Deliberate self-harm and substance dependence: The management of patients seen in the general hospital

1996 ◽  
Vol 23 (2) ◽  
pp. 246-252 ◽  
Author(s):  
K. Wylie ◽  
A. House ◽  
D. Storer ◽  
D. Raistrick ◽  
M. Henderson
Keyword(s):  
General Hospital ◽  
Substance Dependence ◽  
Deliberate Self Harm ◽  
Self Harm

Deliberate Self-Harm Patients Who Discharge Themselves from the General Hospital Without Adequate Psychosocial Assessment

Crisis ◽  
2004 ◽  
Vol 25 (4) ◽  
pp. 183-186 ◽  
Author(s):  
Rachel Crowder ◽  
Rohan Van Der Putt ◽  
Ceri-Anne Ashby ◽  
Andrew Blewett
Keyword(s):  
General Hospital ◽  
Care Pathway ◽  
Alcohol Intoxication ◽  
Psychosocial Assessment ◽  
Hospital Environment ◽  
Control Group ◽  
Deliberate Self Harm ◽  
Increased Risk ◽  
Self Harm ◽  
Integrated Care Pathway

Abstract: Deliberate self-harm patients who leave the acute hospital environment before the completion of psychiatric assessment have an increased risk of subsequent self-harm. We considered the available data on 50 premature self-discharges identified prospectively in a general hospital with a well-developed integrated-care pathway for self-harm patients, and compared them to a control group. The self-discharge group was found to be more likely to have attempted self-poisoning without alcohol intoxication or other forms or combinations of self-harm, and an absence of identifiable previous self-harm or prior contact with local specialist psychiatric services. The two groups showed no difference in age, sex, or area of residence based on community mental health team sectors. It is proposed that these findings indicate hypotheses for further studies of why people leave the hospital without adequate assessment, and how service design could be improved in order to help them.

scholarly journals Effect of death of Diana, Princess of Wales on suicide and deliberate self-harm

2000 ◽  
Vol 177 (5) ◽  
pp. 463-466 ◽  
Author(s):  
Keith Hawton ◽  
Louise Harriss ◽  
Louis Appleby ◽  
Edmund Juszczak ◽  
Sue Simkin ◽  
...  
Keyword(s):  
General Hospital ◽  
Suicidal Behaviour ◽  
Poisson Regression ◽  
Public Figure ◽  
Deliberate Self Harm ◽  
England And Wales ◽  
Self Harm ◽  
The Impact

BackgroundThe death of the Princess of Wales in 1997 was followed by widespread public mourning. Such major events may influence suicidal behaviour.AimsTo assess the impact of the Princess's death on suicide and deliberate self-harm (DSH).MethodAnalysis, using Poisson regression, of the number of suicides and open verdicts (suicides’) in England and Wales following the Princess's death compared to the 3 months beforehand, and the equivalent periods in 1992–1996. Similar analysis on DSH presentations to a general hospital.ResultsSuicides increased during the month following the Princess's funeral (+ 17.4%). This was particularly marked in females (+33.7%), especially those aged 25–44 years (+45.1%). Suicides did not fall in the week between the death and the funeral. Presentations for DSH increased significantly during the week following the death (+44.3%), especially in females (+65.1%). Examination of case notes suggested that the influence of the death was largely through amplification of personal losses or exacerbation of existing distress.ConclusionsThe death of a major public figure can influence rates of suicidal behaviour. For DSH, the impact may be immediate, but for suicide it may be delayed.

scholarly journals Psychiatric and personality disorders in deliberate self-harm patients

2001 ◽  
Vol 178 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Camilla Haw ◽  
Keith Hawton ◽  
Kelly Houston ◽  
Ellen Townsend
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Psychiatric Disorders ◽  
General Hospital ◽  
Representative Sample ◽  
Deliberate Self Harm ◽  
Common Diagnosis ◽  
Icd 10 ◽  
Self Harm

BackgroundPrevious UK studies have reported much lower rates of psychiatric and personality disorder in those who attempt suicide than in those who die by suicide.AimsTo determine the nature and prevalence of psychiatric and personality disorders in deliberate self-harm (DSH) patients.MethodA representative sample of 150 DSH patients who presented to a general hospital were assessed using a structured clinical interview and a standardised instrument. Follow-up interviews were completed for 118 patients approximately 12–16 months later.ResultsICD–10 psychiatric disorders were diagnosed in 138 patients (92.0%), with comorbidity of psychiatric disorders in 46.7%. The most common diagnosis was affective disorder (72.0%). Personality disorder was identified in 45.9% of patients interviewed at follow-up. Comorbidity of psychiatric and personality disorder was present in 44.1%.ConclusionsPsychiatric and personality disorders, and their comorbidity, are common in DSH patients. This has important implications for assessment and management.

