Deliberate Self Research Articles

“Unraveling the Diagnostic Dilemma: Unusual Presentation of Huntington’s Disease with Predominant Psychiatric Symptoms and Late-Onset Motor Manifestations”

IntroductionHuntington’s Disease is a neurodegenerative disease inherited in an autosomal dominant fashion.The underlying genetic defect is unstable CAG trinucleotide repeat expansion with a repeat length longer than 36 resulting in pathological aggregation of abnormal protein causing cell death.The clinical symptoms encompass 3 main domains-motor,cognitive and psychiatric.The psychiatric symptoms often in atypical form appear decades before other symptoms causing significant impact on patient’s functioning and quality of life.Here, we discuss an unusual presentation of Huntington’s Disease causing diagnostic dilemma.ObjectivesCase report discussing the unusual presentation of Huntington’s Disease.MethodsCase: Mr X is a 61 year old Caucasian male.He had an uneventful birth and early childhood attaining milestones appropriately. He experienced childhood adversity in the form of sexual abuse between ages 2-14 years. His mental health difficulties started following sexual abuse when he attempted to end his life by hanging and overdosing at age 15. He got married twice, both of which broke down. There is a history of significant alcohol abuse between ages 40-50. Following this, he had a myocardial infarction and a stroke requiring stenting.He presented to Psychiatric Outpatient Services in 2011 with auditory hallucinations, social anxiety with panic attacks, OCD type rituals, claustrophobia and feeling hot all the time. He was started on an antipsychotic medication for psychosis ,but clinically deteriorated. He started having anger outbursts, marching on the spot ,and head banging. He was diagnosed with Huntington’s Chorea in 2021 after he had developed chorea. He currently has low mood and is head banging for hours.ResultsPsychiatric symptoms in HD can span a variety of domains but most common are symptoms of frontal lobe dysfunction-disinhibition, poor attention, irritability, impulsivity and personality change. Apathy, emotional blandness and social withdrawal are also prominent features.Mr X had strong family history of Paranoid Schizophrenia (aunt and cousin).There was no family history of HD. His mental health problems started early in life with DSH, Depression and Harmful use of Alcohol. He presented predominantly with psychotic symptoms like auditory hallucinations, social anxiety, paranoia. Motor symptoms started late which he incorporated into voluntary movements like head banging which made it difficult to differentiate from deliberate self harm.ConclusionsPsychiatric symptoms constitute the core of HD. Studies have shown that though depression and personality change are typical of HD, there are number of other psychiatric symptoms that can impair quality of life. Early diagnosis and treatment of these symptoms will help patients and families to cope better with severe symptoms of this progressive disease.Disclosure of InterestNone Declared

The role of Theory of Mind in the transition towards suicidal attempts in youth NSSI: an exploratory pilot study.

Non-suicidal self-injury (NSSI) can both precede and co-occur with suicidal attempts (SA). Underlying mechanisms/factors leading to the transition to SA in NSSI youths have been proposed (including the role of social cognition), despite they should be yet confirmed. Therefore, the study aims at exploring the role of the Theory of Mind in the differentiation of a sample of NSSI youngsters (aged 15-24) according to the presence of SA. We divided the sample into 4 groups using the Deliberate Self Harm Inventory (DSHI) and Columbia Suicide Severity Rating Scale (C-SSRS): control group (notNSSInotSA), NSSI without SA (NSSInotSA), NSSI with SA (NSSIplusSA), and SA without NSSI (SAonly). NSSIplusSA patients displayed higher Reading the Mind in the Eyes Test (RMET) scores (indicative of ToM abilities) than both the NSSInotSA (p=0.0016) and SAonly groups (p=0.0198), while SAonly patients showed lower RMET scores compared to the control group (p=0.0214). Multiple regression models used to differentiate NSSInotSA and NSSIplusSA found a significant association between RMET and LOSCS-CSC (Level Of Self-Criticism Scale-Comparative Self-Criticism) (pC=0.0802, pD=0.0016, pG=0.0053). Our findings supported the hypothesis that a hypertrophic affective ToM may possibly be associated with the occurrence of SA in youth NSSI. Further larger and longitudinal studies should confirm these preliminary findings, by exploring all social cognition dimensions.

