Suicide And Self harm

Question 1

What is deliberate self harm?

Answer 1

Refers to the intentional act of self injury or self poisoning, irrespective of the motivation or apparent purpose of the act, it is usually an expression of emotional distress.

Question 2

What are the risk factors for deliberate self harm?

Answer 2

Divorced, single, living alone 
Severe life stressors 
Harmful drug/alcohol use 
Less than 35 
Chronic physical health problems 
Violence (domestic) or childhood maltreatment 
Socioeconomic disadvantage 
Psychiatric illness

Question 3

What can deliberate self harm take the form of and what is the most common?

Answer 3

Self poisoning in the form of overdose
Self injury in the form of cutting, burning, slashing.
90% of DSH is cutting, while 10% are self injury

Question 4

What are the two commonest complications of deliberate self harm?

Answer 4

. Permanent scarring to the skin and damage to the tendon/muscles
. Acute liver failure due to paracetamol overdose

Question 5

What are the reasons people describe harm?

Answer 5

Death wish 
Attention 
Punishment 
Influencing others 
Relief (seeking unconsciousness or pain as a means of temporary relief).

Question 6

What investigations would you do in someone who has self harmed?

Answer 6

Bloods- paracetemol levels, salicylate levels, U and Es, LFTS, clotting
Urinalysis
CT head
Lumbar puncture

Question 7

What is the management of suicide and self harm?

Answer 7

Acute management= specific antidotes, suturing, surgical input for complex wounds

Make sure to manage the high suicide risk by doing a full risk Assessment and consider inpatient psychiatric Assessment

Treat any underlying psychiatric disorders

Manage psychosocial needs

Refer to drug/alcohol services if appropriate

Offer occupational and financial rehabilitation service

Question 8

What is the antidote for paracetamol?

Answer 8

N-acetylcysteine

Question 9

What is the antidote for opiates?

Answer 9

Naloxone

Question 10

What is the antidote for benzodiazepines?

Answer 10

Flumazenil

Question 11

What is the antidote for warfarin?

Answer 11

Vit K

Question 12

What is the antidote for beta blockers?

Answer 12

Glucagon

Question 13

What is the antidote for TCAs (amitriptyline)?

Answer 13

Sodium bicarbonate

Question 14

What is the antidote for organophosphate?

Answer 14

Atropine

Question 15

What can be used early to prevent absorption of the drug?

Answer 15

Activated charcoal

Question 16

What questions should you ask to establish whether a self harm act was a serious attempt of suicide?

Answer 16

Was it planned?
Was a suicide note left?
Was the patient intoxicated with drugs or alcohol?
Was the patient alone?
Were there efforts to avoid discovery? 
Did the patient seek help after the attack or were they found and brought in by someone else? 
How does the patient feel about it now? 
How did they feel when they were found?

Question 17

What is suicide?

Answer 17

A fatal act of self harm initiated with the intent of ending ones own life.

Question 18

What is attempted suicide?

Answer 18

The act of intentionally trying to take ones own life with the primary aim of dying but failing to succeed in this endeavour.

Question 19

What are the protective factors of suicide?

Answer 19

Children at home 
Pregnancy 
Strong religious beliefs 
Strong social support 
Positive coping skills 
Positive therapeutic relationship 
Supportive living arrangements 
Life satisfaction 
Fear of the physical act of suicide 
Fear of disapproval by suicide 
Hope for the future

Question 20

What are the suicidal risk factors?

Answer 20

Institutionalised 
Mental health disorders 
Lack of social support 
Male 
Middle aged 
Alcohol use
Rational thinking lost 
Sickness 
Occupation 
Unemployment