Suicide and self-harm

Question 1

What is deliberate self harm (DSH)?

Answer 1

Intentional act of self-poisoning or self-injury irrespective of the motivation or apparent purpose of the act - expression of emotional distress

Question 2

Name some risk factors for DSH?

Answer 2

Divorced / single / living alone

Severe life stressors

Harmful drug use

Less than 35 years old

Chronic physical health problems

Domestic violence

Socioeconomic disadvantage

Psychiatric illness e.g. depression or psychosis

Question 3

What is the most common form of DSH in the UK? What is used?

Answer 3

Drug overdose

Non-opiod analgesics (including paracetamol and salicylates - aspirin), anxiolytics including benzos, antidepressants

Question 4

What are the 3 commonest complications of DSH?

Answer 4

Permanent scarring of the skin

Damage to tendons and nerves

Acute liver failure

Question 5

What are the investigations for DSH?

Answer 5

Bloods including paracetamol levels (accurate between 4 and 15 hours after ingestion), salicylate levels, U&Es (renal function), LFTs and clotting (synthetic hepatic function)

Urinalysis for toxicological analysis

CT head if intracranial cause for altered consciousness

Lumbar puncture if meningitis suspected

Question 6

What is the biopsychosocial management of self-harm?

Answer 6

Biological = treat any overdose with antidote, suturing (maybe anti-tetanus treatment)

Psychological = counselling and CBT for underlying depressive illness. psychodynamic psychotherapy for personality disorder

Social = social services and samaritans / mind

RISK ASSESS (+ MHA)

Maybe use crisis team in the community

Follow up 48 hours after discharge

Question 7

What are the antidotes to the following overdoses:

Paracetamol

Opiates

Benzodiazepines

Warfarin

Beta-blocker

TCA (e.g. amitriptyline)

Organophosphates

Answer 7

Paracetamol = N-Acetylcysteine

Opiates = naloxone

Benzodiazepines = flumazenil

Warfarin = Vit K

Beta-blocker = Glucagon

TCA (e.g. amitriptyline) = Sodium bicarbonate

Organophosphates = atropine

Activated charcoal if used within one hour of injection can prevent absorption of the drug

Question 8

What are some protective factors against suicide?

Answer 8

Children at home

Pregnancy

Strong religious beliefs

Positive therapeutic relationship

Question 9

What are the risk factors for suicide?

Answer 9

Psychiatric illness

Childhood abuse

FH

Alone

Male

Middle aged

Depression

Previous attempts

Alcohol abuse

No job

Question 10

Name some features of a high risk attempted suicide

Answer 10

• Note
• Planned attempt
• Tried to avoid discovery
• Help not sought after
• Violent methods
• Final acts: sorting out finances, writing a will

Question 11

What is in the managment plan of attempted suicide?

Answer 11

• Ensure safety: remove means for suicide
• Medically stabilized e.g. management of drug overdose
• Risk assess (possibly admit using MHA)
• Involve crisis resolution and home treatment team