Self Harm & Suicide Flashcards
(22 cards)
What is self harm?
Self-harm involves intentional self-injury without suicidal intent. Cutting is the most common method of self-harm. It is often a response to emotional distress and acts as a way for the person to cope with their emotions. Self-harm is not always associated with depression, anxiety or suicide, although it does increase the risk of these conditions.
Who is self harm more common in?
It is more common in females and those aged under 25.
What is suicide?
Suicide involves a person causing their own death
Who is death by suicide more common in?
Death by suicide is around three times more common in men and most common around the age of 50 years. It also increases in older age.
The cycle of self-harm involves the following six repeating steps:
Emotional suffering
Emotional overload
Panic
Self-harming
Temporary relief
Shame and guilt
What are suicidal thoughts?
Suicidal thoughts range from a passing idea that is quickly dismissed and involves no intention to robust and persistent thoughts with intentions and a plan. They need to be explored in detail to determine the risk and suitable management strategy. They can change over time, so a safety plan and reassessment when required are necessary.
Presenting features that increase the risk of suicide include:
Previous suicidal attempts
Escalating self-harm
Impulsiveness
Hopelessness
Feelings of being a burden
Making plans
Writing a suicide note
Background factors that increase the risk of suicide include:
Mental health conditions
Physical health conditions
History of abuse or trauma
Family history of suicide
Financial difficulties or unemployment
Criminal problems (prisoners have a high rate of suicide)
Lack of social support (e.g., living alone)
Alcohol and drug use
Access to means (e.g., firearms)
Protective factors that may help reduce the risk of suicide include:
Social support and community
Sense of responsibility to others (e.g., children or family)
Resilience, coping and problem-solving skills
Access to mental health support
General management for patients who self harm/ suidcide risk
Safety-netting, a safety plan and follow-up are important aspects of management. Potential safeguarding issues need to be considered. With the person’s consent, involving others (e.g., relatives or friends) may be helpful.
Patients may require immediate referral to A&E after a suicide attempt or for physical injuries, overdoses or safety concerns. Once their physical health problems have been managed, they will be seen by the mental health team to decide on further management. This may result in an informal admission to hospital (meaning the patient agrees to the the admission). The Mental Health Act (1983) provides a legal framework for admitting patients to hospital against their wishes for a mental health disorder when required for treatment or safety.
Management considerations for self-harm include:
Empathy, supportive communication and building rapport
Identifying triggers for episodes
Separating the means of self-harm (e.g., removing blades or medications from the environment)
Discussing strategies for avoiding further episodes (e.g., distractions, alternative coping strategies and getting help)
Providing details for support services in a crisis (e.g., mental health services, Samaritans and Shout)
Treating underlying mental health conditions (e.g., depression and anxiety)
Cognitive behavioural therapy
_________ may be given within one hour of overdose of various substances to reduce the absorption (e.g., aspirin, SSRIs, tricyclic antidepressants, antipsychotic drugs, benzodiazepines and quinine).
Activated charcoal
Treatment of Overdose / Toxicity of Paracetamol
Acetylcysteine
Treatment of Overdose / Toxicity of Opioids
Naloxone
Treatment of Overdose / Toxicity of Benzodiazepines
Flumazenil
Treatment of Overdose / Toxicity of Beta blockers
Glucagon for heart failure or cardiogenic shock
Atropine for symptomatic bradycardia
Treatment of Overdose / Toxicity of Calcium channel blockers
Calcium chloride or calcium gluconate
Treatment of Overdose / Toxicity of Cocaine
Diazepam
Treatment of Overdose / Toxicity of Cyanide
Dicobalt edetate
Treatment of Overdose / Toxicity of Methanol (e.g., solvents or fuels)
Ethylene glycol (e.g., antifreeze)
Fomepizole or ethanol (alcohol)
Treatment of Overdose / Toxicity of Carbon monoxide
100% oxygen
Generally, the first step when a patient presents with an overdose is to check ____
TOXBASE for recommendations about treating an overdose of almost any substance.
