Suicide and Deliberate Self Harm Flashcards
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______
1) do not take their own life
2) are suffering from a major psychiatric illness
3) dont have a major psychiatric illness
Are suicide rates higher in men or women?
men
Majority of suicides are in what age group?
middle age
especially in richer countries
Suicide rates are higher in _____ deprived areas
more
Scotland has a _____ suicide rate than RUK
higher
Suicide rates are _____ in urban areas vs rural
higher
Describe seasonal variation in suicide rates?
there is a spring peak and an autumn trough
Describe marital status and suicide rates?
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)
What occupations have the highest rates of suicide? Why?
farmers, vets and doctors
thought to be due to easier access to high end modes of lethality
Doctor specialities with highest rates of suicide?
anaesthetists, GPS and psychiatrists
Relationship between smoking and suicide rate?
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)
Describe media reporting and suicide rates?
increased reporting and media around suicide e.g. 13RW, Robin Williams articles increases suicide
Rates of suicide by a particular method correlate very much to _______
the availability of that particular method
Explain suicide pacts?
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
Explain murder suicide?
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
Describe neurobiology of suicide and DSH?
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
Relationship between childhood sexual abuse and DSH?
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
Describe common methods of suicide in men and women?
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
Describe prevention of suicide and limiting access to methods?
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
Describe the suicide help app?
patients who have had suicidal thoughts download and make a plan for when they have these feelings
Describe the relationship between illness and suicide?
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
Describe population of DSH vs suicide?
DSH is more females in early adulthood
suicide is more men in middle age
Most episodes of self harm are ________
self poisoning
The more bizarre the method of self harm the more likely the patient is to be suffering from _________
psychosis
What is the single strongest risk factor for suicide?
history of DSH
Structure of assessment of suicidal risk consultation?
Before, during, after event, screen for other mental disorders that can increase suicide risk
Describe what questions you would ask in the before section of suicidal risk consultation? (5)
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
Describe what questions you would ask in the during section of suicidal risk consultation? (6)
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?
Describe what questions you would ask in the after section of suicidal risk consultation? (12)
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?
Name 3 mental disorders you want to screen for in suicidal risk consultation?
depression, anorexia and psychosis
What is paracetamol overdose treated with?
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
What is tri-cyclic antidepressant overdose treated with?
sodium bicarbonate
What is benzodiazepine overdose treated with?
IV flumanezil