Sociodemographic Profile and Psychological Factors Influencing Deliberate Self Harm in a Tertiary Rural Health Care Setup: A Cross-sectional Study

Introduction: There has been a rising trend of deliberate self-harm (DSH) in India recently. The tendency to harm oneself is associated to female sex, younger age, stressful life events and mental illnesses such as depression. Knowledge of socio-demographic factors and psychiatric morbidities in patients having self-harming behavior can be helpful in planning suicide prevention strategies.Methods: This was a hospital-based descriptive, observational, cross-sectional study. The data was collected from 150 consecutive referrals DSH to the psychiatry OPD in Rural Tertiary Care Centre. Corresponding validated psychometric scales quantified severity of depression, and suicide intent.Results: Most of the study population belonged to 18 to 29 years age group and most were males (n = 105, 70%). Poisoning was the most common mode of DSH (n = 133, 88.7%). Diagnosable psychiatric illnesses were found in 52 (34.6%) patients, most common being adjustment disorder (n = 25, 16.6%).Conclusion: Our study highlights the socio-demographic, psychosocial and clinical factors present in individuals attempting self-harm.

Метгемоглобинемия вследствие отравления нитритом натрия (клиническое наблюдение)

The article presents a clinical case of the successful treatment of secondary methemoglobinemia resulting from deliberate self- poisoning with sodium nitrite salt. The need for all patients with central cyanosis if their status does not improve for the insufflation with humidified oxygen is emphasized

Mental Health Conditions Among University Students

College students are one of the populations that are vulnerable to mental health disorders; various reasons can cause this. Sometimes there are triggers that cause students to feel that their mental health is not good, such as academic fatigue, academic stress, social support, and others. This study aims to find out how the mental health conditions at a university in Jakarta are described. The study involved 207 participants from 7 faculties using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Deliberate Self Harm Inventory questionnaires. The analysis technique used was accidental sampling, and the data analysis technique used the Independent Sample T-test. The results showed that men have lower levels of anxiety and depression than women, while women tend to hurt themselves more than men. In conclusion, every faculty has students who experience anxiety disorders, depression, and self-harm behavior. As for this research, it can be used as additional data from previous research, especially at the University where this study was taken. The limitations of this research are in the aspects of the sampling method and the limitations of measuring instruments.

EARLY ONSET AGGRESSIVE BEHAVIOR INDUCED BY PERAMPANEL IN THE TREATMENT OF CHRONIC INSOMNIA: A CASE REPORT

IntroductionChronic insomnia, resistant to different treatments (pharmacological, sleep hygiene and cognitive-behavioral therapy) remains one of the greatest challenges in our daily practice as psychiatrists. The pharmacological options include benzodiazepines and their analogues (zolpidem, zopiclone, etc.). However, when trying to treat chronic insomnia the use of off-label drugs, including antidepressants with sedative action (such as trazodone), antipsychotics or antiepiletic drugs, is not uncommon.Perampanel is a non-competitive AMPA receptor antagonist, marketed for the treatment of partial onset epilepsy and primary generalized tonic-clonic seizures. It has been used in the treatment of chronic insomnia with positive results and it has shown to improve the quality of sleep in a recent observational retrospective cohort study.The most frequent adverse effects of Perampanel include dizziness and drowsiness. Perampanel can also cause psychiatric and behavioral adverse effects, aggression and irritability in up to 10% of patients, as well as depression, and suicidal ideation, with higher rates in patients with psychiatric history.ObjectivesTo draw attention to possible adverse effects of Perampanel and to add knowledge to improve the treatment for chronic insomnia.MethodsCase report and non-systematic literature review of the current data.ResultsA 33 year old woman with Anorexia Nervosa was admitted to the psychiatric hospitalization unit due to suicidal ideation and a history of chronic insomnia. Perampanel was started at a dose of 2mg/day, progressively titrated to 6mg/day, following patient’s informed consent. A week after the initiation of treatment, her sleep pattern had improved but she became aggressive, showed low tolerability to minor frustrations and suffered from an intensification of suicidal ideation. She became extremely hostile to the personnel, had severe tantrums and deliberate self injurious behavior. Perampanel was discontinued and in less than a week her aggressive behavior succumbed. Although she was not re-exposed to Perampanel the symptoms she presented are considered a very likely adverse drug reaction. Levomepromazine 20mg/day and Lormetazepam 0.5mg/day were reinstated as a treatment for insomnia.ConclusionsPsychiatric comorbidity is known to be a risk factor for behavioral adverse effects of Perampanel. Therefore Perampanel as a treatment for chronic insomnia needs a careful individual benefit-risk assessment and monitoring for adverse effects.Disclosure of InterestNone Declared

