Suicide, Self Harm + Mental State Assessment Flashcards
What scores can be used to assess mental state?
Mini mental state examination (MMSE)
GP assessment of cognition (GPCOG)
Outline mini mental state examination
- used to assess patients presenting with mental health symptoms
- risk assessment follows to give an estimate of risk of self harm, suicide + harm to others
What is euthymia?
Normal + neutral mood
Not low or elevated
What is anhedonia?
Lack of interest in activities
What is avolition?
Lack of motivation
What is self harm?
Intentional self injury without suicidal intent
Most commonly cutting
What demographic is self harm most commonly in?
Females
<25 years old
What factors are associated with self harm + suicide ?
- mental health conditions e.g. depression, anxiety, PTSD, schizophrenia
- socio-economic disadvantage
- substance misuse
- lack of support
- access to means
- criminal problems
Cycle of self harm
6 steps
- 1: emotional suffering
- 2: emotional overload
- 3: panic
- 4: self harming
- 5: temporary relief
- 6: shame + guilt
Classification of self harm
Suicide attempt (intent to die)
Non-suicidal self injury (no intent to die)
Short term management after an act of self harm in primary care
- establish means of self harm
- assess severity of injury, safeguarding concerns, whether referral to specialist mental health is neeed
- consider admission to hospital if safety concerns
- if ED admission is not needed, determine need for urgent referral to secondary mental health services
- seek consent to liase involved in care
- if they decline management, assess mental capacity
- provide emotional support
Acute management of a person at risk of self harm
- psychosocial assessment incl, social, psychological + physical needs
- identity risk + protective factors
- safeguarding
- if immediate risk, refer to crisis resolution
- manage + follow up if decline to referral
- offer written information
Long term management of self harm
- mental health services normally responsible
- distraction or coping strategies
- approaches to self care
- wound hygiene + aftercare
- provide information on potential complications
- CBT
- create a crisis plan incl. self management strategies, contact numbers
- regular follow up
Long term management of self harm in primary care
- manage identified psychosocial needs
- manage mental health problems
- consider what meds are prescribed
Positive + negative prognostic factors of self harm
Positive:
- early intervention
- strong support system
- developing healthy coping skills
- addressing underlying conditions
.
Negative:
- repetitive episodes
- substance abuse
- severe psychological distress
- untreated mental health conditions
Protective factors that may reduce suicide risk
- social support + community
- sense of responsibility for others e.g. children
- resilience + coping
- access to mental health support
Complications of self harm
- physical: wound infects, scarring, blood loss, nerve or damage, death
- emotional: shame, worsening mental health, suicidal thoughts, social is location
- relationship issues
- employment struggles
What is dysthymia?
Persistent depressive disorder
What is the biggest risk factor of suicide?
History of self harm
Presenting fractures that increase risk of suicides
- previous attempts
- escalating self harming
- impulsiveness
- hopelessness
- feeling of being a burden
- making plans
- writing a suicide note
Management of suicide in primary care
Based on risk:
High risk: clear suicidal intent, access to means, lack of protective factors
- don’t leave pt alone
- urgent referral to crisis team or emergency psychiatric services
- consider hospital admission
.
Moderate Risk:
- develop safety plan - who to contact + coping strategies
- arrange urgent mental health referral - community MH team or crisis team
.
Low risk:
- provide emotional support
- encourage protective factors
- offer self help resources - Samaritans, local crisis lines
Outline suicide risk assessment
- assess risk factors
- assess current intent + plans
- assess needs
- screen for mental health disorders
- past psychiatric, medical, drug, social + family history
