are the 2 main types of deliberate self-harm?

Answer 19

Self-poisoning

Self-injury

Question 20

Outline the epidemiology of deliberate self-harm in the UK

Answer 20

150,000 new attendances at A&E per year
Higher rate in females
Peak age 15-44

Question 21

What is the impact of deliberate self-harm on risk of suicide?

Answer 21

40-60% increase in risk of suicide

Question 22

What is the risk of suicide within one year of deliberate self-harm?

Answer 22

0. 7%
1. 1% if male
2. 5% if female

Question 23

Name 3 risk factors for repeated self-harm

Answer 23

Previous self harm
Psychiatric Hx
Unemployment, low SE
Hx trauma or abuse
Forensic Hx or violence
Single, divorced, separated
Family Hx - 4x risk

Question 24

List motives for acts of deliberate self-harm

Answer 24

Wish to die
Cry for help
Communication
Unbearable symptoms

Question 25

What psychological characteristics contribute to deliberate self-harm?

Answer 25

Impulsivity
Cognitive rigidity
Problem-solving deficits
Hopelessness

Question 26

Describe the association between substance abuse and deliberate self-harm

Answer 26

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.

Question 27

Outline the risk assessment of suicide

Answer 27

Risk factors: dynamic, static, modifiable
Specific suicide inquiry
Protective factors

Question 28

What should be included in the specific suicide inquiry?

Answer 28

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

Question 29

What risk management options exist regarding suicide?

Answer 29

Treat any underlying psychiatric disorders

Inpatient: closer supervision, Tx adherence, staff training, safer environment

Question 30

Outline the association between psychiatric disorder and homicide (risk to others)

Answer 30

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.

Question 31

What information is required if child protection may be involved in psychiatry?

Answer 31

Child’s name, DOB, residence, relationship