Suicide And Self Harm Flashcards
What is DSH?
Deliberate self harm is the act of self injury (cutting, hanging, stabbing) or self poisoning (OD, household substances), regardless of the motivation. Usually due to emotional distress.
What are the RF for DSH?
DSH Largely Comes Via Self-Poisoning Divorce, single, lives alone Severe life stressors Harmful drugs/alcohol use (half take alcohol 6hrs before the act) Less than 34yrs old Chronic health conditions Violence I.e. domestic or child abuse Socioeconomic status low Psychiatric illness I.e. depression
What are the common methods of DSH in the UK?
What are the two most common side effects of DSH?
Paracetamol, benzodiazepines and anti-depressants OD. (90%)
Self injury. (10%)
Permanent scarring of skin and damage to nerves/tendons.
Acute liver failure due to paracetamol OD.
How is DSH investigated?
Hx- DRIPS Death wish? Relief from self harming? Influencing others to change their views/behaviours? Punishing oneself? Seeking attention to try get help?
Is there a psychiatric illness?
What are the current problems (stressors) in their life?
What were their intentions before and after the act?
Collateral Hx is important.
Investigations-
Bloods- paracetamol levels (accurate within 4-15hrs), salicylate levels, U+Es, LFTs and clotting.
Urinalysis
CT if alternated consciousness is suggested by an intracranial cause (instead of self poisoning)
Lumbar puncture if intracranial infection is suspected as an alternative cause (to self poisoning)
What are the differentials for DSH?
Self poisoning- head trauma, intracranial haemorrhage, intracranial infection, liver disease, metabolic abnormalities i.e. hypoglycaemia.
Self injury- clotting disorders (causing significant bruising, bleeding)
How is DSH managed?
Biopsychosocial-
Biological-
Give antidotes
Suture any lacerations
Give anti-tetanus treatment for deep lacerations
Psychological-
CBT and counselling for underlying depression
Psychodynamic psychotherapy if PD
Social-
Social services input
Voluntary organisations i.e. Samaritans, Mind
Risk assessment- checking the need for hospitalisation +/- use of MHA section 2.
Crisis team in the community
If refusing medication, assess mental capacity
Treat underlying psychiatric illness
Side effects of overdose should be considered I.e. TCAs cause arrhythmias and convulsions
Psychosocial assessment
Follow up within 48hrs of discharge
Remove access to means of DSH I.e. limited prescribing
What are the antidotes for OD?
Paracetamol- N-Acetylcysteine Opiates- Naloxone Benzodiazepines- Flumazenil Warfarin- Vitamin K B-blockers- Glucagon TCAs- Sodium Bicarbonate Organophosphates- Atropine
What is suicide?
Self harm with the intention of ending ones own life.
Attempted suicide- failed attempt of suicide
What are the RF for suicide?
What are the protective factors for suicide?
RF- I’M A. SAD PERSON
Institutionalised
Mental health disorder/martial status I.e. single, divorced.
Alone (lack of social support)
Sex (male)
Age (middle age)
Depression
Previous attempt Ethanol use Rational thinking lost Sickness Occupation (vet, farmer, nurse, doctor, dentist) No job (unemployed)
Protective-
Family, pregnant, religious beliefs, spiritual beliefs, society disapproval, scared to carry out the thought etc.
What are the clinical features of suicide?
Most common method was suffocation, hanging and strangulation, followed by poisoning.
Feel hopeless/helpless No plans for future, dwell on past Preoccupied with thought of death Distant from others Anhedonia Isolated from society
How is suicide investigated?
Collateral Hx
Medical investigation dependent on method I.e blood test for LFTs, U+Es, drug levels etc.
Post mortem
Questionnaire- Tool for suicide assessment risk.
Enquire about: Note left behind Planned attempt Attempts to avoid discovery Help not sought after event Violent method Final acts I.e. sorting out finances, writing a will etc.
Explore suicidal ideation- How do you feel about your future? Do you feel life is worth living? Was it planned? What method did they use? Explore RF Explore protective factors Explore risk to others Formulate a management plan
How is suicide managed?
Ensure safety by removing means of suicide or harm to others.
Stabilise medically I.e. OD or physical harm management.
Risk assessment
Admit to hospital if high risk of suicide, may be under MHA.
Refer to secondary care (if suicidal ideation, underlying severe psychiatric illness, lack of social support, presentation change for a repeated self harmer)
Treat psychiatric illness
Involve crisis resolution and home treatment team.
Prevention strategies
How can suicide be prevented?
Individual level-
Detect and treat psychiatric disorders
Urgent hospitalisation under MHA
involve Crisis Resolution and home treatment team
Population level-
Public education
Reduce means of suicide I.e. dispose of unwanted tablets, safer prescribing, safety railing at heights.
Easy and rapid access to psychiatric care
Decreasing societal stressors I.e. unemployment, domestic violence.
Reducing substance misuse
