Summary Australian and New Zealand Clinical Practice Guideline for the Management of Adult Deliberate Self-Harm (2003)

Abstract

Objective: To provide a summary of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guideline for the Management of Deliberate Self-Harm. Conclusions: This guideline covers self-harm regardless of intent. It is an evidence-based guideline developed from a systematic review of epidemiological, treatment and medico-legal literature. All patients presenting to hospital after deliberate self-harm should be comprehensively assessed to detect and treat the high rates of mental disorders, alcohol and other drug problems and personality disorders in this group. General hospital management aims to ensure safety from further self-harm, assess and treat injuries; prevent disablement and death as a result of injuries or poisoning and manage suicide risk by ensuring prompt psychiatric referral and mobilizing social supports. Psychological management aims to detect and treat underlying mental disorders, reduce distress and enhance coping skills and thereby, reduce repeat episodes and habituation of self-harm. Managing suicide risk is a continuous responsibility and suicide vulnerability may persist long-term in some patients. There is little firm guidance from the literature on treatment efficacy to guide ongoing psychiatric management. Studies are often compromised because between 41 and 70% of patients do not attend follow up. The mainstay of psychological care remains the treatment of underlying Axis I and Axis II disorders. Cognitive-behavioural therapy (CBT) and problem-orientated approaches appear promising for reducing repeated self-harm for most patient groups but no single treatment has confirmed superiority. Dialectical behaviour therapy (DBT) appears to confer most benefit. Self-harm may follow some forms of in-depth therapy in some vulnerable individuals. There is no one recommended pharmacological treatment specifically to reduce self-harming behaviours. Lithium may have antiself-harm properties for some groups with bipolar disorder. There is emerging evidence for selfharm reduction using clozapine for patients with schizophrenia and schizoaffective disorder.