Psych - Deliberate Self Harm

Question 1

What is the average annual death toll from suicide?

Answer 1

800,000

Question 2

What phrase should you use rather than ‘Attempted Suicide’?

Answer 2

Non-fatal deliberate self harm

Question 3

What is Rational Suicide?

Answer 3

Proportion of people who decide to commit suicide in absence of psychiatric illness or deliberate self harm

Question 4

True or False:

The vast majority of people who deliberately self harm do NOT suffer from a psychiatric illness

Answer 4

TRUE

Question 5

What is the World suicide rate?

Answer 5

10.7 per 100,000 pa (2015)

Question 6

Do males or females generally have a higher rate of suicide worldwide?

Answer 6

Males

M - 15.0 per 100,000
F - 8.0 per 100,000

Question 7

How do the peaks of suicide rates differ between low-income and high-income countries?

Answer 7

Low-income - lower peak (15-25) and larger % of suicides (75.5%)

High-income - older peak (50ish yrs) and smaller % of suicides (14.5%)

Question 8

Is the suicide rate higher in England or Scotland?

Answer 8

Scotland

S - 21.9 (M), 7.3 (F)
E - 14.8 (M), 4.6 (F)

Question 9

True or False:

The suicide rates in Scotland are 3 times higher in most deprived

Answer 9

True

Question 10

How can you track the fluctuations in suicide rates over years?

Answer 10

5 year rolling average

e.g. In Scotland there was an 18% reduction from 01/05 to 11/15

Question 11

Which of the EU countries have the highest and lowest suicide rates (2014)?

Answer 11

Highest:

1. Lithuania
2. Latvia
3. Hungary
4. Slovenia

Lowest (Mediterranean countries):

1. Cyprus
2. Greece
3. Italy
4. United Kingdom

Question 12

What is a theory for the considerable drops in suicide rates during WW1 and WW2?

Answer 12

Greater sense of national cohesion

Less alienation and greater unity as a country

Question 13

Give an example of when affecting the modality of suicide method has an overall effect on suicide rate

Answer 13

1960’s - change in domestic gas supply from toxic goal gas to less toxic sea gas
By 1973 putting head in oven would cause a bad headache but not death
Massive reduction in number of suicides by gassing

Question 14

Give an example of when a public figure death affected the rates of suicide

Answer 14

1) 1997 Princess Diana’s death
Increased by 17% (33% in women) in months after her death
This was an excess above what was expected
2) Robin Williams
Was reported in detail in media and lead to increased (EXCESS) suicides by hanging in the States

Question 15

Traditionally which suicide modalities are favoured by each gender?

Answer 15

Males - Hanging (generally more violent methods)

Females - poisoning, overdose

Question 16

Why was it important when Barbituates were switched to Benzodiazepines as sleeping tablets?

Answer 16

Benzodiazepines are far less likely to cause overdose in your sleep

Barbituate overdose can lead to unconsciousness and breathing difficulties

Question 17

True or False:

Suicide rates higher in rural areas compared to urban areas

Answer 17

FALSE
Rates higher in urban (city) areas
More marked in women even though smaller contribution to overall death toll

Question 18

Which seasonality has a higher rate of suicide?

Answer 18

Spring (lower in Autumn)

Question 19

What is a theory behind why suicide rates are lower in Autumn and higher in Spring?

Answer 19

Autumn - easier to be mentally ill and less isolated from people when days are shorted and generally people are more subdued + more clothes

Spring - people are being cheerier and shedding layers, more alienating to be mentally ill

Question 20

What affect does being born in the Spring have on your risk of suicide?

Answer 20

Increases risk of suicide by 17% (compared to being born in Autumn)
(stronger risk in women)

Question 21

What percentage of doctors reported that they would not seek help or treatment if they had a mental health disorder?

Answer 21

41%

DON’T BE PART OF THIS 41%

Question 22

Which medical specialities have a higher rate of suicide?

Answer 22

GP
Psychiatrist
Anaesthetist

ACCESS TO MEANS
(Paediatricians have the lowest rate)

Question 23

What general findings did the Hawton 2004 study on 38 doctor suicides find?

Answer 23

25 had psychiatric illness
Most died from self-poisoning
15 received treatment
21 left a note (higher than average rate of leaving suicide notes)

Question 24

Give examples where it has shown access or restriction to firearms affects suicide rate

Answer 24

UK - tighter gun laws after mass shootings showed reduced suicide by firearm

Switzerland - Swiss Army put new legislation in place that distributed firearms are stored at home while ammunition stored centrally (has shown reduction in suicide rate)

USA - person most at risk from legally held firearm is owner themselves
83% suicide, 12% shooting spouse, 3% children, 2% intruder (the reported purpose of the firearm)

Question 25

Give examples of when media coverage influenced suicide rates

Answer 25

Hong Kong - suicide by CO (Charcoal-burning) majorly reported by media and romanticised ('died with rosy cheeks') showed rapidly increasing deaths by Carbon Monoxide in Hong Kong Very suddenly become substantial death toll

Question 26

What changes could neuroimaging potentially show us in high-lethality or low-lethality DSH patients?

