Self Harm and Suicide

Question 1

What is the lifetime risk of self-harm?

Answer 1

7-13%

Question 2

What social classes are most at risk?

Answer 2

Social classes IV,V

Question 3

How many suicide attempts end in suicide?

Answer 3

1 in 20

Question 4

Why are men more likely to have successful suicide than women?

Answer 4

Because they choose more violent methods

Question 5

RF for self harm

Answer 5

• Genetics
• Child abuse
• Stressful life events
• LGBTQ+
• Bevearment
• Social isolation
• Physical illness
• Psychiatric illness

Question 6

How many people dying by suicide have a psychiatric disorder?

Answer 6

9/10

Question 7

What to explore in the clinical presentation of a suicide. attempt

Answer 7

PREPARATION

• research on methods
• obtaining equipment
• visiting potential locations
• rehearsals
• last acts

METHOD

DISCOVERY

• did they come into hospital themselves?
• did they text a friend?
• were they accidentally discovered? Did they resist assistance?

Question 8

What are symptoms of paracetamol OD?

Answer 8

Nausea, vomiting

LIVER - Fulminant liver failure (jaundice, abdomen pain, confusion, coma, death)

Question 9

How do you treat paracetamol OD?

Answer 9

N-acetylcysteine

Question 10

What are symptoms of NSAID overdose

Answer 10

Headache, nausea, vomiting, drowsiness, dizziness, blurred vision, tintinnuss
KIDNEY - AKI

Question 11

How do you treat benzodiazepine OD?

Answer 11

Flumazenil

Question 12

How do you treat opiate overdose?

Answer 12

Naxolone

Question 13

How do you treat Digoxin OD?

Answer 13

Digibind (digoxin speicic antibody fragments)

Question 14

When is gastric lavage used for overdose?

Answer 14

Rarely

Within 1 hour of overdose only

Question 15

when is activated charcoal used for overdose

Answer 15

within 1 h of overdose

Question 16

How long after self harm must you follow up

Answer 16

within 48h

Question 17

How do you manage self harm

Answer 17

Bio - treat any underlying disorder e.g. depression
Psycho: CBT based therpy, mentalisation based therapy, transference based therapy
Consider referral to CMHT, outptient clinic,

Question 18

Who do you refer in self harm, and to where?

Answer 18

to A&E if overdose
or significant concer

Consider referral to CMHT

CAMHS if child

Question 19

what are coping strategies for self harm

Answer 19

distraction techniques 
mood raising activities 
put tablets and sharp objects away 
avoid triggering images 
stay in public places or with supportive people 
avoid drugs and alcohol 

pain - squeeze ice cubes, elastic band around wrist, bite into strong flabour (e.g. lemon)