Deliberate Self Harm - DSH |
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| 2007-12-24 | No history |  | Add My version | |
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| Mind map Deliberate Self Harm - DSH (from MedMaps.co.uk) - the online mind map resource for medical students and doctors. Psychiatry. Medicine. | |
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DSH
Characteristics
7-14% of adolescents
commonly kept secret
30% report previous acts
Impulsive
within minutes of thinking about it
1/3 psychiatric co-morbidities
depression
Unspecific triggers
family issues
sexual abuse
bullying at school
drug abuse
Depression
physical illness
Risk factors
20-25y/o
peak incidence
older in males
female
especially South Asian in UK
alone
acute stress
family problems
sexual abuse
substance abuse
Purpose
to die
relieve tension
communicate distress
help-seeking behaviour
revenge
manipulation
escape
S&S
Cutting
commonest
Poisoning
paracetamol
NSAIDS
Complications
accidental death
suicide
10% lifetime risk
0.2%-4% in adolescents
Prognosis
recurrence
10% within 1 year
increased risk of recurrence
depressed
continuing stressors
broken home
substance abuse
psychiatric co-morbidities
social isolation
poor school records
increased risk of suicide
male
violent DSH
multiple episodes of DSH
substance misuse
psychiatric hospital admission
Biopsychosocial management
Investigations
paracetamol levels
Treatment
all serious to hospital
specialist evaluation
In-patient
high risk of suicide
psychotic
severe social difficulties
out-patient
majority
Therapies
Cognitive Behavioural Therapy
if depressed
Problem solving therapy
Group therapy
Family therapy
5-6 sessions
home based
Medication
Analgesia / local anaesthetics
Antidepressants
fluoxetine in adolescents
Antipsychotics
Social
New accommodation
Foster parents
Differential
attempted suicide
Examination
Assess suicidal intent
not proportional to DSH
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