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AIP: Self-harm > Self harm presentations/ history > Flashcards

Self harm presentations/ history Flashcards

1
Q

What is the definition of deliberate self harm?

A

intentional act of self-poisoning or self-injury, irrespective of the motivation or apparent purpose of the act

usually the expression of emotional distress

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2
Q

What are 8 examples of methods of self injury?

A
  1. Cutting
  2. Burning
  3. Hanging
  4. Stabbing
  5. Swallowing objects
  6. Shooting
  7. Jumping from height
  8. Jumping in front of vehicles
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3
Q

What are 4 examples of methods of self-poisoning?

A
  1. Medication (prescribed or OTC)
  2. Illicit drugs
  3. Household substances e.g. washing liquid
  4. Plant material
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4
Q

What is the mnemonic to remeber the risk factors for deliberate self-harm and what does it represent?

A

DSH Large Comes Via Self-Poisoning

  1. Divorced/single/living alone
  2. Severe life stressors
  3. Harmful drug/alcohol use
  4. Less than 35 (age)
  5. Chronic physical health problems
  6. Violence (domestic) or childhood maltreatment
  7. Socioeconomic disadvantage
  8. Psychiatric illness e.g. depression, psychosis
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5
Q

How many people in the UK are affected by DSH?

A

2 in 1000

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6
Q

What is the gender ratio of DSH?

A

F:M 1.5:1

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7
Q

In what age group is DSH more common?

A

adolescents and young adults, peaks in females 15-19 ad males 20-24

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8
Q

How does the frequency of DSH compare with suicide?

A

20-30x more common than suicide

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9
Q

How does the rate of suicide in people who have self-harmed change vs general population?

A

50-100x greater in people who have self-harmed

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10
Q

What is the biggest cause of DSH in the UK?

A

drug overdose

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11
Q

What are 4 examples of commonly ingested medications in drug overdose?

A
  1. Non-opioid analgesics: paracetamol
  2. Salicylates (aspirin)
  3. Anxiolytics including benzodiazepines
  4. Antidepressants (commonly depressed)
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12
Q

What proportion of DSH cases are due to self-injury?

A

10%

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13
Q

What are common locations for self-injury?

A

forearms and wrists (cus with razors or glass)

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14
Q

What proportion of people who perform DSH have taken alcohol in the last 6 hours prior to the act?

A

half men, quarter of women

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15
Q

What are the 2 commonset complications of deliberate self-harm?

A
  1. Permanent scarring of skin and damage ot tendons and nerves as a result of self-cutting
  2. Acute liver failure due to paracetamol overdose
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16
Q

What are 5 key aspects of the history for DSH?

A
  1. Intention: what were their itentions before and during the act?
  2. Suicidal ideation: does the patient now wish to die?
  3. Severe life stressors: what are the current problems in their life?
  4. Psychiatric illness: is there a psychiatric disorder?
  5. Collateral history: from firneds, relatives, GP
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17
Q

What is the acronym to remember motives behind DSH and what does it represent?

A

DRIPS

  • D: death wish - genuine wish to die
  • R: relief - seeking unconsciousness or pain as a means of temoprary relief and escape from problems
  • I: influencing others - trying to influence another person to change their views or beaviour e.g. making spouse feel guilty for not caring enough
  • P: punishment - to punish oneself
  • S: seeking attention - trying to get help or seek attention (expression of emotional distress)
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18
Q

What are 7 possible findings on mental state assessment of a patient with DSH?

A
  1. Obvious self-inflicted injuries may be seen
  2. Patient may be tearful or exhibit signs of neglect
  3. Behaviour may reflect underlying mental disorder e.g. depression, schizophrenia
  4. Thoughts may include feelings of guilt, worthlessness or helplessness
  5. Hallucinations may be present in cases of schizophrenia and depression with psychosis where DSH is triggered by command hallucinations
  6. Concentration is often impaired
  7. Insight can vary
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19
Q

What are 5 blood tests to be performed in the workup for DSH?

A
  1. Paracetamol levels
  2. Salicylate levels
  3. U+Es
  4. LFTs
  5. Clotting (synthetic hepatic function)
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20
Q

During what time frame are paracetamol levels accurate after a paracetamol overdose?

