Self-Harm and Suicide

Question 1

What is self-harm?

Answer 1

Intentional act of self-poisoning or self-harm, irrespective of motivation or apparent purpose of the act

Question 2

What are methods of self-injury?

Answer 2

Cutting
Burning
Stabbing
Hanging
Swallowing objects
Shooting

Question 3

What are methods of self-poisoning?

Answer 3

Medication overdose
Illicit drug use
Ingesting household substances (eg. bleach)

Question 4

What are RF’s for self harm?

Answer 4

Divorced
Severe life stressors
Harmful drug/alcohol use
Age < 35
Chronic physical health problems
Violence
Childhood abuse
Socioeconomic disadvantage
Psychiatric illness (eg. depression, schizophrenia)

Question 5

What are complications of self-harm?

Answer 5

Permanent scarring of skin
Damage to tendons and nerves
Acute liver failure

Question 6

What investigations may be done?

Answer 6

• Investigate reasons for self-harm
• MSE
• Bloods: paracetamol levels, salicylate levels, U&E, LFTs, clotting
• Urinalysis
• CT head
• Lumbar puncture (if suspected intracranial infection from poisoning)

Question 7

What may be reasons for self-harm?

Answer 7

• Wish to die
• relief and escape from problems
• Attempt to influence others (eg. make someone feel guilty)
• Punishment
• Seeking attention either for help/emotional distress

Question 8

What may an MSE show?
- Appearance
- Behaviour
- Thoughts
- Hallucinations
- Cognition
- Insight

Answer 8

Question 9

How may self-harm be managed?

Answer 9

• Treat overdose with appropriate antidote
• Suture lacerations
• Counseling, antidepressants, CBT for underlying depressive illness
• Psychodynamic psychotherapy for underlying PD
• Social service input
• Refer to drug and alcohol services
• Remove access to means of self harm
• MUST do risk assessment (as immediate risk of suicide and repeat acts of self-harm)

Question 10

What patients are at greater risk of suicide and self harm?

Answer 10

Men

Question 11

What methods are men vs women more likely to use?

Answer 11

Men - violent methods (eg shooting, hanging)

Women - prescribed/OTC drug OD’s

Question 12

What should suicide be differentiated from?

Answer 12

NSSI (non-suicidal self-injurious behaviour)

• intent to harm without attempt to end one’s life

Question 13

What is the peak age of NSSI in women?

Answer 13

15-24

Question 14

What is the peak age of NSSI in men?

Answer 14

25-34

Question 15

What components should you ask about in a suicide risk assessment?

Answer 15

HEADSS

Home and environment
Education
Activities
Drugs and Alcohol
Sexuality
Suicide and Depression

Question 16

What should you gauge in an acute presentation?

Answer 16

Collateral hx from friend or relative if present

Question 17

What is used in adolescents who present with an OD?

Answer 17

Pathos Score

Problems (> 1 month)

Alone (alone at the time?)

Time (planned for > 3 hrs?)

Hopeless (feeling hopeless about future?)

Sad (feeling sad for most of the time before the OD?)

Each “yes” answer = higher risk of future harm and intent

Question 18

What may an MSE show in suicide?
- Appearance
- Behavior
- Mood
- Thought
- Perception
- Cognition

Answer 18

Question 19

What investigations may be done?

Answer 19

Bloods - paracetamol levels, U&E’s, LFTs

Urinalysis

Questionnaire - tool for suicide risk assessment

Note left behind, writing a will

Question 20

What questions should be asked in a risk assessment?

Answer 20

Question 21

How should suicide patients be managed?

Answer 21

Remove means for suicide
Medically stabilise
Risk assessment
Psychiatric tx
Involve Crisis Resolution and Home Tx team

Question 22

What are population level suicide prevention strategies?

Answer 22

Public education

Reduce access to means of suicide (eg. safer prescribing)

Decrease social stressors

Reduce substance misuse

Easy, rapid access to psychiatric care

Question 23

Self harm vs suicide

Answer 23

Question 24

Read Geeky medics suicide risk assessment
https://geekymedics.com/suicide-risk-assessment-osce-guide/