Deliberate Self Harm

Question 1

Non-fatal deliberate self-harm is more common than suicide. TRUE/FALSE?

Answer 1

TRUE

Question 2

What phrase should not be used in relation to non-fatal deliberate self-harm?

Answer 2

“attempted suicide”

Question 3

Describe the difference of psychiatric illness in patients who die from suicide and those who deliberately self-harm?

Answer 3

vast majority of those who die from suicide DO have a psychiatric illness

majority of those who deliberately self-harm do not have a true psychiatric illness - often due to other causes

Question 4

What is the gender ratio of suicide almost everywhere in the world?

Answer 4

Males>females

except certain parts of China

Question 5

HOw many deaths do the WHO claim are due to suicide each year?

Answer 5

800,000

Question 6

Describe the difference in suicide age peaks between high and low income countries

Answer 6

High income countries = less suicide overall, and age peak is middle age

Low income countries = more suicide overall and age peak is late adolescence/young adult

Question 7

Scotland has the highest suicide rates in the UK. TRUE/FALSE?

Answer 7

FALSE

higher than England and Wales BUT lower than Northern Ireland

Question 8

What are the preferred methods of suicide in Scotland and the rest of the Western World?

Answer 8

Hanging (males)

Poisoning (females)

Question 9

In countries with high suicide rates, both the male and female suicide rates are markedly above that of the UK and other countries. TRUE/FALSE?

Answer 9

FALSE

Many countries with high suicide rates have normal female rates of suicide, yet male suicide is significantly high

Question 10

What area of Europe is thought to have lower suicide rates than others?

Answer 10

Mediterranean

Question 11

What time periods in history showed lower rates of suicide and why?

Answer 11

WWI and WWII - due to sense of community and purpose

1960s - change of toxic gas ovens to North Sea gas => less suicide by carbon monoxide poisoning (head in oven)

Question 12

Rates of suicide increase after coverage of a celebrity dying or committing suicide appears in the media. TRUE/FALSE?

Answer 12

TRUE

e. g. Diana Princess of Wales (mainly affected women her age)
e. g. Robin Williams

Question 13

What theory of suicide relates to Generation X? (i.e. Babies born between 1965 and 1980 - after the baby boomers)

Answer 13

The peak age of suicide is following the age which Generation X are becoming each year

• is this just a more suicidal generation?
• did something in their adolescence contribute to this?

Question 14

What change caused a reduction in suicide by poisoning from the 1960s to 70s?

Answer 14

Change of sleeping tablets from barbiturates to benzodiazepines
=> patients much less likely to overdose on benzodiazepines

Question 15

Are suicide rates higher in urban or rural areas?

Answer 15

Urban

Question 16

What season has the highest rates of suicide and why is this thought to be the case?

Answer 16

Spring

- due to alienation of vulnerable patients as everyone else is going outside again and getting ready for summer

Question 17

Being born in what season can increase the risk of suicide in later life?

Answer 17

Babies born in Spring months

especially females

Question 18

Marriage is a protective factor from suicide. TRUE/FALSE?

Answer 18

TRUE

- those who are married have lower suicide rates than patients who are single, separated, divorced or widowed

Question 19

What occupations are more at risk of suicide?

Answer 19

Unskilled labourers
Construction workers
Doctors
Dentists
Farmers

Question 20

What sub-specialities of Doctor are more at risk of suicide than others?

Answer 20

GPs
Anaesthetics
Public Health
Psychiatry

Question 21

Why are Doctors, Dentists and farmers more likely to commit suicide than other occupations?

Answer 21

These groups have access to the means to carry out a suicide

Question 22

What features of a doctor make them more susceptible to suicide?

Answer 22

• culture of hiding mental illness/ feeling of shame
• High stress work environment
• Qualities of diligence, self-efficacy and perfectionism

Question 23

Describe the EU suicide rates during and after 2008?

Answer 23

Suicide rates crashed in 2008 and then began rising again after this

Question 24

Accessibility of a method of suicide will increase the rate of its use. TRUE/FALSE?

Answer 24

TRUE

e. g. jumping from height in NYC or Hong Kong due to frequency of multistory buildings
e. g. Switzerland access to guns and ammunition during cold war

Question 25

Who is most at risk from a legally held firearm in America?

Answer 25

Owner (even though many people claim it is to protect them from an intruder)

• many suicides occur as a result of possession of firearm

Question 26

What methods of suicide are prominent in Asian countries?

Answer 26

Asia in general - pesticide suicide is common

Hong Kong - charcoal-burning causing CO poisoning

Question 27

What physical health problems can increase the likelihood of suicide?

Answer 27

Chronic pain

Neurodegenerative conditions

Question 28

Only a minority of suicide cases leave a note. TRUE/FALSE?

Answer 28

TRUE

doctors are more likely than most to leave a note

Question 29

What is a suicide pact?

Answer 29

More than one person arranging to commit suicide together or help one another commit suicide.

2/3 of these cases are incomplete and at least ONE person lives

Question 30

What is family annihilation?

Answer 30

Suicidal act where patient kills family (their own or other) and then themself afterwards

Question 31

Explain how patients with a history of deliberate self-harm have abnormal neurobiology

Answer 31

They have less serotonin (5HT) breakdown products in their CSF
=> serotonin system dysfunction

Question 32

What does neuroimaging show in patients with a high lethality deliberate self harm VS a low lethality deliebrate self harm?

Answer 32

High lethality = more prefrontal cortex activity

Question 33

Suicide rates increase dramatically in ALL twins. TRUE/FALSE?

Answer 33

FALSE
Mono-zygotic twins = 13.2% increase
Di-zygotic twins = 0.7% increase

Question 34

Adverse childhood events such as sexual abuse can increase suicide rates. TRUE/FALSE?

Answer 34

TRUE

Question 35

Why is smoking not always a useful predictor of suicide?

Answer 35

Suicide rates are increased in patients who smoke BUT psychiatric patients are MORE likely to smoke than patients with other health conditions

Question 36

What mood stabiliser has a reduced risk of suicide compared to others?

Answer 36

Lithium (compared to Valproic Acid/ carbamazepine etc)

Question 37

What are suicide hot-spots?

Answer 37

places where many patients choose to commit suicide

e.g. bridges

Question 38

Why are suicidal prevention messages usually put on bridges/ suicidal hotspots?

Answer 38

Many patients are ambivalent on decision to commit suicide => posters for prevention could change their mind

Question 39

What is meant by an Alcoholic Myopia?

Answer 39

a “pseudo” vision issue where patient’s can only see their problems and nothing past them

Question 40

What is NSSI?

Answer 40

Non-suicidal self injury

• patient is confident in that they do not wish to die
• injuring themself to deal with increased emotins

Question 41

What gender is more likely to deliberately self-harm?

Answer 41

Females > males

Question 42

Low cholesterol causes what effect on suicide risk?

Answer 42

LOW cholesterol increases the risk of suicide

Question 43

What is meant by the “ejector seat” motive?

Answer 43

Patients want to get out of the distressing situation as quickly as possible

Question 44

How should you manage a patient with deliberate self harm?

Answer 44

Calm patient
Let them vent emotions in a controlled way
Ask about suicide (as this cannot cause it)
Involve family and friends as support
Make action plan on suicide help app for any further situations