Deliberate Self harm- A Hospital based cross sectional study

Background: Self-harm is a growing concern especially among the teenagers and young adults. Non-Suicidal Self-Injury is defined as intentional destruction of one’s body tissue without suicidal intent.Material and methods: A 2 years’ retrospective studyfrom January 2021 to December 2022 comprising of 434 cases of deliberate self-harm that presented at the Trauma center of Jawaharlal Nehru Medical College, A.M.U, Aligarh, Uttar Pradesh.Results: Total 434 cases of self-harm were examinedin which 297 were males while 137 were females.Most of the survivors were from age groups 19-30 years (26.5%) and belonged to rural areas 291 (67.1%). The most common method used for self-harm was taking poison or medicinal drugs (80.9%).Conclusion: A significant proportion of suicide attempts are impulsive, solitary efforts that are often the result of interpersonal conflicts which can be avoided by supportive communication with the patient.Keywords: Self harm, Suicide, Poisoning, Hanging, Cut throat.

EVALUATION OF STRESSFUL LIFE EVENTS AND SUICIDAL INTENT IN PATIENTS WITH DELIBERATE SELF HARM

Background: Deliberate Self Harm (DSH) is a psychiatric emergency. Stressors in life, suicidal intent and social variables like marital status, family, and social support are among the many determinants of DSH and have shown to be strongly associated with suicide. Aim was Methodology to evaluate stressful life events and suicidal intent in those who attempted DSH. Sixty consecutive patients admitted with attempted suicide were interviewed. Deliberate Self Harm Inventory, Beck Suicidal Intent Scale and Presumptive Stressful Life Event Scale were used along with a semi structured proforma during interview. Data was analysed using appropriate statistical tests. The demographical mean age of the Results participants was 25.2 years and 63% of participants were females.71.1% of the patients had stressful life event score between 101 and 200. About 66.7% had medium intent and 88.3% participants had self harm through poisoning. Patients of a Conclusion ttempted suicide had medium suicidal intent and poisoning was the commonly preferred method of self harm. This study implies that suicide attempters should be specically looked for suicidal intent and their coping styles, so as to plan appropriate psychiatric therapy to prevent future suicide attempt.

A Play in Five Acts: Bringing Healthy NC 2030 Into Focus.

### Background Injury is a leading cause of death in children. Emergency department (ED) data offer a potentially rich source of data on child injury. This study uses an emerging national ED data collection system to examine sociodemographics and temporal trends in child injury attendances in England. ### Methods Cross sectional examination of ED attendances for key injury types made by children aged 0--14 years between April 2010 and March 2011 (road traffic injury (RTI) n=21 670; assault n=9529; deliberate self harm (DSH) n=3066; sports injury n=88 250; burns n=22 222; poisoning n=12 446). Multivariate analyses examined the impact of demographics (age, gender, residential deprivation) and temporal events (day, month, school and public holidays) on risk of attendance for different injury types. ### Results For most injury types, attendance increased with deprivation. The attendance ratio between children from the poorest and richest deprivation quintiles was greatest for assaults (4.21:1). Conversely, sports injury attendance decreased with deprivation. Males made more attendances than females for all but DSH. Age and temporal profiles varied by injury type. Assault attendances reduced at weekends while burns attendances increased. RTI and sports injury attendances were increased during school term times. ### Conclusions ED data can provide a major epidemiological resource for examining both temporal and demographic risks of child injury. Emerging systems, such as the one analysed here, can already inform the targeting of prevention, and with improved data coding and use, their utility would be greatly strengthened.

