BACKGROUND: The aim with this article is to provide an introduction to self-harm as a clinical phenomenon, with phenomenological descriptions and definitions, and by presenting risk factors, epidemiological data and functions of self-harm. MATERIAL AND METHOD: The basis for the article is a non-systematic literature search of the electronic databases Medline, PsychInfo and EMBASE (1985 - 2008). and our own archive of literature on self-harm. RESULTS: There is some evidence for an increase in the prevalence of self-harm. Among possible risk factors are childhood abuse, abandonment, neglect, trauma and separation, and the affective quality of the attachment bonds in childhood. A common factor is self-harm as a bodily practice for affect regulation, and as such, it can be understood as a dysfunctional competence. INTERPRETATION: To search for understanding of self-harm in individual, familiar and cultural contexts contributes to meet individuals with such tendencies with empathy and beneficial interventions. Language: no

[What is self-harm?].

http://www.info-suicide.be/wp-content/uploads/2014/02/The_European_Psychiatric_Association_guidance_on_suicide_treatment.pdf

The European Psychiatric Association (EPA) guidance on suicide treatment and prevention.

Suicide is the 15th most common cause of death worldwide. Although relatively uncommon in the general population, suicide rates are much higher in people with mental health problems. Clinicians often have to assess and manage suicide risk. Risk assessment is challenging for several reasons, not least because conventional approaches to risk assessment rely on patient self reporting and suicidal patients may wish to conceal their plans. Accurate methods of predicting suicide therefore remain elusive and are actively being studied. Novel approaches to risk assessment have shown promise, including empirically derived tools and implicit association tests. Service provision for suicidal patients is often substandard, particularly at times of highest need, such as after discharge from hospital or the emergency department. Although several drug based and psychotherapy based treatments exist, the best approaches to reducing the risk of suicide are still unclear. Some of the most compelling evidence supports long established treatments such as lithium and cognitive behavioral therapy. Emerging options include ketamine and internet based psychotherapies. This review summarizes the current science in suicide risk assessment and provides an overview of the interventions shown to reduce the risk of suicide, with a focus on the clinical management of people with mental disorders.

https://www.bmj.com/content/bmj/351/bmj.h4978.full.pdf

Suicide risk assessment and intervention in people with mental illness

BackgroundPrediction of suicidal behaviour is an aspirational goal for clinicians and policy makers; with patients classified as 'high risk' to be preferentially allocated treatment. Clinical usefulness requires an adequate positive predictive value (PPV).AimsTo identify studies of predictive instruments and to calculate PPV estimates for suicidal behaviours.MethodA systematic review identified studies of predictive instruments. A series of meta-analyses produced pooled estimates of PPV for suicidal behaviours.ResultsFor all scales combined, the pooled PPVs were: suicide 5.5% (95% CI 3.9-7.9%), self-harm 26.3% (95% CI 21.8-31.3%) and self-harm plus suicide 35.9% (95% CI 25.8-47.4%). Subanalyses on self-harm found pooled PPVs of 16.1% (95% CI 11.3-22.3%) for high-quality studies, 32.5% (95% CI 26.1-39.6%) for hospital-treated self-harm and 26.8% (95% CI 19.5-35.6%) for psychiatric in-patients.ConclusionsNo 'high-risk' classification was clinically useful. Prevalence imposes a ceiling on PPV. Treatment should reduce exposure to modifiable risk factors and offer effective interventions for selected subpopulations and unselected clinical populations.

/pdf/predicting-suicidal-behaviours-using-clinical-instruments-23t5fdlxqn.pdf

Julian Bird

Papers

Evaluation of suicidal patients: The SAD PERSONS scale

SAD PERSONS Scale