scholarly journals Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital

2003 ◽  
Vol 182 (6) ◽  
pp. 537-542 ◽  
Author(s):  
Keith Hawton ◽  
Daniel Zahl ◽  
Rosamund Weatherall
Keyword(s):  
General Hospital ◽  
Age Groups ◽  
First Year ◽  
Prevention Strategies ◽  
Deliberate Self Harm ◽  
Long Term Follow Up ◽  
Self Harm ◽  
Annual Risk

BackgroundDeliberate self-harm (DSH) is the strongest risk factor for future suicide. Up-to-date information on the extent of risk is lacking.AimsTo investigate the risk of suicide after DSH during a long follow-up period.MethodA mortality follow-up study to 2000 was conducted on 11583 patients who presented to hospital after DSH between 1978 and 1997. Data were obtained from a general hospital DSH register in Oxford and the Office for National Statistics, and from equivalent mortality registers in Scotland and Northern Ireland.ResultsThree hundred patients had died by suicide or probable suicide. The risk in the first year of follow-up was 0.7% (95% CI 0.6–0.9%), which was 66 (95% CI 52–82) times the annual risk of suicide in the general population. The risk after 5 years was 1.7%, at 10 years 2.4% and at 15 years 3.0%. The risk was far higher in men than in women (hazard ratio 2.8, 95% CI 2.2–3.6). In both genders it increased markedly with age at initial presentation.ConclusionsFollowing DSH there is a significant and persistent risk of suicide, which varies markedly between genders and age groups. Reduction in the risk of suicide following DSH must be a key element in national suicide prevention strategies.

Fatal Deliberate Self-Harm seen in a Sri Lankan Hospital

1988 ◽  
Vol 152 (3) ◽  
pp. 420-423 ◽  
Author(s):  
T. Ganesvaran ◽  
R. Rajarajeswaran
Keyword(s):  
Sri Lanka ◽  
General Hospital ◽  
Sri Lankan ◽  
Deliberate Self Harm ◽  
Self Harm ◽  
Methods Of Suicide

A total of 328 patients were admitted for deliberate self harm (DSH) to the General Hospital Jaffna, Sri Lanka, during the year 1984. Twenty-two of these patients succumbed to their injuries. Information about these patients collected before death, and their methods of suicide, are reported.

Assessment following deliberate self-harm: who are we seeing and are we following the guidelines?

2001 ◽  
Vol 18 (4) ◽  
pp. 116-119 ◽  
Author(s):  
MacDara McCauley ◽  
Vincent Russell ◽  
Declan Bedford ◽  
Ashar Khan ◽  
Roisin Kelly
Keyword(s):  
General Hospital ◽  
Demographic Data ◽  
Medical Personnel ◽  
Adjustment Disorder ◽  
Discharge Summary ◽  
Service Planning ◽  
Deliberate Self Harm ◽  
Self Harm ◽  
Alcohol And Drug Abuse ◽  
Planning Group

AbstractObjectives: To determine whether assessments of patients admitted to a general hospital following deliberate self-harm (DSH) were in line with the Royal College of Psychiatrists guidelines. To examine the profile of cases and presentations and to make recommendations for improvements to the service.Method: Clinical and demographic data recorded on 70 admissions after DSH during 1997-98 were analysed retrospectively. A checklist was also developed, using factors shown by previous research to be associated with future risk of suicide, to determine the quality of assessments.Results: The majority (70%) of assessments took place within 24 hours of admission thereby meeting College recommendations. Medical personnel performed all adult assessments. Circumstances of the overdose, recent stresses, psychiatric diagnosis, immediate risk and follow-up arrangements were documented in the majority of cases. Family psychiatric history, past suicidal behaviour, alcohol and drug abuse history, and previous violence, were frequently not documented. A copy of a discharge summary to the GP was found in 41% of charts. Overdoses accounted for 93% of cases of DSH. The most frequently recorded problem (37.5%) was adjustment disorder.Conclusions: Despite evidence showing that non-psychiatric medical staff are competent in assessing DSH and guidelines encouraging multidisciplinary involvement, DSH assessments remain the preserve of the medical psychiatric team. Closer attention should be paid to all the risk factors associated with suicide by assessors; a checklist could prove helpful. There is room for improved communication between psychiatric services and GPs following DSH. The setting up of a self-harm service planning group could improve the co-ordination and efficiency of delivery of general hospital services to this patient group.

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