Self-harm & suicide Flashcards
Define self-harm
Intentional act of self-injury or self-poisoning irrespective of the motivation or apparent purpose of the act.
What is the most common type of self-harm?
90% = self-poisoning
Who are the risk factors for self-harm?
Women Younger people (15-25) Lower social class South asian women Unemployed Urban living
What are the main causes of self-harm?
Drug/alcohol dependency
Major depressive disorder
Abuse & bullying
Emotional/stressful/traumatic events
What are the types of self-harm?
Ingestion: Excessive substance, non-ingestible substance, recreational/illicit drugs
Behavioural: self-cutting
What questions should be asked of someone who attempted suicide? Would you be concerned if they were positively answered?
CONCERN
- Was there a clear precipitant/cause for attempt
- Was the act premeditated or impulsive
- Did the patient leave a suicide note
- Would the patient do it again?
- Had the patient taken steps not to be discovered?
- Did the patient make the attempt in strange surroundings?
Are there any further questions you would ask to someone who has committed suicide?
- Continued suicide intent
- Precipitant/crisis resolved?
- Any psychiatric symptoms
- What is the patients social support system?
- Physical illness
- Has anyone in the family ever taken their life
- Has the patient inflicted self-harm before?
What are absolute indications for referral to a psychiatrist?
- Clinical depression
- Psychotic illness of any kind
- Clearly preplanned suicidal attempt with intent not to be discovered
- A violent method used
- Persistent suicidal intent
What are common indications for a referral to a psychiatrist?
- Alcohol/drug misuse
- Patient >45 especially male OR young adolescents
- FHx of suicide
- Those with serious (incurable) physical disease
- Persistent attempts
- Those living alone/unsupported
How is a drug overdose treated?
Activated charcoal (within 1hour of ingestion to prevent absorption)
What toxins will not bind to charcoal?
Hydrocarbons Alcohol Metals Corrosives Malathion
What should NOT be used in self-poisoning?
Emetics (Ipecac)
Gastric lavage- unless specific recommendations from Toxbase
What is the prognosis for suicide?
1-2% of people who attempt suicide will kill themselves in the year following self-harm
66% who commit suicide have seen a GP in past 12m
Risk of repetition 15%
What factors increase the risk of suicide?
Male Older age (>45) Living alone/single/divorced Immigrant status Recent bereavement Recent loss of job/retirement/unemployed FHx affective disorder Prev suicide attempt Addiction to alcohol/drugs Severe depression Incapacitating illness Prisoners
What is the most common cause of suicide?
90% = mental illness
What tools can be used to assess suicide?
TASR
Tool for assessment of Suicide Risk
What is contained in a TASR assessment?
- Individual risk profile
- Symptom risk profile
- Interview risk profile
- Risk buffers
What is found in the individual risk profile section of a TASR assessment?
Demographics Fix Past/Present psychiatric diagnosis Poor social support Domestic problems Exposure to suicide Past/present abuse Past suicide behaviours Poor stress tolerance
What is found in the symptom risk profile section of a TASR assessment?
Depression/dysphoria Hopelessness Severe anhedonia Intense emotion Shut down Severe self-reproach/worthlessness Impaired reasoning Psychosis Poor self-control problematic alcohol/drug use
What is found in the interview risk profile section of a TASR assessment?
Suicide ideation Suicide intent Suicide plan Concealed suicidality Past suicide attempt Access to lethal means Recent alcohol/drug consumption Suicide trigger Unsolvable problem Intolerable state
What is found in the risk buffers section of a TASR assessment?
Reasons for living
Internal strengths for managing risk
External strengths for managing risk
What are the 5 key components of suicide?
Ideation Intent Plan Access to lethal means History of past suicide attempts
What questions would you ask someone about ‘before’ they attempted to commit suicide?
Events leading up to the attempt
Planning
What questions would you ask someone about ‘during’ they attempted to commit suicide?
Mechanism Where & when How were they discovered Alcohol/drug use Uncooperative PATHOS score
What is the PATHOS score and how is it used?
13-18year olds who present with an overdose
P-roblems: Had any problems for more than 1month
A-lone: Were you alone at the time?
T-ime: Have you planned it for more than 3hours
H-opeless: Are you feeling hopeless about the future
S-ad: Were you feeling sad for most of the time before the overdose
Each yes is an indicator of greater risk of future harm/intent
What questions would you ask someone about ‘after’ they attempted to commit suicide?
Feelings Now
Future feelings
If you were to go home now, what would happen?
What are individual risk factors for self harm?
Psychiatric illness
Learning disability
Death of parent at young age
Childhood neglect/abuse
What are predisposing factors for self harm?
Physical illness (patient or family member)
Relationship loss/difficulties
Criminal proceedings
