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Psychiatry > Suicide and RA > Flashcards

Suicide and RA Flashcards

1
Q

DSH

A

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

Expression of emotional distress

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2
Q

Epidemiology DSH

A

More common in adolescents and young adults. Women 15-19 years while men is 20-24

20-30 times more common than suicide

Those who have self harmed have a 50-100x greater risk of suicide

UK - 90% of DSH is drug overdose.

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3
Q

RF DSH

A

DSH Largely Comes Via Self Poisoning

Divorced / single
Severe life stressors
Harmful drug or alcohol use
Less than 35yo
Chronic physical health problems
Violence - domestic - or childhood maltreatment or ACE
Socioeconomic disadvantage
Psychiatric illness e.g. depression or psychosis

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4
Q

Methods of self injury

A
  • Cutting
  • Burning
  • Hanging
  • Stabbing
  • Swallowing objects
  • Shooting
  • Jumping from heights, or infront of vehicles
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5
Q

Methods of self poisoning

A
  • Medication
  • Illicit drugs
  • Household substances
  • Plant material
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6
Q

Examination of DSH

A

HX

  • Intention
  • Suicide ideation
  • Severe life stressors
  • Psychiatric illness
  • Collateral history from relatives or friends
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7
Q

Reasoning for DSH

A

DRIPS

Death wish - wish to die

Relief - temporary from other problems

Influencing others - change views or behaviour (make someone feel guilty for not caring enough)

Punishment - punish oneself

Seeking attention - expression of emotional distress

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8
Q

Ix DSH

A
  • Bloods - including paracetamol levels, salicylate levels and U+E and LFT / clotting factors
  • Urinalysis
  • CT head - intracranial causes - self poisoning
  • Lumbar puncture - intracranial infection - self poisoning
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9
Q

Treatment DSH

A

Bio - treatment of any overdose with antidote // suturing and anti-tetanus treatment if applicable to deep lacerations

Psych - CBT and counselling for underlying illnesses. Psychodynamic psychotherapy if PD.

Social - social services input and voluntary organisations - samaritans / mind

  • RA
  • Crisis team / hospitalisation if needed
  • Mental capacity assessment
  • Treating underlying illnesses
  • Psychosocial assessment
  • Pt must be followed up 48 hours after discharge.
  • 1 in 6 people who self harm and attend a+e will attend again within a year
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10
Q

Acute management of DSH

A

manage high suicide risk - treat psych disorder - enable pt to resolve difficulties leading to DSH - enable pt to manage future crisis

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11
Q

DDX

A
  • Self poisoning - head trauma, intracranial haemorrhage, intracranial infection, liver disease, metabolic abnormalities
  • Self injury - clotting disorders
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12
Q

Paracetamol OD antidote

A

N-acetylcystine

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13
Q

Opiate antidote

A

Naloxone

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14
Q

Benzo antidote

A

Flumazenil

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15
Q

Warfarin antidote

A

Vit K

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16
Q

Beta Blocker antidote

A

Glucagon

17
Q

TCA antidote

A

Sodium bicarbonate

18
Q

Organophosphate antidote

A

Atropine.

19
Q

Activated charcoal role in OD

A

within an hour can prevent or reduce absorption

20
Q

Help sites for OD

A

OXBASE - viewed for overdoses

National poison information service - further info if not known.

21
Q

Complications DSH

A
  1. Permanent scarring of skin and damage to tendons or nerves as a result of cutting
  2. Acute liver failure due to paracetamol overdose
22
Q

Suicide

A

Fatal act of self harm with intention of ending life

23
Q

Most common forms of suicide

A

hanging, strangulation and suffocation followed by poisoning

24
Q

Protective factors of suicide

A
  • Children
  • pregnancy
  • Strong religious beliefs
  • Strong social support
  • Positive therapeutic relationships
  • Supportive living arrangements
  • Life satisfaction
  • fear of physical act of suicide
  • Fear of disapproval by society
  • Responsibility for others
  • Pets
  • Hope for the future
25
Q

Risk of Suicide

A

IM A SAD PERSON

Institutionalised

Mental health disorders

Alone

Sex - male

Age - middle

Depression

Previous attempts

Ethanol use

Rational thinking is lost

Sickness

Occupation

No job - unemployed

26
Q

Clinical RF suicide

A
  • History of DSH
  • Psychiatric illness
  • Childhood abuse
  • FHx
  • Medical illness - disabling, terminal or painful
27
Q

Socio-demographic RF Suicide

A
  • Male
  • Age
  • Employment and financial status
  • Occupation
  • Access to lethal means
  • Social support
  • Marital status
  • Recent life crisis
28
Q

Symptoms of suicidal people

A
  • Preoccupation with death
  • Sense of isolation and withdrawal from society
  • Emotional distance and distress
  • Distraction and lack of pleasure
  • Focus or fixation on the past
  • Feelings of hopelessness and helplessness
29
Q

Examination of Suicidal person

A
  • Exploring suicidal ideation
  • Exploring suicide intent
  • Exploring risk factors
  • Perform MSE
  • Explore protective factors
  • Explore risk to others
  • Formulate management plan
  • COLLATERAL HISTORY
30
Q

RA of suicidal patient

A

Determining risk of suicide following DSH

Note Planned Attempts Are Very Frightening

Note left behind

Planned attempt

Attempts to avoid discovery

Afterwards help was not sought

Violent method

Final acts - sorting finances, wills etc

31
Q

Ix A Suicide

A
  • Drug levels
  • Tool for assessment of suicide risk - TASR
  • Suicide post mortem
32
Q

treatment suicide

A
  • Ensure safety
  • Medically stabilised
  • RA
  • Admission to hospital if needed under MHA
  • Referral to secondary care
  • Psych treatment
  • Crisis resolution and home treatment team
  • Outpatient and community treatment
  • Prevention
33
Q

Individual prevention suicide

A
  • Detect and treat psych disorders
  • Urgent hospitalisation under MHA
  • Crisis team
34
Q

Population suicide prevention

A
  • Public education
  • Reducing access to means of suicide - safety rails, limiting tablets etc and safe prescribing
  • Easy and rapid access to psych care - samaritans 24/7
  • Decreasing societal stressors - unemployment and domestic abuse
  • Reducing substance misuse
35
Q

Suicide vs DSH factors

A

Suicide -

  • males
  • risk with age increases
  • act may be planned meticulously
  • violent
  • physical and psych illness more common

DSH

  • females
  • young people
  • impulsive
  • overdose or cutting
  • physical and psych illness less common

Psychiatry (17 decks)

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