Problem-Based Review: Self-Harm and Suicide Risk

2011 ◽  
Vol 10 (3) ◽  
pp. 156-159
Author(s):  
Charlotte Heaps
Keyword(s):  
Internal Medicine ◽  
Risk Assessment ◽  
Suicide Risk ◽  
Clinical Case ◽  
Management Plan ◽  
Case Vignette ◽  
Acute Medicine ◽  
Self Harm ◽  
The Uk ◽  
Discharge From Hospital

170,000 people present to Emergency Departments in the UK each year following an act of self-harm1 and this incidence is increasing. Deliberate overdose currently accounts for ≥10% of all acute medical admissions.2 The frequency and importance of this presentation to trainees in Acute Medicine is emphasised in the curriculum for Acute Internal Medicine 20093 which states that trainees must be able to perform a risk assessment following self-harm and formulate a management plan for care upon discharge from hospital. This article uses a common clinical case vignette to address these competencies.

scholarly journals Cruising through the journey without getting drowned: The saga of a PhD student in the Netherlands

2017 ◽  
Vol 16 (1) ◽  
pp. 43-45
Author(s):  
Louise Van Galen ◽  
◽  
Joyce Wachelder ◽  
Keyword(s):  
Internal Medicine ◽  
The Netherlands ◽  
Scientific Research ◽  
Acute Medicine ◽  
Medical Trainees ◽  
Scientific World ◽  
The World ◽  
Doctor Of Philosophy ◽  
The Uk

Young medical trainees all over the world are encouraged to investigate unknown areas of medicine that need clarification. This often leads them to undertake a PhD (Doctor of Philosophy). Being curious, critical, and creative are necessary competences which enable us to engender scientific research within acute (internal) medicine. Worldwide, huge numbers of professionals are pursuing a PhD, with the aim of receiving a ‘Doctor’-title. These PhD trajectories vary distinctly between countries. Since the distances in the scientific world are getting smaller and it is becoming more easy to work with each other across borders, it might be interesting to know what it requires to become an academic ‘doctor’ overseas. Hereby, we provide a concise insight in to the differences between doing PhD in (acute) medicine in the Netherlands and in the UK

Evaluation of a novel risk assessment method for self-harm associated with Borderline Personality Disorder

2017 ◽  
Vol 25 (5) ◽  
pp. 460-465 ◽  
Author(s):  
Sathya Rao ◽  
Jillian H Broadbear ◽  
Katherine Thompson ◽  
Anna Correia ◽  
Martin Preston ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Case Vignette ◽  
Management Options ◽  
Specific Risk ◽  
Self Harm ◽  
Chronic Risk

Objectives: Borderline personality disorder (BPD) is associated with frequent self-harm and suicidal behaviours. This study compared physician-assessed self-harm risk and intervention choice according to a (i) standard risk assessment and (ii) BPD-specific risk assessment methods. Methods: Forty-five junior and senior mental health physicians were assigned to standard or BPD-specific risk training groups. The assessment utilized a BPD case vignette containing four scenarios describing high/low lethality self-harm and chronic/new patterns of self-harm behaviour. Participants chose from among four interventions, each corresponding to a risk category. Results: Standard and BPD-specific groups were alike in their assessment of self-harm risk. Divergence occurred on intervention choice for assessments of low lethality, chronic risk ( p<.01) and high lethality, chronic risk ( p<.005). Overall, psychiatrists were more likely than their junior colleagues to correctly assess risk and management options. Conclusions: Although standard and BPD-specific methods are well aligned for assessing self harm-associated risk, BPD-specific training raised awareness of BPD-appropriate interventions, particularly in the context of chronic patterns of self-harm behaviour. Wider dissemination of BPD-specific risk training may enhance the confidence of mental health clinicians in identifying the nature of self-harm risk as well as the most clinically appropriate interventions for clients with BPD.

scholarly journals Trainee Update September 2014

2014 ◽  
Vol 13 (3) ◽  
pp. 131-131
Author(s):  
Nerys Conway
Keyword(s):  
Internal Medicine ◽  
Chief Executive ◽  
Important Work ◽  
Acute Medicine ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
The Family ◽  
The Uk ◽  
Southmead Hospital ◽  
New Jobs

