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Psychiatry > 1 (E): Self-harm and suicide > Flashcards

1 (E): Self-harm and suicide Flashcards

(43 cards)

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1
Q

Define self-harm

A

intentional self-injury or self-poisoning irrespective of the purpose of the act

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2
Q

What gender is self-harm more common in

A

Female

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3
Q

What age do women tend to self-harm

A

15-25

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4
Q

What age do men tend to self-harm

A

25-35

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5
Q

Why may people self-harm

A
  1. Emotional dysregulation - maladaptive coping mechanism, addictive
  2. Communicate feelings
  3. Produce reaction
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6
Q

What is the single biggest risk factor for self-harm

A

Previous self-harm (50-100)

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7
Q

What are 6 other risk factors for self-harm

A
  1. FH - observed self-harm
  2. Other psychiatric illness
  3. Gay or bisexual
  4. Social deprivation
  5. Single, divorced or widowed
  6. Childhood adversity
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8
Q

What is the most common type of self-harm

A

Cutting (65%)

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9
Q

What are 3 other types of self-harm

A
  • Burning
  • Poisoning
  • Head-banging
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10
Q

What needs to be cleared before psychiatric assessment is made in self-harm

A

Medical assessment

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11
Q

What are the components of psychiatric assessment

A

Psychiatric assessment
Risk assessment
Mental state exam

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12
Q

What are the 4P’s important for formulating factors contributing to self-harm

A

Predisposing
Precipitating
Perpetuating
Protective

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13
Q

How should the 4P’s be looked at in self-harm

A

Bio-Psycho-Social model

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14
Q

What other assessments should be taken for self-harm

A

Mental Capacity Assessment

Collateral History

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15
Q

What are the 3-steps to the ‘general’ management plan for self-harm

A
  1. Immediate management
  2. Secondary problems
  3. Prevention
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16
Q

What is part of the immediate risk management

A

Medical Management

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17
Q

Explain how self-poisoning is managed

A
  • Take samples: urine, blood and vomit to determine sample ingested
  • Gut decontamination if soon after
  • Activated charcoal if in 1h and maintaining airway
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18
Q

Explain how cutting is managed if <5cm and superficial

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A

Tissue adhesive or skin closure strips

19
Q

Explain how cutting is managed if >5cm or deep

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A

Exploration and surgical management

20
Q

As part of immediate management, what is performed following medical assessment

Study These Flashcards
A

Psychological assessment

21
Q

What is recommended to assess emotional state in A+E following self-harm

Study These Flashcards
A

Australian mental health triage score

22
Q

How is a patient psychologically assessed following self-harm in the immediate management

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A
  • Psychiatric assessment
  • Risk assessment
  • Mental Status Exam

Performed by liaison psychiatrist

23
Q

If severe self-harm how is patient managed

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A

Consider detaining under mental health act (1989)

24
Q

When may a patient be detained under mental health act (1989)

Study These Flashcards
A
  • feel they will be unsafe at home
  • unable to assess them immediately (eg. intoxicated)
  • abusive partner or unsafe home situation
25
How is moderate self-harm managed
Refer to crisis and resolution home treatment team (CRHT)
26
How is mild self-harm managed
Refer to community mental health team (CMHT)
27
How soon should a patient be followed up in outpatients, by community mental health or GP following the episode
1W
28
How are children who have self-harmed managed
Refer to CAMHS (child adolescent mental health service) and safeguarding assessment
29
How are individuals who have self-harmed managed in long term
1. Provide information 2. Involve families - if patient wants 3. Assessment of needs 4. Planning - escalation/crisis plan 5. Implement prevention strategies 6. CBT or psychodynamic therapy 7,. Manage mental health
30
What % of people who self-harm will go on to commit suicide in one-year
1%
31
What % of people who self-harm will commit suicide in 10-years
5%
32
Define suicide
Intentional Self-Inflicted Death
33
In which population is suicide the leading cause of death
Men under 35-years
34
What is a mnemonic to remember risk factors for suicide
SADPERSONS
35
What are the risk factors for suicide
Sex: Male A: <15 or >45 Depression, other mental health conditions Previous attempts Ethanol Rational thinking Seperation/Divorce Organised plan No social support State future attempts
36
What 5 mental health conditions have an increased risk of suicide
1. Schizophrenia 2. Depression 3. Substance mis-use 4. Bipolar 5. Personality Disorder
37
What mental health condition is most associated with suicide
Schizophrenia
38
What are 4 protective factors for suicide
1. Men - married 2. Social support 3. Religious belief 4. Meaningful employment
39
What is one method to assess individuals following suicide attempt
'Target ring method' - Bullseye = feelings towards act - Inner ring = Precipitating factors - what happened that day - Middle ring = Background - how had the past few months been - Outer ring = Personal + Family History
40
What are the 4-stages of managing a failed suicide attempt
1. Agree contract - negotiating, may involve family. 2. Treat co-morbid conditions (depression, anxiety) 3. Problem-solving therapy 4. Preventative strategies - Samaritans - Shift to stability - Limit access to lethal means
41
How should suicide be managed
- Ensure gathered information before approaching family - Discuss organ donation - Bereavement counselling
42
What are 3 legislative factors to try and prevent suicide
- barriers on bridges - catalytic converter (prevent inhalation) - restriction to 2 packs paracetamol
43
What are 5 factors that increase chance someone will commit suicide again
1. Writing a note 2. Planning 3. Efforts to avoid discovery 4. Final acts (sort bills) 5. Violent method

Psychiatry (13 decks)

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