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Yr4: Psychiatry > Self Harm & Suicide > Flashcards

Self Harm & Suicide Flashcards

1
Q

Define self harm

A

Intentional act of self-poisoning or self-injury irrespective of the motivation or apparent purpose of the act

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2
Q

State some methods of self-injury

A
  • Cutting
  • Burning
  • Stabbing
  • Swallowing objects
  • Hanging
  • Shooting
  • Jumping from heights
  • Jumping in front of vehicles
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3
Q

State some methods of self-poisoning

A
  • Medication (prescribed or OTC)
  • Illicit drugs
  • Household substances
  • Plant materia
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4
Q

For self-harm, discuss:

  • Prevalence
  • Male to female ratio
  • Common ages
  • Impact it has on suicide risk
A
  • Common (around 1 in 4 women and 1 in 10 men aged 16-24yrs reported self-harming at some point ~NICE based on 2014 evidence)
  • Females > male (1.5:1)
  • Adolescents & young adults
  • Rate of suicide increases by 50-100 fold
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5
Q

What is the most common mechanism of self-harm in UK; self-injury or self-poisoning?

A

Self poisoning. Most commonly via medication overdose (paracetamol, aspirin, anxiolytics e.g. benzodiazepines, antidepressants)

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6
Q

State some risk factors for self harm

A
  • Severe life stressors
  • Age (adolescent/young adult)
  • Chronic physical health problems
  • Domestic violence
  • Childhood abuse
  • Harmful alcohol/drug use
  • Psychiatric illness e.g. depression, psychosis
  • Low socioeconomic class
  • Harmful drug/alcohol use
  • Divorced/single/living alone
  • Availability of means
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7
Q

Suggest some reasons as to why people self harm

A
  • Physical pain provides a relief from emotional/mental pain
  • Cry for/seeking help
  • Way of punishing themselves
  • Genuinely want to die
  • Trying to infuence another person to change their behaviour (e.g. make a partner feel guilty about threatening to end relationship)
  • Way to feel in control

Many reasons which can be complex

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8
Q

State some common complications of self-harm

A
  • Scarring of skin (self-cutting)
  • Damage to tendons & nerves (self-cutting)
  • Acute liver failure (paracetamol overdose)
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9
Q

State some key questions/aspects of history in self-harm case

A

Use the usual psychiatric history structure but key questions to think about/ensure you ask:

  • What was the intention?
  • Any suicidal ideation?
  • Why?
  • Current problems in life
  • Previous self-harm
  • Any psychiatric or medical illness
  • Safeguarding
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10
Q

Discuss potential MSE of pt who has self-harmed

A
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11
Q

State some investigations you may do in a pt who has self-harmed

A

Bedside

  • Urine drug screen
  • ?ABG

Bloods

  • Paracetamol levels
  • Salcicylate levels
  • U&Es: renal func
  • LFTs: liver damage
  • Clotting: liver function

Imaging

  • CT head: if suspect intracranial cause for altered consciousness
  • Lumbar puncture: if intracranial infection suspected for altered consciousness or other symptoms
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12
Q

Discuss general points in management of self-harm

*Not asking about biopsychosocial model, asking about other aspects of management that don’t fit into that model

A
  • Risk assessment!!
    • Do need admission or CHRT in community?
  • Mental capacity assessment may be required if refuse medical treatment for consequences of self-harm
  • Psychosocial assessment
  • Ensure pt is followed up within 48hrs discharge
  • Written and/or verbal information-with focus on what to do in time of crisis
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13
Q

Discuss the biopsychosocial management of self-harm

A

Biological

  • Antidotes for self-poisoning
  • Suturing (and possible tetanus vaccine) for deep lacerations
  • Supportive care e.g. fluids
  • Harm minimisation techniques in long term

Psychological

  • Counselling
  • CBT
  • Family/systematic therapy e.g. couples therapy
  • Psychodynamic psychotherapy (may be appropriate if pt has personality disorder)

Social

  • Social services input for e.g housing, finances
  • Support from voluntary organisations e.g. Mind, Samaritans
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14
Q

Which of the antidepressant drugs are most hazardous in overdose & why?

A

Tricyclic antidepressants

Risk of cardiac arrhythmias & convulsions

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15
Q

State the antidotes for following drugs that are commonly used to overdose:

  • Paracetamol
  • Opiates
  • Benzodiazepines
  • Warfarin
  • Beta blockers
  • TCAs
  • Organophosphates
A
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16
Q

How long following discharge from hospital does a self-harm pt require follow up?

A

48hrs

17
Q

What number of peopple who attend A&E following an act of self-harm will self-harm again within a year?

A

1 in 6

18
Q

Which sex is suicide more common in?

A

Men (3x more likely to commit suicide. Chose more lethal methods)

19
Q

What age group has highest rate of suicide?

A

45-49yrs (in both men & women)

20
Q

State some of the most common methods of suicide

A
  • Hanging
  • Strangulation
  • Suffocation
  • Poisoning
21
Q

State some protective factors against suicide

A
22
Q

State some risk factors for suicide- think about biological, psychological & social risk factors

A

​Biological

  • Psychiatric illness e.g. depression, schizophrenia, substance miuse, personality disorder
  • History of DSH or suicide
  • Familly history
  • Chronic physical illness
  • Male
  • Age 45-49

Psychological

  • Childhood abuse
  • Stressful life event

Social

  • Low socioeconomic status
  • Unemployment
  • Occupation (vets, doctors, farmers- think about means!)
  • Little social support e.g. living alone
  • Single, divorced, widdowed
  • Institutionalised
23
Q

Discuss what should be involved in your risk assessment for suicide- 6 key sections

A
  • ​Explore suicidal ideation
  • Explore suicide intent
    • ​Explore plans
    • Notes left behind
    • Final acts e.g. writing a will
    • Were they alone?
    • Precautions to avoid discovery?
    • How did they end up with you now; did they seek help, did someone find them
    • How do they feel about it now? Regret? Angry didn’t work?
  • Risk factors
    • ​Stress
    • Previous DSH or suicide
    • Psychiatric illness
    • Chronic physical illness
    • FH
    • Social circumstances
  • Protective factors
  • Risk
    • ​To others
    • From others
  • MSE
24
Q

Management of a pt who is at risk of suicide depends on the level of risk; suggest some options for management

A

Key is to ensure safety of pt and others

  • Treatment e.g. for depression
  • Referral to secondary care
  • Admission to hosptial or place of safety (may be under MHA)
  • Involve CRHT to provide support immediately after discharge

*NOTE: if pt attempted suicide must medically stablise them

25
Q

State some prevention strategies both on an individual level and a population level

A
26
Q

Compare self-harm and suicide

A

Yr4: Psychiatry (17 decks)

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