A

between 4 and 15 hours after ingestion

21
Q

What are 4 types of investigations to perform in DSH and why may each be indicated?

A
  1. Bloods (paracetamol level, salicylate level, U+Es, LFTs, clotting)
  2. Urinalysis: for possible toxicological analysis
  3. CT head: if intracranial cause for altered consciousness suspected in self-poisoning
  4. Lumbar puncture: if intracranial infection e.g. meningitis suspected in self-poisoning
22
Q

What are 5 differentials for self-poisoning?

A
  1. Head trauma
  2. Intracranial haemorrhage
  3. Intracranial infection e.g. meningitis, encephalitis
  4. Metabolic abnormalities e.g. hypoglycaemia
  5. Liver disease
23
Q

What is a differential diagnosis for self injury?

A

clotting disorders (causing significant bruising or bleeding)

24
Q

What are the 3 key aspects of the management of self-harm?

A

biological, psychological, social

25
Q

What is the biological management of self-harm?

A

treating any overdose with the appropriate antidote and suturing (and anti-tetanus treatment if appropriate) for deep lacerations

26
Q

What is the psychological management of self-harm? 2 examples

A
  1. counselling and CBT for underlying depressive illness
  2. psychodynamic psychotherapy may be appropriate if individual has a personality disorder (long term, needs appropriate assessment)
27
Q

What is the social management of self-harm? 2 examples

A
  1. Social services input
  2. Voluntary organisations e.g. Samaritans, Mind
28
Q

Why is risk assessment mandatory following DSH?

A

there is an immediate risk of suicide and risk of repeat acts of self-harm

29
Q

What must be considered if the need for hospitalisation is possible in a patient with DSH?

A

use of MHA Section 2

30
Q

What will be required if a patient refuses medical treatment fo rhte consequences of self harm, e.g. acute liver failure or deep lacerations?

A

mental capacity assessment required

31
Q

What team in the community is sometimes involved as an alternative to hospital admission in cases of DSH?

A

Crisis team in the community

32
Q

What is the most dangerous type of antidepressant to overdose on and why?

A

TCAs - can cause arrhythmias and convulsions in overdose

33
Q

Within what time frame must a patient be followed up following discharge after a DSH attendance?

A

within 48 hours of discharge

34
Q

What proportion of people who attend A+E following an act of self harm will self harm again within a year?

A

1 in 6

35
Q

What are 3 examples of acute management of DSH?

A
  1. Specific antidotes
  2. Suturing
  3. Surgical input for complex wounds
36
Q

What are 3 examples of enabling a patient to resolve difficulties that led to DSH?

A
  1. Manage psychosocial needs
  2. Refer to drug/ alcohol services if appropraite
  3. Offer financial and occupational rehabilitation advice
37
Q

What are 3 aspects of enlabling a patient to manage future crises?

A
  1. Arrange for follow-up
  2. Offer written and verbal communication
  3. Remove access to means of DSH e.g. prescribe limited supply of meds at any one time
38
Q

What are the 5 stages/principles behind managing DSH?

A
  1. Acute management
  2. Manage high suicide risk
  3. Treat any psychiatric disorder
  4. Enable patient to resolve any difficulties that led to the DSH
  5. Enable patient to maange future crises
39
Q

What is the specific antidote to paracetamol overdose?

A

NAC

40
Q

What is the specific antidote to opiate overdose?

A

naloxone

41
Q

What is the specific antidote to benzodiazepine overdose?

A

flumazenil

42
Q

What is the specific antidote to warfarin overdose?

A

vitamin K/prothrombin complex

43
Q

What is the specific antidote to beta blocker overdose?

A

glucagon

44
Q

What is the specific antidote to TCA overdose?

A

sodium bicarbonate

45
Q

What is the specific antidote to organophsophate (pesticide/weedkiller etc.) overdose?

A

atropine

46
Q

What are 2 sources of information for poisoning management?

A

TOXBASE and National Poisons Information Service

47
Q

What is an initial drug that can be given in some cases of overdose, for a wide variety of overdoses?

A

activated choarcoal - early use in majority of drugs taken in overdose, within the first hour, can prevent/reduce absorption

48
Q

Within what time frame should activated charcoal be given?

A

within 1 hour of ingestion of poison

AIP: Self-harm (15 decks)

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