I hope you have all settled well into your new jobs and a very warm welcome to those that have recently joined the ‘family’ of acute medicine. I would first of all like to thank Ruth Johnson for all her hard work as trainee representative over the last 18 months and wish her all the best as she ventures into consultant territory: her replacement will be announced later in the autumn. July was a busy month, dominated by our Acute Medicine Awareness Week, during which AMUs across the UK undertook events to raise the profile of the speciality and the important work they were doing locally. Barnsley completed a 25 mile virtual marathon, Crosshouse Hospital made £350 in a cake sale, Salford Royal staff walked around every acute medical unit in Greater Manchester, North Staffordshire staff ran a half marathon and there was more cake on sale in Kings College and Leicester Royal. The AMU staff at Southampton raised over £400 with their cake sale and cycle challenge, during which they were joined by the Trust Chief Executive for a ‘virtual’ 120 miles on an exercise bike situated outside the hospital entrance. The highlight, however was the contribution of Dr Nigel Lane, an acute medicine trainee from Southmead Hospital in North Bristol, who put together an outstanding weekly programme of events. This included a visit from the Chief Executive of the trust, visit from local GPs to the unit, daily MDT teaching, daily ‘messages of the day’ located on the trust website and lots of screensavers, banners and information scattered throughout the hospital. I am delighted to announce that Nigel has received the SAM awareness week prize. This involves the opportunity to join the European School of Internal Medicine and attend the winter EFIM school camp in Latvia. Nigel will also be joining us as one of the speakers in the trainee session at SAM Brighton. He will be speaking on “Preparing for your PYA”. There will also be talks in the trainee session on “Keeping your e-portfolio updated”, “Choosing your specialist skill” and “Preparing for your consultant job”. The session will be aimed at both junior and senior trainees. The trainee that has produced the best poster at Brighton will also have a chance to win a place to attend the summer EFIM school camp. The day before the conference starts there will be a SCE revision session. I attended last year and found it extremely helpful! Looking forward to seeing you all in Brighton. In the meantime if you have any problems or suggestions please tweet or email me at the addresses below.

Suicide among psychiatric in-patients in a changing clinical scene

1997 ◽  
Vol 171 (6) ◽  
pp. 561-563 ◽  
Author(s):  
H. G. Morgan ◽  
Ruth Stanton
Keyword(s):  
Risk Assessment ◽  
Clinical Practice ◽  
Suicidal Ideation ◽  
Suicide Risk ◽  
Psychiatric Patients ◽  
Patient Status ◽  
Rapid Changes ◽  
Similar Series ◽  
Discharge From Hospital ◽  
Suicidal Ideas

BackgroundRapid changes in styles of clinical practice mean that we should carefully monitor the way suicides occur among psychiatric patients both in hospital and in the wider community.MethodPatients who had died through suicide either while receiving in-patient care or within 2 months of discharge from hospital were compared with a similar series reported 10 years previously. Clinicians' perceptions of patients' behaviour were compared with concurrent controls.ResultsPatients in the more recent study were younger, more often male, and a greater proportion had been discharged from in-patient status. Hazards which complicated risk assessment included short-lasting misleading clinical improvements, variability in degree of distress, and a reluctance to discuss suicidal ideas. Over a range of perceived behaviours it was not possible to distinguish suicides from controls.ConclusionsIn assessing suicide risk paramount importance should be attached to monitoring suicidal ideation and addressing the several hazards which might complicate this procedure.

scholarly journals Fatal and non-fatal repetition of self-harm

2002 ◽  
Vol 181 (3) ◽  
pp. 193-199 ◽  
Author(s):  
David Owens ◽  
Judith Horrocks ◽  
Allan House
Keyword(s):  
Systematic Review ◽  
General Population ◽  
Suicide Risk ◽  
Experimental Studies ◽  
Inclusion Criteria ◽  
Strong Connection ◽  
Effective Interventions ◽  
Self Harm ◽  
The Uk

