[15] Deliberate self-harm Flashcards
What is deliberate self-harm (DSM)?
An intentional act of self-poisoning or self-injury, irrespective of motivation or apparent pupose of the act. It is usually an expression of emotional distress
What forms can self harm take?
- Self poisioning
- Self-injury
Give 7 methods of self-injury
- Cutting
- Burning
- Hanging
- Stabbing
- Swallowing objects
- Shooting
- Jumping from heights or in front of vehicles
Give 4 methods of self-poisoning
- Medications, prescribed or OTC
- Illicit drugs
- Household substances, e.g. washing up liquid
- Plant material
What are the risk factors for DSH?
- Divorced, single, or living alone
- Severe life stressors
- Harmful drug/alcohol use
- Less than 35
- Chronic physical health problems
- Domestic violence
- Childhood maltreatment
- Socioeconomic disadvantage
- Psychiatric illness, e.g. depression, psychosis
Is DSH more common in men or women?
Women (ratio of 1.5:1), but ratio varies greatly with age
What is the peak age of incidence of DSH?
15-19 years in females, 20-24 years in males
How much more common than suicide is DSH?
20-30 times
By how much does DSH increase the rate of suicide?
50-100 times greater than the suicide rate in the general population
What % of DSH cases in the UK are a result of a drug overdose?
90%
What medications are commonly ingested in DSH?
- Non-opioid analgesics, e.g. paracetamol and salicylates (aspirin)
- Anxiolytics (including benzodiazepines)
- Antidepressants
What % of DSH cases in the UK are due to self-injury?
10%
What are the most common locations for self-injury in DSH?
Forearms and wrists
What proportion of people have taken alcohol in the 6 hours prior to the act?
About half the men and a quarter of women
What are the most common complications of DSH?
- Pernament scarring of skin, and damage to tendons and nerves as a result of self-cutting
- Acute liver failure due to paracetamol overdose
What questions should you ask when a patient presents with DSH?
- What were their intentions before and during the act?
- Does the patient now wish to die?
- Wha are the current problems in their life?
- Is there a psychiatric disorder?
- Collaterol history from relatives, friends, or the GP
What are the potential motives behind DSH?
- Genuine wish to die
- Relief - seeking unconscioussness or pain as a means of temporary relief and escape from problems
- Influencing others - trying to influence another person to change their views or behaviour, e.g. by making someone feel guilty
- To punish themselves
- To try and get help or seek attention
What investigations should be done in a patient who presents with DSH?
- History
- MSE
- Bloods
- Urinalysis for possible toxicological analysis
- CT head is an intracranial cuase of altered consciousness is suspected
- Lumbar puncture if intracranial infection e.g. meningitis is suspected
What bloods should be done in the investigation of DSH?
- Paracetamol levels
- Salicylate levels
- U&Es
- LFTs and clotting
When are blood paracetamol levels accurate?
4-15 hours after ingestion
What is the purpose of U&Es in investigation of DSH?
Assess renal function
What is the purpose of LFTs and clotting in investigation of DSH?
Synthetic hepatic function
What are the differential diagnoses for self-poisioning?
- Head trauma
- Intracranial haemorrhage
- Intracranial infection, e.g. meningitis, encephalitis
- Metabolic abnormalities, e.g. hypoglycaemia
- Liver disease
What are the differential diagnoses for self-injury?
Clotting disorders, which can cause significant bruising or bleeding
