Suicide and self-harm Flashcards
What is deliberate self-harm
Intentional act of self poisoning or self injury
Irrespective of motivation
Usually to express emotional distress
What are the risk factors for deliberate self harm
Divorced/single/living alone
Severe life stressors
Harmful drug/alcohol use
Age <35
Chronic physical health problems
Violence or childhood maltreatment
Socioeconomic disadvantage
Psychiatric illness
What is the epidemiology for deliberate self-harm
M>F
Peak in males 15-19
Peak in females 20-24
20-30 times more common than suicide
What are the clinical features of deliberate self-harm
Self-poisoning
- Overdose
Self-injury
- Cutting, burning, slashing
Complications
- Permanent scarring of skin
- Damage to tendons/nerves
- Acute liver failure (paracetamol)
What are the investigations for deliberate self-harm
Bloods
- Paracetamol levels, salicylate levels, U&Es, LFTs, clotting screen
Urinalysis for toxic agents
CT head/lumbar puncture
What is the management for deliberate self harm
Biological
- Treat overdose, suturing
Psychological
- Counselling, CBT, psychodynamic psychotherapy
Social
- Social services input
Through risk assessment
Follow up in 48 hours
What are the antidotes for commonly overdosed drugs
Paracetamol
- N-acetylcystine
Opiates
- Naloxone
Benzodiazepines
- Flumazenil
Warfarin
- Vitamin K
Beta-blockers
- Glucagon
Organophosphates
- Atropine
What are the risk factors for suicide
History of self harm
Previous suicide attempts
Psychiatric illness
Childhood abuse
Family history
Medical illness
M>F
Age 40-44
Unemployed
Low socioeconomic status
Occupation (vets, doctors, nurses, farmers)
Access to lethal means
Lack of social support
Institutionalised
Recent life crisis
What are the common protective factors from suicide
Children/pregnancy
Strong religious/spiritual beliefs
Strong social support
Positive coping skills
Positive therapeutic relationship
Supportive living arrangements
Life satisfaction
Fear of physical act of suicide
Fear of disapproval by society
Hope for the future
What are the common methods of suicide
Hanging
Strangulation
Suffocation
Poisoning
What are the clinical features of high suicide risk
Preoccupation with death
Sense of isolation and withdrawal from society
Emotional distance from others
Distraction and lack of pleasure
Focus on the past
Hopelessness
Helplessness
What is involved in a suicide risk assessment
Explore suicidal ideation
Explore suicidal intent
Explore risk factors
Perform MSE
Explore protective factors
Explore risk to/from others
Formulate management plan
What is the management for suicide risk
Ensure safety
Medically stabilise
Thorough risk assessment
Consider admission
Psychiatric treatment
Involve crisis team
Prevention strategies
- Education, easy access to care, decrease social stressors