BackgroundNon-fatal self-harm frequently leads to non-fatal repetition and sometimes to suicide. We need to quantify these two outcomes of self-harm to help us to develop and test effective interventions.AimsTo estimate rates of fatal and non-fatal repetition of self-harm.MethodA systematic review of published follow-up data, from observational and experimental studies. Four electronic databases were searched and 90 studies met the inclusion criteria.ResultsEighty per cent of studies found were undertaken in Europe, over one-third in the UK. Median proportions for repetition 1 year later were: 16% non-fatal and 2% fatal; after more than 9 years, around 7% of patients had died by suicide. The UK studies found particularly low rates of subsequent suicide.ConclusionsAfter 1 year, non-fatal repetition rates are around 15%. The strong connection between self-harm and later suicide lies somewhere between 0.5% and 2% after 1 year and above 5% after 9 years. Suicide risk among self-harm patients is hundreds of times higher than in the general population.

scholarly journals General Practitioners’ Accounts of Patients Who Have Self-Harmed

Crisis ◽  
2016 ◽  
Vol 37 (1) ◽  
pp. 42-50 ◽  
Author(s):  
Amy Chandler ◽  
Caroline King ◽  
Christopher Burton ◽  
Stephen Platt
Keyword(s):  
Risk Assessment ◽  
General Practitioners ◽  
Suicide Risk ◽  
Assessment Method ◽  
Service Development ◽  
Structured Interviews ◽  
Increase Risk ◽  
Self Harm ◽  
The Right ◽  
The Relationship

Abstract. Background: The relationship between self-harm and suicide is contested. Self-harm is simultaneously understood to be largely nonsuicidal but to increase risk of future suicide. Little is known about how self-harm is conceptualized by general practitioners (GPs) and particularly how they assess the suicide risk of patients who have self-harmed. Aims: The study aimed to explore how GPs respond to patients who had self-harmed. In this paper we analyze GPs’ accounts of the relationship between self-harm, suicide, and suicide risk assessment. Method: Thirty semi-structured interviews were held with GPs working in different areas of Scotland. Verbatim transcripts were analyzed thematically. Results: GPs provided diverse accounts of the relationship between self-harm and suicide. Some maintained that self-harm and suicide were distinct and that risk assessment was a matter of asking the right questions. Others suggested a complex inter-relationship between self-harm and suicide; for these GPs, assessment was seen as more subjective. In part, these differences appeared to reflect the socioeconomic contexts in which the GPs worked. Conclusion: There are different conceptualizations of the relationship between self-harm, suicide, and the assessment of suicide risk among GPs. These need to be taken into account when planning training and service development.

Risk factors for violence: an audit on the effect of a tutorial on risk assessment

2004 ◽  
Vol 21 (1) ◽  
pp. 28-29
Author(s):  
Frederick Sundrum ◽  
Stephen Browne
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Previous History ◽  
Management Plan ◽  
Case Note ◽  
Adult Psychiatry ◽  
History Of ◽  
Self Harm ◽  
State Examination ◽  
The Ideal

AbstractObjectives: To evaluate the effect of a risk assessment tutorial on the adequacy of case note documentation in a general adult psychiatry setting.Methods: A comparison of case note documentation of risk factors for violence prior to and subsequent to a risk assessment tutorial.Results: Prior to the tutorial there were very low rates of documentation of risk of violence. Subsequent to the tutorial, statistically significant improvements in documentation occurred in approximately one third of the items being assessed. Significant improvements occurred in the following; recording a collateral history (from 18%-36%) and previous history of deliberate self harm (from 24%-50%), noting emotions related to violence in the mental state examination (from 2%-24%) and documenting a risk management plan (from 2%-28%). However, levels of documentation remained overall sub-optimal.Conclusions: Some improvement in case note documentation can result from providing tutorials in risk assessment. However, the ideal format for teaching risk assessment needs to ascertained.

