Suicide and self-harm Flashcards
Define suicide.
Any act that deliberately brings about one’s own death.
1) What is self-harm?
2) Name 3 methods of self-harm.
1) Any act that intentionally causes physical harm to the body, but does not result in death. Some may represent attempted suicide, but many have little or no suicidal intent.
2) Cutting, burning or poisoning (overdoses).
1) What percentage of all deaths are suicides?
2) How has the suicide rate changed in the last 50 years?
3) What might reflect the lowest ever suicide rates currently in the UK?
4) Which age groups are at the highest risk of suicide?
5) In causes of death of young men aged 15-24, what is suicide second to?
6) Why are men 3-4 times more likely than women to die by suicide in the UK?
1) 1% of all deaths are suicide (a million deaths worldwide each year).
2) Increased from 10 to 16 per 100,000 (suicide is one of the top 10 causes of death in every country).
3) They are possibly a reflection of government measures to prevent suicide, some of which have been in place since 1997.
4) The elderly (>65) and 15-30 year olds.
5) Road traffic accidents.
6) Due to the method chosen. Method is usually more violent (hanging/ shooting).
List the 4 social causes of suicide.
1) life events and stress: suicide often preceded by life events, especially bereavement and other losses.ACEs may predispose individuals to suicide in later life.
2) Social class: social classes I and V are at the highest risk of suicide. Social classes `IV and V are at the highest risk of self harm.
3) Social isolation: People who die by suicide are more likely to be isolated, divorced, widowed, single, unemployed or living alone. Social cohesion is a protective factor.
4) Occupation: certain stressful jobs with access to lethal means have higher rates of suicide (vets, pharmacists, dentists, farmers and doctors).
List 6 mental health causes of suicide.
1) Previous suicide attempt: non-fatal self harm with clear suicidal intent is the strongest predictor of eventual suicide.
2) Previous self harm: up to 60% people who kill themselves have previously self harmed, regardless of suicidal intent.
3) Depression: Up to 80% people who die by suicide are depressed.
4) Schizophrenia: Young ambitious patients are particularly vulnerable when they are early in their illness with insight into the severity of the diagnosis. Command hallucinations may place people at extra risk,
5) Substance misuse: Alcohol dependance carries a lifetime risk of suicide of 3-4%. Alcohol and drug abuse also increase the risk of suicide.
6) Personality disorders: up to half of the people who die from suicide have a personality disorder.
1) As well as social and psychiatric causes of suicide, give 2 others.
2) Name 3 government interventions in the UK which have lowered suicide rates.
3) What proportion of individuals who die by suicide have a major mental illness at the time of death?
4) Why does risk of suicide increase for severely depressed people as they begin to recover?
1) Physical health problems such as chronic, painful or terminal illnesses and a family Hx of suicide.
2) Limiting packet sizes of paracetamol, installing barriers at suicide ‘hotspots’, providing a free telephone to call Samaritans, catalytic converters have decreased the suicide rate from inhaling car exhaust fumes).
3) 9 out of 10.
4) Because they gain energy and motivation to act on suicidal ideas as they begin to recover.
Before speaking to friends and family of a person who has died by suicide, what 6 facts about the death might you want to find out?
1) Names of key staff involved.
2) Suicide method
3) Injuries sustained.
4) Treatments given.
5) Whether they were conscious when found.
6) Any ‘final words’.
1) Why should you not avoid the topic of organ donation in a situation where a person has died by suicide?
2) For every suicide, how many people suffer intense grief reactions on average?
1) Because this might be the only positive outcome for the bereaved.
2) 6.
Give 5 characteristics of depressed patients with the highest risk of suicide.
Depressed patients at the highest risk of suicide tend to:
1) be older/ single
2) have previously self-harmed
3) Experience recurrent suicidal thoughts
4) Suffer insomnia or weight changes
5) Feel extremely hopeless, worthless or guilty.
1) What is the most common form of self harm?
2) Which type of self-harm causes the most presentations to hospital?
3) Name 3 other methods of self-harm.
4) What is a fairly common explanation for self-cutting?
1) Self-cutting.
2) Overdoses.
3) Burning, bruising and self-stabbing.
4) A sense of pressure or tension grows as emotions build up. Self-harm ‘releases’ the tension and a sense of calm or mild elation takes over (either at the point of cutting or at the point of seeing the blood).
Give 6 possible reasons for a patient self-harming.
1) Avoiding more dangerous self-harm or suicide.
2) Self-punishment
3) Suicide attempt.
4) Substituting psychological distress with physical pain.
5) Overcoming numbness.
6) To change intolerable situations (often relationship issues.
1) What is the lifetime risk of self-harm?
2) Which groups of people is self-harm more common in?
3) Who is more likely to present to casualty after self-harming?
4) What 2 diagnoses is self harm associated with?
5) People with which disorders are at a higher risk of self harm due to impulsivity?
1) 7-13%.
2) More common in children and adolescents.
3) Women are more likely to present although rates are thought to be similar.
4) Affective disorder and personality disorder.
5) Those suffering from substance abuse, borderline and dissocial personality disorder.
1) Which 2 social factors are common associations with self-harm?
2) What is the theory behind people with ACEs being at increased risk of self-harm?
1) Past childhood abuse and current domestic violence.
2) When childhood is traumatic, abusive or neglectful, there is little space for reflection and thought, and os emotional experiences can only be dealt with by action. This may evolve into self-harm as a way of dealing with difficult emotions when the ability to mentalist is poorly developed or damaged.
1) What does good management of patients who have self-harmed involve?
2) What should happen with regards to treatment for self-harm if a patient lacks capacity?
3) What treatment might be given if a patient has overdosed on antidepressants?
1) Depends on building rapport with patients who have self-harmed to understand their actions.
2) They should be treated based upon best interests.
3) Activated charcoal as it decreases gut absorption of some substances.
1) What pharmacological treatment is given if a patient has overdosed on paracetamol?
2) How might lacerations need to be treated?
3) What may allow a patient to receive ongoing treatment at home after significant self-harm as opposed to being admitted to a psychiatric hospital?
1) N-acetylcysteine.
2) Sutures/ steristrips/ plastic surgery for deep cuts with nerve or tendon damage/ adequate analgesia.
3) If the patient does not feel suicidal, if they have supportive friends and family around them and if they are willing to seek help if they experience suicidal ideation.
