Suicide and Self-Harm Flashcards
What is the definition of deliberate self-harm?
Refer to intentional acts of self-poisoning or self-injury irrespective of motivation or apparent purpose of the act. Usually, an act of emotional distress
What are risk factors of Deliberate Self-harm?
- Divorced/single/living alone
- Severe life stressors
- Harmful drug/alcohol use
- Less than 35 years of age
- Chronic physical health problems
- Violence or childhood maltreatment
- Socioeconomic disadvantage
- Psychiatric illness e.g. depression, psychosis
What are methods of deliberate Self-harm?
- Methods of self-injury: cutting burning, hanging, stabbing, swallowing objects, shooting, jumping from heights or in front of vehicles, drowning oneself
- Methods of self-poisoning: medication overdose (paracetamol, salicylates, anxiolytics, antidepressants), plant material
What are complications of Deliberate Self-harm?
- Permanent scarring of skin and damage to tendon and nerves as result of self-cutting
- Acute liver failure due to paracetamol overdose
What are investigations for Deliberate Self-Harm?
- Bloods: paracetamol levels, salicylate levels, U&Es, LFTs and clotting
- Urinalysis: possible toxicological analysis
- CT head if intracranial cause for altered consciousness is suspected
- Lumbar puncture if intracranial infection suspected
What is the management for Deliberate self harm?
- Biological: treat any overdose with appropriate antidote and suturing for deep laceration. Anti-tetanus treatment if appropriate
- Psychological: include counselling and CBT for underlying depressive illness. Psychodynamic psychotherapy appropriate of has personality disorder.
- Social: social services input and voluntary organisations
- Mandatory risk assessment for suicide and repeated acts of self-harm. MCA assessment may be required. Crisis team involvement in community
- Treat underlying psychiatric illness with medication and/or psychological therapies. Consider safety in overdose of antidepressants. Ensure follow up 48 hours post discharge
What are common drugs of poisoning and their antidotes?
Paracetamol → N-acetylecysteine
Opiates → Naloxone
Benzodiazepine → Flumazenil
Warfarin → Vitamin K
Beta-blockers → Glucagon
TCAs (e.g. amitryptiline) → Sodium Bicarbonate
Organophosphates → Atropine
What is the use of activated charcoal?
For majority of drugs taken in overdose, early use of activated charcoal (within one hour of ingestion) can prevent or reduce drug absorption
What is the definition of Suicide?
Suicide: fatal act of self-harm initiated with the intention of ending one’s life
- 13th leading cause of death. Most common methods are hanging, strangulation and suffocation following by poisoning
What is attempted suicide?
- Act of intentionally trying to take own life with primary aim of dying but failing to succeed
What are clinical risk factors of Suicide?
- History of deliberate self-harm or attempted suicide
- Psychiatric illness: depression, schizophrenia, substance misuse, alcohol abuse and personality disorder
- Childhood abuse (sexual or physical)
- Family history of suicide or suicide attempt
- Medical illness
What is the socio-demographic risk factors of Suicide?
- Male gender
- Age: 40 to 44 in men
- Employment and financial status: low socioeconomic and unemployed
- Occupation: vets, doctor, nurses and farmer
- Access to lethal means
- Low social support, living alone, institutionalised
- Single widowed, separated or divorced
- Recent life crisis e.g. bereavement, family breakdown
- Alcohol or drug misuse
What are factors associated with increased risk of completed suicide at future date in a patient who has attempted suicide in the past?
- Efforts to avoid discovery
- Planning
- Leaving a written note
- Final acts such as sorting out finances
- Violent method
What are protective factors for suicide?
- Family support
- Having children at home
- Religious belief
- Fear of disapproval from society
- Positive therapeutic relationship
- Supportive living arrangement
- Fear of the physical act of suicide
What are clinical features of someone who is suicidal?
- Preoccupation with death: Thoughts, fantasies, ruminations and preoccupations with death, particularly self-inflicted death.
- Sense of isolation and withdrawal from society.
- Emotional distance from others.
- Distraction and lack of pleasure: Often are ‘in their own world’ and suffer from anhedonia.
- Focus on the past: They dwell on past losses and defeats and anticipate no future; they voice the notion of Beck’s cognitive triad that the world would be better off without them.
- Feelings of hopelessness and helplessness.
What are investigations for Suicide?
- Investigate according to method
- TASR, BECK suicide intent scale
- Suicide confirmed by post-mortem
What are key differences between suicide and self-harm?
Suicide
- More in males
- Risk increases with age
- Act may be planned meticously
- Act is more often violent
- Physical and psychiatric illness is common
Self-harm
- More common in females
- More common in young people
- Act is impulsive
- Usually in form of overdose or cutting
- Physical and psychiatric illness is less common
What is the immediate management of Suicide?
- Ensure safety: Immediate action should include removing means for suicide and ensuring the safety of the patient and others.
- Patients who have attempted suicide and failed, should be medically stabilized, e.g. management of drug overdose or treatment of physical injury.
What should be done before the patient is discharged?
- Risk assessment: The risk of further suicide should then be assessed. People with a high degree of suicidal intent, specific plans, or chosen methods (particularly if lethal) should be assigned a higher level of risk
- Admission to hospital (or observation in a safe place) is generally indicated if individuals pose a high and immediate risk of suicide. MCA might be required if the patient refuses help and there is evidence of a mental illness.
- Referral to secondary care.
How should a patient who has attempted suicide be followed up?
- Psychiatric treatment: Depression or psychosis should be detected and treated accordingly. Involvement of the Crisis Resolution and Home Treatment team to provide support immediately following discharge can be instrumental.
- Outpatient and community treatment may be more suitable for patients with chronic suicidal ideation but no history of previous significant suicide attempts. For this to succeed, a strong support network and easy access to outpatient and community facilities are required.
- Prevention strategies
