Patients with deliberate self-harm seen by a consultation-liaison service

Adjustment Disorder and Suicidal Behaviours Presenting in the General Medical Setting: A Systematic Review

Background: Adjustment disorder (AD) is a condition commonly encountered by clinicians in emergency departments and liaison psychiatry settings and has been frequently reported among patients presenting with suicidal behaviours. A number of previous studies have noted the strong association between suicidal ideation and behaviours, and AD. In this paper, we aimed to explore this relationship, by establishing the incidence of AD in patients who present with self-harm and suicidal ideation, and the rates of self-harm among patients with a diagnosis of AD. Methods: We conducted a review of the literature of well-established databases using specific key words then synthesised the results into a descriptive narrative as well as representing it in table form. Results: Sample sizes and study methods varied significantly across the review. A majority of studies were retrospective chart-based reviews, and only three used structured diagnostic instruments. A high prevalence of AD (ranging from 9.8 to 100%) was found, with self-poisoning representing the most common form of suicide attempt in the majority of studies. Interpersonal difficulties were the main precipitant in studies which examined this. Conclusions: This study suggests there is a strong association between AD and suicidal behaviours. Given the paucity of research in the area, there is a need to build the evidence base for effective treatment strategies.

Young people who self-harm: a prospective 1-year follow-up study

PURPOSE

To explore repetition, service provision and service engagement following presentation of young people to emergency services with self-harm.

METHODS

969 patients who presented to accident and emergency services after self-harm were followed up prospectively for a period of 1 year. Data on rates, method, clinical history, initial service provision, engagement and repetition (defined as re-presenting to emergency services with further self-harm) were gathered from comprehensive electronic records.

RESULTS

Young people were less likely to repeat self-harm compared to those aged 25 and above. A psychiatric history and a history of childhood trauma were significant predictors of repetition. Young people were more likely to receive self-help as their initial service provision, and less likely to receive acute psychiatric care or a hospital admission. There were no differences in engagement with services between young people and those aged 25 and above.

CONCLUSION

Younger individuals may be less vulnerable to repetition, and are less likely to represent to services with repeated self-harm. All young people who present with self-harm should be screened for mental illness and asked about childhood trauma. Whilst young people are less likely to be referred to psychiatric services, they do attend when referred. This may indicate missed opportunity for intervention.

Psychiatric consultations and therapy recommendations following a suicide attempt in a general hospital and their associations with selected parameters in a 1-year period

OBJECTIVE

Our study aims to determine the frequency and distribution of suicide attempts according to the patients' characteristics and type of suicide attempt as well as the method of treatment proposed by the consultation-liaison service in a general hospital.

METHODS

This retrospective naturalistic study covers a 1-year period (2012), during which 51 suicide attempters were hospitalised in the Charité Berlin, Campus Benjamin Franklin, Germany. The following data were analysed: method of suicide, account of prior psychiatric history and medication, as well as the acute psychiatric diagnosis and treatment - including pharmacotherapy.

RESULTS

Most of the patients were diagnosed with a psychiatric illness. Major depressive disorder was the most frequent diagnosis in consultation. Treatment recommendations more often entailed further psychiatric treatment than medication. In the cases where medication was indeed given, benzodiazepines were the most frequently prescribed.

CONCLUSIONS

Most of the suicide attempters needed further therapy in psychiatric hospitals. A specialised pharmacotherapy (antidepressants, mood stabilisers) was rarely recommended by the psychiatric consultation service. The psychiatric consultation and therapy recommendations are important in guiding future acute treatment procedures.

Survivors of self-inflicted stab wounds

OBJECTIVE

There are a number of studies describing the survivors of self-incised wounds, but few studies have described the psychiatric condition of survivors of self-inflicted stab wounds. We aimed to describe the characteristics of a complete series of patients treated for self-inflicted stab wounds in a major hospital, and to compare the characteristics of patients with psychotic illness to those with other conditions.

METHODS

A review of the files of all patients who had a psychiatric evaluation after presenting for treatment following deliberate self-harm. Stab wounds were defined as wounds made by a sharp instrument in which the width was less than the depth.

RESULTS

There were 41 survivors of self-inflicted stab wounds among 2119 patients assessed after deliberate self-harm. Of these, 15 were diagnosed with a psychotic illness and the remainder had other conditions, including depression, personality disorder and substance use disorder. There was little difference in the demographic features, clinical variables and in the proportion who were intoxicated between patients diagnosed with psychotic illness and those with other disorders. The patients with psychosis were more likely to have inflicted multiple stab wounds, to have stabbed their chest or abdomen and to have reported the intention of committing suicide.

CONCLUSIONS

The results suggest that a significant proportion of patients who present for treatment after stabbing themselves suffer from a psychotic illness. However, there were few differences in the characteristics of the patients who had a diagnosis of psychosis and those with other disorders.

Meeting standards set for non self-harm presentations to emergency departments

OBJECTIVES

The commonest psychiatric presentation in most emergency departments (EDs) is deliberate self-harm. However, there are other significant categories of psychiatric presentation which include alcohol and substance misuse, acute psychosis and mood disorder. In addition to the NICE Guidelines for deliberate self-harm, there are good practice guidelines available for the management of other psychiatric attendances to the ED. The aim of this study was to identify the psychiatric attendances other than deliberate self-harm to Beaumont Hospital ED over a 12-month period with the objective of studying the rates and characteristics of attendances and to investigate whether good practice guidelines were met.

METHOD

From a total of 657 psychiatric attendances other than deliberate self-harm which were recorded, data was collected on demographics, provision of a psychosocial assessment and adherence to good practice guidelines.

RESULTS

Alcohol (38%) was the most common reason for presentation. Of the total number of attendees, only 44% received a psychosocial assessment compared to 59% of attendees who had presented following deliberate self-harm during the same 12-month period.

CONCLUSIONS

The attendees who did not receive a psychosocial assessment represent a vulnerable group in which the levels of psychosocial assessment need to be improved in order to meet good practice guidelines standards of care.