Suicide and Self Harm Flashcards
1
Q
epidemiology: self harm
A
- F>M
- overdose most common followed by cutting
- peak 15-24y
2
Q
Appleby studies
A
- majority died of suicide had history of DSH
- nearly half lived alone
- comorbid alcohol and drugs
- almost hlf in contect with services week before death
- 1-2 weeks peak day 3 post discharge
- economic adversity major risk
- 25% major physical health condition
- domestic violence and recent anniversary of life event both RF
3
Q
RFs: suicide
A
- male
- unemploed
- social isolation
- previous suicide attempt
- family histor
- significant life event
- recent acute psychiatric admission
- major physical illness
- economic adversity
- domestiv abuse
- anniversary of life event
- post discharge
4
Q
management: post-discharge
A
follow up on day 3
5
Q
psychiatric and medical RFs: suicide
A
mood disorders - depressive and BPAD
schizophrenia esp negative symptoms and functional decline
substance abuse
chronic physical health condition
6
Q
prevention: suicide
A
- government policies - zero suicide
- decreasing availability of common methods (paracetamol etc)
- antidepressants and use of drugs less toxic in overdose
- education about mental health issues and reducing stigma
- improved detection and treatment of mental illness in primary care
- construction changes (bridge phones and fences etc)
7
Q
risk assessment: suicide
A
- clear plan/preparations?
- final acts - letters, change in will etc)
- ongoing wishes to die
- hx previous attempts
- support available?
- planned or impulsive?
- ay alcohol/dugs taken?
- precaustions against being foound?
- how was patient found?
- chosen method dangerous/lethal?
- did they change their mind when they were doing it/regretful?
8
Q
tx: suicide
A
bio-psycho-social rx
biological: antidepressants/mental illness drugs
limit number of tablets dispensed
psycho: address addictions and signpost help services
arrange follow ups
social: involve family members in care plan with pt consent
9
Q
RF: violent behavious and acts
A
- history violence
- male
- unemployed
- living in violent subculture
- substance abuse
- low IQ/brain injury
- availability of weapons
- command hallucinations
- delusions of control/persecution
- poor enagagement with treatment and services
10
Q
violent: risk assessment
A
- previous violence/ forensic hx
- evidence of few relationships, frequent change of jobs or addresses
- personality traits
- poor compliance with tx or disengagement from psychiatric aftercare
- substance abuse or social background prompting violence
- precipitants/ change in MSE/behaviour
