Self Harm

Question 1

What is self harm

Answer 1

Self poisoning/injury regardless of intent

-risk factor for suicide

Question 2

What are the reasons for self harm

Answer 2

Attempt to end/preserve life
Communicate with others
Secure help/care
Relief from difficult states

Question 3

How would you triage a self harm patient

Answer 3

ABCDE

If self injury => find ways of closure
If self poisoning => Toxbase for info
Charcoal, gastric lavage, bowel irrigation

Question 4

What are the antidotes for

• paracetamol
• benzodiazapenes
• Opioids

Answer 4

Paracetamol
-IV acetylcysteine

Benzodiazepines
-Flumenazil

Opioids
-Naloxone

Question 5

What extra questions would you like to ask in a history

What else would you be looking for?

Answer 5

Drugs, alcohol
Personal Hx
Social Hx
Forensic Hx

Appearance
Behaviour
Speech
Mood 
Cognitions

Question 6

What are the static factors for suicide

How would you judge this from the history

Answer 6

PC
-evidence of careful planning/violent methods

Psych Hx

• self harm
• MH
• psych admission

FHx

• self harm
• MH
• suicide

SHx

• male, increased age
• separation, divorce, legal troubles
• physical, sexual abuse

Question 7

What are the dynamic factors for suicide

How would you judge this from the history

Answer 7

PC

• suicidal ideation/plan
• MH

Psych Hx

• poorly optimized MH treatment
• concurrent physical illness
• loss of functional independence/impairment

Drug, alcohol
-use, abuse

SHx

• Marital/family issues
• Access to method of suicide
• Live alone, poor social support
• Exposure to suicidal behavior

Question 8

How could you assess the suicide risk

Answer 8

Ideation
Intent
Planning
Access to lethal means
Past attempts

Question 9

How would you manage a patient in the long term

Answer 9

BIOPSYCHOSOCIAL

• Treat MH condition
• Self harm interventions
• Harm reduction

Come up with a care and risk management plan