8/30/2012

Objectives Self Harm & Risk Assessment

Defining self-harm Epidemiology Causes Risk assessment References

Wakil Ahmed ST-5 General Adult Psychiatry

Definition
Suicide: * an act with fatal outcome * deliberately initiated * person in knowledge & expectation of its fatal outcome Deliberate self-harm: * a non-fatal deliberate act * inflict self injury or ingest a substance in excess of any prescribed / recognised dosage

Epidemiology
Suicide: Male: female 2-4:1 Men 17/100,000/year Women 5-3/100,000/year Men: hanging 40%, OD 20%, car exhaust 10% Women: OD 46%, hanging 27%, drowning 7% DSH: 3/1000/year 2:1 female to male, now the gap is reducing

Causes / Association
Association with mental illness

Causes / Association
Biological factor:
* reduced activity of 5-HT pathways * this causes increased impulsivity & aggression

Other risk factors:

* high unemployment * poverty * divorce * age over 75 * doctors / farmers * debilitating physical illness

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Risk Assessment
General Aims:
The immediate risks of suicide The subsequent risks of further DSH Current medical or social problem

Risk Assessment
1. Obtain detail of the act: (e.g., in case of OD)
How many tablets were taken? What type of tablets was taken? When was the overdose taken? How was the medication obtained? Where was the patient when he/she took the OD? How and by who was he/she discovered? What made him/her think of harming herself? (Or) What sorts of things have been worrying him/her

Specific Inquiries:
Pts intention at the time of self harm Do they now intend to die What are their current problem(s) Is there a psychiatric disorder What helpful resources are available

Risk Assessment
What did he/she do after the overdose? How did he/she end up coming to hospital? Did he/she take anything else with the tablets, for example, alcohol? Why did she take the overdose? (Or) What was the event leading up to the suicidal act? (Or)

Risk Assessment
2. Assessment of the degree of intent:
Was the act planned or impulsive? Was anyone else actually present at the time? Did he/ she convey suicidal intent to others? Where did the act take place? Would he/she have anticipated being found? Did he/she take measures to avoid discovery? Did he/she make any preparations like arranging for the care of children etc? Did he/she leave any suicide note?

Risk Assessment
4. Explore depressive / psychotic symptoms: 5. Assess current mental state:
mood & depressive ve cognitions such as hopelessness, worthlessness etc, suicidal thoughts or plan

References
Shorter Oxford textbook of Psychiatry, 5th Edition NICE Guideline, CG 16, 2004 Office of national statistics,
http://www.ons.gov.uk/ons/rel/subnational-health4/suicides-in-the-unitedkingdom/2010/stb-statistical-bulletin.html

6. Past psychiatric Hx & background information:

Suicidal / DSH behaviour Mental illness Substance misuse Family Hx of mental illness, self harm