Deliberate Self-harm:

 

uAn episode of intentional self-harm that did not lead to death and may or may not have been motivated by a desire to die. It is a non-fatal act in which an individual deliberately causes self injury or ingests a substance in excess of any prescribed or generally recognized dosage.

u

uMethod: In UK 90% cases --- drug overdose  and most of  them  present  no serious threat  to  life.

uCommon drugs -- paracetamol , Aspirin, TCA, SSRIs,  Alcohol etc.

u

uSelf –injury: Laceration of  fore-arms  or  wrists. Other  forms  are  jumping  from  heights or  in  front  of  a  train  or  motor  vehicle,  shooting  and  drowning.

 

Causes of deliberate self-harm:

u1) Stressful life problems-- recent quarrel with spouse, girlfriend or  boyfriend is common. Other events are  separation from or rejection by a  sexual partner,  illness of a family member, recent personal physical illness .

u2) Early parental loss

u3) Parental neglect or  abuse

u4) Personality disorder-- paranoid,  Borderline.

u5) Financial difficulties

u6) Unemployment.

Psychiatric disorders cause self-harm:

uDepressive disorder

uDependency of alcohol and other illicit drugs

uPersonality disorder.

uAnxiety disorder.

Reasons for deliberate self-harm:

u1) To die

u2) To escape from unbearable anguish

u3) To get  relief

u4) To  change the behaviors of others

u5) To escape from a situation

u6) To show desperation to others

u7) To get help

u8) To make the other people to feel guilty.

Management:

uIt involves a variety of  services including primary care teams, ambulance services, emergency department  staff  and  social services.

u

uTo  assess the  immediate risk.

uTo evaluate the pt’s intention

uWas it planned or  carried out on  impulse.

uWhat are the current problems.

Suicide:

u

u

uSuicide is among the ten leading causes of death in most of the countries.

uIt is an act of fatal out-come, deliberately initiated and performed by the person in the knowledge  of  its  fatal out-come.

uMethod: Hanging

u                  Drug overdose

u                  Self  poisoning by car exhaust fumes

u                  Drowning,  jumping from heights

u                   Gunshot etc. 

u            

The act of suicide:

uMost completed suicide are planned.

uIn most cases warning is given.

uHigh rates associated with mental illness.

uHigher rates among the immigrants in USA.

uLess in Asian countries and very low in Islamic countries. 

SUICIDE-2: