Suicide And Self harm Flashcards
What is deliberate self harm?
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.
What are the risk factors for deliberate self harm?
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
What can deliberate self harm take the form of and what is the most common?
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
What are the two commonest complications of deliberate self harm?
. Permanent scarring to the skin and damage to the tendon/muscles
. Acute liver failure due to paracetamol overdose
What are the reasons people describe harm?
Death wish Attention Punishment Influencing others Relief (seeking unconsciousness or pain as a means of temporary relief).
What investigations would you do in someone who has self harmed?
Bloods- paracetemol levels, salicylate levels, U and Es, LFTS, clotting
Urinalysis
CT head
Lumbar puncture
What is the management of suicide and self harm?
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
What is the antidote for paracetamol?
N-acetylcysteine
What is the antidote for opiates?
Naloxone
What is the antidote for benzodiazepines?
Flumazenil
What is the antidote for warfarin?
Vit K
What is the antidote for beta blockers?
Glucagon
What is the antidote for TCAs (amitriptyline)?
Sodium bicarbonate
What is the antidote for organophosphate?
Atropine
What can be used early to prevent absorption of the drug?
Activated charcoal
What questions should you ask to establish whether a self harm act was a serious attempt of suicide?
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?
What is suicide?
A fatal act of self harm initiated with the intent of ending ones own life.
What is attempted suicide?
The act of intentionally trying to take ones own life with the primary aim of dying but failing to succeed in this endeavour.
What are the protective factors of suicide?
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
What are the suicidal risk factors?
Institutionalised Mental health disorders Lack of social support Male Middle aged Alcohol use Rational thinking lost Sickness Occupation Unemployment