Answer 26

High-lethality patients have different PFC (pre-frontal cortex) activity to low-lethality DSH patients SPECTS of 2 patients who self-harmed showed decreased frontal activity

Question 27

What is the Werther-effect? | Goethe-effect

Answer 27

A spike of emulation suicides (copycat suicide) after a publicised suicide known as Werther effect. The publicised suicide can serve as a trigger in a susceptible or suggestive person Originates from Goethe's novel about a young man who committed suicide after he was rejected by the woman he loved - showed a marked increase in suicide following publication

Question 28

How many people are estimated to have died from jumping off the Golden Gate Bridge since it first opened?

Answer 28

Estimated 16,000 Fatality rate roughly 98% (die from impact with water) Only 34ish people known to have survived the jump

Question 29

True or False: | Suicidal people tend to be very ambivalent

Answer 29

TRUE Putting restrictive methods in place may be enough to make them hesitate Asking them what's wrong or discouraging the act may be enough to change their plans

Question 30

What was the affect of a bill in 1984 in Russia that restricted the sale and consumption of alcohol?

Answer 30

Had huge effect on alcoholism within the country Rise in life expectancy In following 4 years the rate of suicide reduced by 40%

Question 31

Roughly how many people are found to have alcohol in their systems at time of death?

Answer 31

Over 1/3

Question 32

True or False: | People who spend more than 5 hours per day on social media are found to have lower rates of suicidal thinking

Answer 32

FALSE | Found to have the highest rate of suicidal thinking

Question 33

What are some possible reasons that male suicide is more common than female?

Answer 33

Men chose more violent methods so more likely to be successful Less stigmatised for women to seek support Women tend to have bigger, wider social networks and support

Question 34

What is the incidence of DSH to suicide?

Answer 34

DSH:Suicide 10-20:1 (WHO 2004)

Question 35

What is Non-suicidal self injury (NSSI)?

Answer 35

Defined as deliberate, self-inflicted destruction of body tissue WITHOUT suicidal intent (they don't want to die)

Question 36

What is the epidemiology of DSH?

Answer 36

Northern europe > Southern Europe Females > Males Low socio-economic status

Question 37

True or False: | The rate of premature mortality in DSH patients increases for years via suicide, IHD, Ca, RTAs, homicide

Answer 37

TRUE

Question 38

What percentage of suicide cases have a history of DSH?

Answer 38

40% | Hx of DSH single strongest risk factor for suicide

Question 39

What is the risk of suicide in 12 months after DSH?

Answer 39

1%

Question 40

Which groups/factors are more likely to suicide after DSH?

Answer 40

``` Older Male Unemployed, retired Single, separated, divorced Isolated Poor health Psych Dx Violent Dx Suicide note Hx of DSH ```

Question 41

Who repeats DSH?

Answer 41

``` Previous DSH Personality disorder Alcohol/drug abuse Previous Psych Rx Unemployed Low socioeconomic group Criminal record 25-54 years Single, separated, divorced ```

Question 42

What are some common motives for DSH?

Answer 42

``` To die To escape anguish To escape a situation To display desperation To influence others To get back at others To get help To repeat what has helped before To roll the dice ```

Question 43

What is 'Hopelessness' a good marker of?

Answer 43

Robust predictor of eventual fatal self-harm - Post DSH or in general Include hopelessness in your MSE

Question 44

What are some initial stages to take in management of DSH before taking a history?

Answer 44

``` Calm the patient (crisis cannot be resolved without release of emotion) Crying (yes), Aggression (no) Be supportive Privacy Deep breathing Direct the interview ```

Question 45

Should you ask about suicidal thoughts in a history?

Answer 45

YES Asking about it does not cause it (Usually a relief for patient to talk about thoughts in a safe, non-judgemental environment)

Question 46

What are some important stock questions to assess risk?

Answer 46

'Have you ever thought life isn't worth living?' 'How close have you come before? What stopped you?' 'What are things that keep you going?'

Question 47

What comes under the Management of bolstering self-esteem & problem solving?

Answer 47

- Discussing personal things with stranger takes bravery - Any relief from discussion is proof that further discussions might help even more - Look for past episodes that have solved problems - Friends or family - Safety Plan

Question 48

What is the idea around a Safety Plan?

Answer 48

Making a compulsory list of activities or tasks you have to complete before you self harm This could be juvenile things with the last being calling for help before you DSH Designed to distract mind and give something to focus on to lower risk of completing DSH

Question 49

What follow-ups may be required for DSH?

Answer 49

``` Psychiatry/Psychology Counselling - rape crisis, womens refuge, cruse Social work Addictions Samaritans ```

Question 50

How can you recognise manipulative DSH patients?

Answer 50

Using the threat of suicide in order to produce a change in their environment

Question 51

What are the different types of 'difficult' patients?

Answer 51

1. Dependent clingers 2. Entitled demanders 3. Manipulative help-rejecters 4. Self-destructive deniers

Question 52

What is meant by a dependent clinger patient?

Answer 52

Describe excessively needy patients who require endless attention and reassurance. Regard themselves as having 'bottomless needs' and the physician as being able to provide inexhaustible stream of services

Question 53

What is meant by Entitled demander patients?

Answer 53

Type of patient that will tell you what types of tests and medications to order (may threaten legal action if denied) Patients often feel helpless and powerless so rather than argue they order

Question 54

What is meant by Manipulative Help-rejecter patients?

Answer 54

Drags physician through endless cycles of help-seeking and help-rejecting Nothing doctor does is satisfactory (but keep returning with new requests)

Question 55

What is meant by Self-destructive denier patient?

Answer 55

Patient knowingly continues behaviours that area dangerous to their health