Self harm and suicide Flashcards
What is self harm as defined by NICE?
Self poisoning or self injury, irrespective of the apparent purpose of the act.
How does the WHO distinguish self harm from smoking?
It must be non-habituel.
What does DSH stand for?
Deliberate self harm.
Why is the term deliberate SH outdated?
Because often patients will say that they don’t know whats happening, that the act is spontaneous with little awareness or conscious thought.
What is the most common form of self harm?
Self-poisoning (90%)
What are the risk factors for self harm? (Name at least 7)
Age – rare before puberty, increases dramatically with onset of adolescence. Peak in women 15-24 years, in men 25-34 years. Older people are at lower risk
Gender - female
Sexual orientation - homosexual/bisexual
Ethnicity - higher in those of South Asian heritage.
Marital status - higher in separated or divorced
SEC - low education, low income
Family characteristics - higher in children of separated parents
Childhood experience - emotional, physical, sexual abuse, domestic violence
Social isolation
Religious affiliation – reduces risk
Physical illness
Substance misuse
Situational factors – adverse life-event in a vulnerable person
‘Contagion’ – influence of media depictions
Criminal justice system – prisoners
Asylum seekers
Armed forces veterans – association with PTSD
Psychosis
Intellectual disability – Lesch-Nyhan syndrome, Smith-Magenis
PSYCHIATRIC DISORDERS (90% of self harmers have a diagnosis of some psychiatric disorder)
What psychological characteristics might people who self harm have?
Poor problem solving skills - instead of tackling problem.
Inflexible thinking
Impulsivity
Hopelessness
Lack of positive future-directed thinking
Interpersonal problems
What two drugs have been shown to reduce the risk of self harm and suicide?
Lithium and clozapine
Why might people self harm?
To die To communicate distress To seek help To escape a situation To gain relief from tension - "blood flowing out can feel like emotion seeping out" Punishment of themselves or others To change others behaviours Confusion
What legislation came in in 1998 with regard to selling of paracetamol?
Paracetamol can only be sold in packets of 32 or 16 and each individual paracetamol has to be in its own pocket. This was brought in to stop the impulsive downing of pill boxes. Each individual pill now has to be pushed out.
Why is where/when/what/who was around so important to ascertain?
Assessment of risk: you can ascertain how likely they were to actually want to die. There is a big difference between self harming with someone in the next room and self harming with no one around.
What must you ascertain in an assessment of risk?
Clear description of circumstances
Determine intent (attitude to act - remorse vs regret that it didn’t work)
Obtain a collateral from family and friend
Look for protective factors - in case this factor changes (e.g. only keeping someone alive is a loved one. If loved one dies this protective factor has disappeared.)
What factors increase the likelihood of suicide following self harm? (Name at least 5)
Older age Male sex Psychiatric disorder Social isolation Avoiding discovery of self-harm Medically severe self-harm Strong suicidal intent Physical illness Substance misuse Violent method of self-harm
Every 40 minutes someone kills themselves. True or False.
False. Every 40 seconds.
What is most common method of suicide in the UK?
Hanging and strangulation
