Self harm and Suicide

Question 1

Define Self Harm

Answer 1

Intentional act of self poisoning/self injury

Usually as a form of emotional distress

Question 2

Describe some potential methods of injury

Answer 2

Cutting, Burning, Hanging, Stabbing, Swallowing Objects

Question 3

Describe some potential methods of poisoning

Answer 3

Medication, Illicit Drugs, Household Substances

Question 4

Name 5 risk factors for Self Harm

Answer 4

Divorced
Severe life stressors
Harmful drug/alcohol use 
Chronic physical health problems
Psychiatric Illness

Question 5

What is the link between alcohol and suicide?

Answer 5

1/2 men and 1/4 women who self harm have taken alcohol in the last 6 hours

Question 6

Describe some potential motives for Self Harm

Answer 6

Death Wish
Relief (eg being unconscious)
Influencing others (guilt tripping them)
Seeking Attention

Question 7

Name two complications of Self Harm

Answer 7

Permanent scarring/damage to tendons and nerves

Acute Liver Failure

Question 8

Name three investigations you could do in a patient that has self harmed

Answer 8

Bloods (Toxin levels, U and Es, LFTs, Clotting)
Urinalysis (Tox Screen)
CT Head

Question 9

Name the antidote for Paracetamol

Answer 9

N Acetyl Cysteine

Question 10

Name the antidote for Opiates

Answer 10

Naloxone

Question 11

Name the antidote for Benzodiazepines

Answer 11

Flumazenil

Question 12

Name the antidote for Warfarin

Answer 12

Vitamin K

Question 13

Name the antidote for Beta Blockers

Answer 13

Glucagon

Question 14

Name the antidote for Tricyclics Antidepressants

Answer 14

Sodium Bicarbonate

Question 15

Name the antidote for Organophosphates

Answer 15

Atropine

Question 16

What is the window in which you can give activated charcoal?

Answer 16

One hour

Question 17

Describe the psychological management options for self harm patients

Answer 17

Counselling and CBT for depressive illness

Psychodynamic Psychotherapy for Personality Disorder

Question 18

How soon after discharge should a self harm patient be followed up?

Answer 18

48hrs

Question 19

Define Suicide

Answer 19

The fatal act of self harm with the intention of ending ones own life

Question 20

Give 5 risk factors for Suicide

Answer 20

Mental Health Disorders
Alone
Male
Ethanol Use
Occupation (Vets, Doctors, Nurses, Farmers)

Question 21

Give three protective factors against Suicide

Answer 21

Children at home
Religious Beliefs
Fear of the act

Question 22

Name three ways someone who has attempted Suicide may present

Answer 22

Isolation/Withdrawal from society
Distraction and lack of pleasure
Hopeless and Helpless

Question 23

Name some typical features of a Suicide History

Answer 23

Note left behind
Attempts to avoid discovery
Sorting out finances/changing will

Question 24

Name the questionnaire used in attempted Suicide patients

Answer 24

Tool for assessment of Suicide Risk

Question 25

Describe the 7 OSCE steps for suicide attempt history taking

Answer 25

1) Explore ideation (how do they feel?)
2) Explore Suicide Intent (Methods, Was it planned)
3) Exploring risk factors (PMH, FH)
4) MSE
5) Explore protective factors
6) Explore risk to others and risk from others
7) Formulate Management Plan

Question 26

Name three reasons you would admit someone who has attempted Suicide to secondary care

Answer 26

Suicidal Ideation clearly stated
Lack of social support
Underlying psychiatric illness is severe

Question 27

How would you manage someone with chronic suicidal thoughts but no action?

Answer 27

Outpatient and community treatment

Question 28

Name three ways of preventing Suicide in the population

Answer 28

Public education and discussion
Reducing access to means of Suicide
Easy rapid access to psychiatric care