Self-harm assessment

Take a calm and thorough approach to self-harm assessments. Share decisions with colleagues and patients, documenting discussions. Well thought-out plans are usually defensible, even when things go wrong. 

Chapter SI Self-harm Preparation Assessment Management What if... ... 

Chapter 71 Self-harm on the ward Preparation Assessment Management What If... ... 

When assessing thoughts of self-harm or an actual self-harm attenpt, you must think about the risk factors for completed suicide (p321-322). There s no formula to calculate whether someone will kill themselves, but the more risk factors - and fewer protective factors - the more concerned you should be. 

Ensure she s been screened by the ED doctors for overt organic causes and undisclosed self-harm Focus on assessment and initial management, containing risks and alleviating distress (Table 21.21. 

Assess MSE, risks, physical health (self-harm, UDS, breathalyser)... 

Expertise in assessing and managing self-harm risk... 

Eveiyone presenting with self-harm or suicidal thoughts needs a full psychiatric assessment, no matter how low risk they seem. Whether self-harm functions as a suicide attempt or not, any act increases the risk of suicide in the followii year. 

Kapur, N., Murphy, E., Cooper, J. et al. (2008) Psycho-social assessment following self-harm results from the Multi-Centre Self-harm project. Journal of Affective Disorders 106 (3), 285-293. 

All self-harming under-16s should be admitted overnight to allow a specialist CAMHS assessment the next day (NICE guidelines). 

Assess the risk of further self-harm, including factors that affect ... 

Assess risk, including evidence of other self-harm... 

Assess for the safety of others and potential for violence. If accompanied by friends or family with whom the patient is living, ask them to remove from the home all guns, caustic chemicals, medications, and objects the person might use to harm self or others. Risk factors for suicide include severity of depression, feelings of hopelessness, comorbid personality disorder, and a history of a previous suicide attempt.19... 

I feel obliged to document my basis for any adverse criticism and expect that editors will ignore critiques that do not do so, regardless of their origin. I have encountered too many self-serving pontifical criticisms that were largely unjustified and did considerable harm to the careers of newcomers. Such assessments not only are useless, but also may be dangerous to the welfare of chemistry. 

Its principal use is against superficial herpes virus infections of humans in which it produces a moderate cure rate without harming the tissue to which the drug is applied. Since dermal herpes simplex is usually self-limiting and of short duration, the assessment of clinical effect is not easy when double-blind trials are carried out. Some authors claim that a statistically positive result is obtained and an almost equal number conclude that the difference between drug and placebo treated patients is not significant. Some patients, however, consider the treatment to be beneficial [190]. 

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