Audit on inpatient risk assessment of mentally ill patients

2011 ◽  
Vol 26 (S2) ◽  
pp. 1618-1618
Author(s):  
R. Jayan ◽  
S.H. Jawed
Keyword(s):  
Risk Assessment ◽  
Mentally Ill ◽  
Suicide Risk ◽  
Substance Misuse ◽  
Action Plan ◽  
Clinical Governance ◽  
Completion Date ◽  
Self Harm ◽  
The Mean ◽  
Stated Time

IntroductionRisk assessment of mentally ill in-patients is an ongoing process in stated time scale. It includes risk of self harm, aggression, violence, self neglect and exploitation and abuse by others. Accurate recording is essential for patient management.Aims and methodsThe aim was to assess the practice of risk assessment in our trust. Retrospective data of 50 consecutive admissions were collected from case notes over a period of 6 months.Results28 females (56%) and 22 males (44%) of average age 41 were included in the audit. The mean duration of admission was 55 days (range 7–270 days). 11 patients (22%) had schizophrenia and 8 patients (16%) each had a diagnosis of depressive disorder and substance misuse. The other patients had diagnoses of schizoaffective, personality disorder and bipolar illness. Four patients (8%) had no risk assessment forms filled in during the admission. Out of 46 forms completed, the time and date of assessment were not recorded in 8 (17%). Completion date was recorded in 9 forms (20%) and review was done in 11 cases (24%). 45% of forms did not have the name and signature of assessor. Suicide risk, neglect and aggression/violence were documented in most forms (90%), however only 20% cases had a further action plan.ConclusionsSignificant number of risk assessment forms lacked important information which is crucial for risk management. This data was presented to the clinical governance team and was highlighted as a priority for improvement which has been implemented in the trust.

Editorial Volume 16 Issue 4

2017 ◽  
Vol 16 (4) ◽  
pp. 155-155
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Internal Medicine ◽  
Case Reports ◽  
Editorial Team ◽  
Research Committee ◽  
Acute Medicine ◽  
The Future ◽  
New Vision ◽  
The Uk

My time has come. After 15 years and over 50 editions it is time for me to hang up my metaphorical red biro, and hand over the role of Editor. It has been an interesting job, and I am extremely grateful to everyone who has contributed and supported the journal over this period. When I took on the position in 2002, this journal was very different to how it is today. Some readers may recall its original incarnation as the CPD journal of Internal Medicine, part of a series of publications produced at that time by Rila. Initially this was comprised predominantly of commissioned review articles, running over a 5 year cycle which was designed to cover the common conditions managed by ‘general’ physicians. As time progressed, the number of unsolicited submissions grew steadily – initially (and continually) dominated by case reports, but with a slowly increasing number of research-based articles as the readership expanded. The quality of these submissions improved further when we finally attained indexing in PubMed, which also attracted more international submissions. I am delighted that the current edition features research papers from the Netherlands and Singapore, both of which have a growing community of Acute Physicians. I remain hopeful that the number of acute medicine-related research submissions from the UK will rise as the speciality grows. The number of high quality abstracts presented at the Society for Acute Medicine (SAM) meetings is indicative of the amount of work that is going on, but it is disappointing that so few of these turn into publications in peerreviewed journals. Acute Physicians are busy people with constant and year-round operational pressures, which may mean that writing up research is continually pushed down the list of priorities. Perhaps also the fact that the number of consultant posts across the continues to exceed the number of Acute Internal Medicine trainees removes some of the ‘pressure to publish’ which is felt by trainees in other hospital specialities. My hopes for the future of this journal have been boosted by the appointment of Tim Cooksley as my replacement ‘Editor in Chief’, who will take over from the Spring 2018 edition onwards. Tim has been a hard working member of the editorial team over recent years, and prior to this was a regular contributor to the journal. He has a strong research background and is a leading member of the SAMBA academy and SAM research committee. I would also like to thank the other members of the editorial board without whose support and contributions this job would have been completely untenable. I understand that Tim plans to keep many of these colleagues in post, as well as bringing in some ‘new blood’ to create a fresh new vision for the future. I wish them all well, and will look forward to reading (as opposed to writing) these editorials. Thanks, finally, to all of the loyal readers who have stuck with the journal over the past 2 decades. I hope that we have managed to keep you entertained and educated on those occasional moments of respite during the acute medical on-call. I wish you all well for the future.

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