Self-harm & suicide

Question 1

Define self-harm

Answer 1

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

Question 2

What is the most common type of self-harm?

Answer 2

90% = self-poisoning

Question 3

Who are the risk factors for self-harm?

Answer 3

Women
Younger people (15-25)
Lower social class
South asian women
Unemployed
Urban living

Question 4

What are the main causes of self-harm?

Answer 4

Drug/alcohol dependency
Major depressive disorder
Abuse & bullying
Emotional/stressful/traumatic events

Question 5

What are the types of self-harm?

Answer 5

Ingestion: Excessive substance, non-ingestible substance, recreational/illicit drugs
Behavioural: self-cutting

Question 6

What questions should be asked of someone who attempted suicide? Would you be concerned if they were positively answered?

Answer 6

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?

Question 7

Are there any further questions you would ask to someone who has committed suicide?

Answer 7

• 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?

Question 8

What are absolute indications for referral to a psychiatrist?

Answer 8

• Clinical depression
• Psychotic illness of any kind
• Clearly preplanned suicidal attempt with intent not to be discovered
• A violent method used
• Persistent suicidal intent

Question 9

What are common indications for a referral to a psychiatrist?

Answer 9

• 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

Question 10

How is a drug overdose treated?

Answer 10

Activated charcoal (within 1hour of ingestion to prevent absorption)

Question 11

What toxins will not bind to charcoal?

Answer 11

Hydrocarbons
Alcohol
Metals
Corrosives
Malathion

Question 12

What should NOT be used in self-poisoning?

Answer 12

Emetics (Ipecac)

Gastric lavage- unless specific recommendations from Toxbase

Question 13

What is the prognosis for suicide?

Answer 13

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%

Question 14

What factors increase the risk of suicide?

Answer 14

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

Question 15

What is the most common cause of suicide?

Answer 15

90% = mental illness

Question 16

What tools can be used to assess suicide?

Answer 16

TASR

Tool for assessment of Suicide Risk

Question 17

What is contained in a TASR assessment?

Answer 17

• Individual risk profile
• Symptom risk profile
• Interview risk profile
• Risk buffers

Question 18

What is found in the individual risk profile section of a TASR assessment?

Answer 18

Demographics
Fix
Past/Present psychiatric diagnosis
Poor social support
Domestic problems
Exposure to suicide
Past/present abuse
Past suicide behaviours
Poor stress tolerance

Question 19

What is found in the symptom risk profile section of a TASR assessment?

Answer 19

Depression/dysphoria
Hopelessness
Severe anhedonia
Intense emotion
Shut down
Severe self-reproach/worthlessness
Impaired reasoning
Psychosis
Poor self-control
problematic alcohol/drug use

Question 20

What is found in the interview risk profile section of a TASR assessment?

Answer 20

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

Question 21

What is found in the risk buffers section of a TASR assessment?

Answer 21

Reasons for living
Internal strengths for managing risk
External strengths for managing risk

Question 22

What are the 5 key components of suicide?

Answer 22

Ideation
Intent
Plan
Access to lethal means
History of past suicide attempts

Question 23

What questions would you ask someone about ‘before’ they attempted to commit suicide?

Answer 23

Events leading up to the attempt

Planning

Question 24

What questions would you ask someone about ‘during’ they attempted to commit suicide?

Answer 24

Mechanism
Where & when
How were they discovered
Alcohol/drug use
Uncooperative
PATHOS score

Question 25

What is the PATHOS score and how is it used?

Answer 25

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

Question 26

What questions would you ask someone about ‘after’ they attempted to commit suicide?

Answer 26

Feelings Now
Future feelings
If you were to go home now, what would happen?

Question 27

What are individual risk factors for self harm?

Answer 27

Psychiatric illness
Learning disability
Death of parent at young age
Childhood neglect/abuse

Question 28

What are predisposing factors for self harm?

Answer 28

Physical illness (patient or family member)
Relationship loss/difficulties
Criminal proceedings