Suicide and Deliberate Self Harm

Question 1

The majority of people suffering from a psychiatric illness ________1___________
The majority of people who take their own life ______2______
Most people who DSH ______3______

Answer 1

1) do not take their own life
2) are suffering from a major psychiatric illness
3) dont have a major psychiatric illness

Question 2

Are suicide rates higher in men or women?

Answer 2

men

Question 3

Majority of suicides are in what age group?

Answer 3

middle age

especially in richer countries

Question 4

Suicide rates are higher in _____ deprived areas

Answer 4

more

Question 5

Scotland has a _____ suicide rate than RUK

Answer 5

higher

Question 6

Suicide rates are _____ in urban areas vs rural

Answer 6

higher

Question 7

Describe seasonal variation in suicide rates?

Answer 7

there is a spring peak and an autumn trough

Question 8

Describe marital status and suicide rates?

Answer 8

marriage is protective of suicide vs any other marital status (however this could be selection bias because those with a severe psychiatric illness are less likely to be married)

Question 9

What occupations have the highest rates of suicide? Why?

Answer 9

farmers, vets and doctors

thought to be due to easier access to high end modes of lethality

Question 10

Doctor specialities with highest rates of suicide?

Answer 10

anaesthetists, GPS and psychiatrists

Question 11

Relationship between smoking and suicide rate?

Answer 11

people who smoke has higher rates of suicide (but again this could be down to the fact that people with a psychiatric illness are more likely to smoke)

Question 12

Describe media reporting and suicide rates?

Answer 12

increased reporting and media around suicide e.g. 13RW, Robin Williams articles increases suicide

Question 13

Rates of suicide by a particular method correlate very much to _______

Answer 13

the availability of that particular method

Question 14

Explain suicide pacts?

Answer 14

these are quite unusual and only 1/3 are completed
this is an agreed plan between 2 or more individuals to die by suicide
plan may be to die together, separately or closely timed

Question 15

Explain murder suicide?

Answer 15

an act in which an individual kills one or more people before or while killing oneself
the other people haven’t consented to being killed

Question 16

Describe neurobiology of suicide and DSH?

Answer 16

Patient with history of DSH often have lower CSF 5-HIAA (serotonin metabolite) than controls
There is also reduced binding to 5-HT (serotonin) transporter sites in the ventral pre frontal cortex
SPECT (type of brain scan) in those just before self harm showed decreased frontal activity
Genetic component - higher rates of concordance in monozygotic vs dizygotic twins

Question 17

Relationship between childhood sexual abuse and DSH?

Answer 17

Experience of childhood sexual abuse is thought to influence epigenetic regulation of hippocampal glucocorticoid expression, ultimately affects the adrenal axis > hence affects the stress response and risk of DSH

Question 18

Describe common methods of suicide in men and women?

Answer 18

Females more commonly poisoning
Men more commonly hanging
Men tend to favour more violent, highly lethal methods of suicide which may partly explain the higher rates

Question 19

Describe prevention of suicide and limiting access to methods?

Answer 19

Limiting access to a method of suicide is important because reducing suicide by 1 method does NOT result in a compensatory rise in other methods
Restricting access leads to overall reduction, not everyone substitutes and those that substitute may choose a lower lethality method

Question 20

Describe the suicide help app?

Answer 20

patients who have had suicidal thoughts download and make a plan for when they have these feelings

Question 21

Describe the relationship between illness and suicide?

Answer 21

about 10% of suicides have a chronic or long term illness
contribution of those with a cancer diagnosis is actually quite small
associations is most marked in those with chronic, debilitating, dignity losing conditions e.g. MND and parkinsons

Question 22

Describe population of DSH vs suicide?

Answer 22

DSH is more females in early adulthood

suicide is more men in middle age

Question 23

Most episodes of self harm are ________

Answer 23

self poisoning

Question 24

The more bizarre the method of self harm the more likely the patient is to be suffering from _________

Answer 24

psychosis

Question 25

What is the single strongest risk factor for suicide?

Answer 25

history of DSH

Question 26

Structure of assessment of suicidal risk consultation?

Answer 26

Before, during, after event, screen for other mental disorders that can increase suicide risk

Question 27

Describe what questions you would ask in the before section of suicidal risk consultation? (5)

Answer 27

Was there a precipitant?
Examples may include an argument with a spouse or a recent bereavement.

Was the self-harm planned, or impulsive?

Did the patient carry out any final acts?
Write a suicide note
Leaving a will
Terminating contracts (e.g. mobile phone, gas and electricity)

Were any precautions taken against discovery?
Closing curtains
Locking doors
Waiting until they knew everyone would be out of the house and not be back for several hours
Going somewhere very remote

Was alcohol used?
Ask about the amount and type used
Ask about previous alcohol use

Question 28

Describe what questions you would ask in the during section of suicidal risk consultation? (6)

Answer 28

What method of self-harm was involved?

Was the patient alone?

Where were they when they self-harmed?

What was going through their mind at the time?

Did they think their self-harm would end their life?

What did they do straight after the self-harm?

Question 29

Describe what questions you would ask in the after section of suicidal risk consultation? (12)

Answer 29

Did the patient call anyone?

How did they get to A&E?

Who were they found by?

How did they feel when help arrived?

How does the patient feel about the attempt now? Do they regret it?

What is the patient’s current mood?

Does the patient still feel suicidal?

If the patient were to go home today, what would they do? (make sure you cover the next few days)

If the patient were to feel like this again, what might they do differently?

What does the patient think might prevent them from doing this again in the future?

Does the patient feel there is anything to live for? (i.e. protective factors)

Will the patient accept treatment?

Question 30

Name 3 mental disorders you want to screen for in suicidal risk consultation?

Answer 30

depression, anorexia and psychosis

Question 31

What is paracetamol overdose treated with?

Answer 31

if within an hour you can give activated charcoal as this decreases gut absorption
if more than an hour it is treated with n-acetyl cysteine

Question 32

What is tri-cyclic antidepressant overdose treated with?

Answer 32

sodium bicarbonate

Question 33

What is benzodiazepine overdose treated with?

Answer 33

IV flumanezil