Self-harming

Increasing evidence shows an effect of lithium on suicidal behavior that is superior to other mood-stabilizing drugs.28 Lithium reduces the risk of deliberate self-harm or suicide by about 70%. 

Impairment in social or occupational functioning need for hospitalization because of potential self-harm, harm to others, or psychotic symptoms. 

Parasuicidal. Behavior that involves self-harm without necessarily the intent to die. 

Psychoactive. Substances that have mood- or reality-altering properties. Referral. A process of sending your client to another professional for care. Schizophrenia. A debilitating class of mental disorders that involve psychosis. Suicidal ideations. Thoughts about self-harm or suicide. 

This discussion brings us to the function of suicidal behavior. For some people, the function of suicidal behavior is to die, but not for everyone. Clearly the most lethal attempts represent a clear intent to die, especially if done in secrecy. However, many other times self-harm behavior is found to have a function besides death after a comprehensive behavioral analysis is completed with a client. For example, some clients have told me that cutting and burning themselves was related to boredom, anger, sadness, shame, uncertainty how to solve a problem, or even revenge toward someone who had hurt them. Parasuicidal... 

When taken in therapeutic doses (approximately 4 g 60mg/kg body weight) paracetamol (N-acetyl-para-ami nophenol, acetaminophen) is a safe and effective analgesic, but overdosage, possibly with the intent of self-harm, is a major cause of drug-induced hepatic toxicity. The cellular damage which may not be evident for up to... 

Johnson F, Sinha S. 1993. Deliberate self-harm by means of kerosene fire by women in Papua New Guinea. Papua New Guinea Medical Journal 36(1) 16-21. 

Deliberate Self-harm and Suicidal Ideas in Adolescents... 

Wheeler BW et al The population impact on incidence of suicide and non-fatal self harm of regulatory action against the use of selective serotonin reuptake inhibitors in under 18s in the United Kingdom Ecological study. Br Med J 2008 336(7643) 542. [PMID 18276667]... 

Long-term health effects from antidepressants include the increased risk of deliberate self-harm (DSH), which may occur more with the SRRIs than the tricyclic antidepressants. The self-harm may occur by overdosing with the prescribed drug, but is more frequently by other means. 

Evans J, Reeves B, Platt H, et al. Impulsiveness, serotonin genes and repetition of deliberate self-harm (DSH). Psychol Med 2000 30(6) 1327-1334. 

Martinez, C., Rietbrock, S., Wise, L., Ashby, D., Chick, J., Moseley, J., Evans, S., Gunnell, D. 2005, Antidepressant treatment and the risk of fatal and non-fatal self harm in first episode depression nested case-control study, Br.Med.J., vol. 330, no. 7488, p. 389. 

Patients, their families and caregivers should note that a small number of patients taking drugs of this type may feel worse instead of better, particularly within the first few weeks of treatment or when doses are adjusted. For example, they may experience unusual feelings of agitation, hostility or anxiety, or have impulsive or disturbing thoughts that could involve self-harm or harm to others (emphasis added). 

A number of clinical reports have described a syndrome of obsessive SSRI-induced suicidality and aggression that seems particular to these drugs, starting with Teicher et al. (1990). These cases bear some similarity to akathisia-driven suicidality, but compulsion toward self-harm is not accompanied by the specific symptoms of akathisia. They summarized, Six depressed patients free of recent serious suicidal ideation developed intense, violent suicidal preoccupation after 2-7 weeks of fluoxetine treatment (p. 207). Additional cases and potential mechanisms of action were analyzed by Teicher et al. (1993). 

Donovan, S., Clayton, A., Beeharry, M., Jones, S., Kirk, C., Waters, K., et al. (2000). Deliberate self-harm and antidepressant drugs Investigation of a possible link. British Journal of Psychiatry, 177, 551-556. 

Over the last decade there has been a debate as to whether SSRIs might increase the risk of suicide in certain individuals. Some patients can respond to SSRIs by becoming agitated and restless and developing symptoms that resemble akathisia. Case reports have suggested that adverse effects of this type could underlie an increased risk of self-harm and aggression. However, results from the placebo-controlled randomized trials carried out for regulatory purposes have not supported the proposal that SSRIs increase the risk of suicide of suicidal behavior. 

In a matched case-control, primary-care study of over 150 000 patients who received at least one prescription for an antidepressant between 1993 and 1999, in which dosu-lepin was used as the reference standard, there was no relative increased risk of non-fatal self-harm for fluoxetine (OR = 1.16 95% Cl = 0.90,1.50), while the risk for paroxetine approached significance (OR = 29 95% Cl = 0.97, 1.70) (24). The authors suggested that the latter finding might have been due to uncontrolled confounding by severity of depression or apparent suicide risk. In the small number of cases of fatal suicide there was no... 

The UK Committee of Safety of Medicines has previously warned that paroxetine appeared to be no more effective than placebo in the treatment of depression in adolescents and might be associated with a greater risk of self harm (SEDA-28, 16). In a meta-analysis of both published and unpublished placebo-controlled trials of SSRIs in childhood and adolescent depression, only fluoxetine seemed clearly to be associated with a positive benefit-harm balance (26). The evidence of efficacy for sertraline and citalopram was doubtful, while the risk of serious adverse events was significantly increased. Additionally, for both drugs the risk of suicidal behavior was numerically increased. In regard to venlafaxine, the risk of suicidal behavior was significantly greater than placebo. 

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