Management of foreign bodies in the urinary tract

Introduction: Foreign bodies in the urinary tract may present in various ways. These require a wide range of interventions for retrieval. In this study, we describe our experience in managing foreign bodies in the urinary tract with emphasis on clinical presentation, mechanism of insertion, investigation and treatment of these patients from a South Asian country. Methods: A retrospective analysis of 30 foreign bodies treated by a single urological surgeon in two teaching hospitals in Sri Lanka over 20 years was performed. Data were retrieved from clinical records and follow-up visits focussing on clinical presentation, nature of foreign bodies, mechanism of insertion, investigations, management and complications. Results: The majority were males (73.3%, n=22) with a median age of 34 years (range:14-72). The majority were self-inserted (n=14) or iatrogenic (n=10). X-rays and ultrasound scans were useful in the majority to clinch the diagnosis. The majority were retrieved endoscopically through minimally invasive approaches. Open surgeries were needed for a patient with a large bladder stone associated with a metal chain and retrieval of a retained swab. Common complications associated with foreign bodies included infections (n=9), calcification/ stone formation (n=9) and acute urinary retention (n=4). Among deliberate self- insertions, two had a low intelligent quotient and the majority had no underlying psychiatric condition needing intervention. Conclusions: Simple investigations such as X-ray and ultrasound scans are sufficient to locate and plan interventions in the majority. Minimally invasive approaches are successful in most. The vast majority of the patients with self-insertion had no psychiatric conditions needing intervention.

Association of deliberate Self Harm among patients with Bipolar Disorder in Karachi

Aim: To evaluate the association of suicide attempt among bipolar disorder patients and evaluate the associated risk factors. Methodology: The target population of the study was adult psychiatric patients who visited the outpatient department of an institute of behavioral sciences in Karachi. A case-control study was conducted in the outpatient department of two major psychiatric services in Karachi. Participants of age above 15 years were recruited through non-purposive sampling and data was collected by a structured questionnaire. Results: From January to April 2021, of the 146 selected psychiatric patientsa, high prevalence of suicide attempts was observed in patients with young age between 20 to 30 years (p=0.000) Almost41.1%of participants were illiterate and 63% belonged to low socioeconomic status) Approximately 43.8% (p=0.00) cases had a history of mental trauma and 24.7% 76.7% (p=0.007) cases had a family history of suicide. It was found that 91.8% (p=0.00) of depression was related to suicide attempt the factors associated with suicide attempt were females, young age, illiteracy, lower socioeconomic status, presence of bipolar disorder, substance abuse, mental trauma, depression, family history of suicide and self-harm. Conclusion: We conclude that there is an association between suicide attempts and bipolar disorder. Mental illnesses are becoming an emerging public health problem. Deeper research into the relationship between suicide attempts and substance abuse, or family history and awareness in psychiatric patients is needed. Keywords:Bipolar Disorder, Suicide Attempt, Self-Harm, Trauma, Suicidal Ideation

Risk factors for Deliberate Self Harm in Bipolar Affective Disorder patients presenting to Tertiary care center- A cross-sectional study

Abstract:-
 Background: Deliberate Self Harm (DSH) is a complex event, associated with psychosomatic, biological, social factors and psychiatric disorders. Current literature shows that, there is rise in DSH in psychiatric disorders and it has been recognised as major public health problem in India. So, objective of this study was to assess the underlying risk factors for DSH in patients with Bipolar Affective Disorder (BPAD).
 Methods:
 This cross-sectional study was conducted on 150 patients diagnosed with BPAD as per International Classification of Diseases; tenth revision (ICD-10). Semi-structured socio-demographic proforma was used to record basic profile. Deliberate self harm inventory (DSHI) was administered to assess the type of DSH. Young Mania Rating scale and Beck Depression Inventory were used to assess severity of symptoms.
 Results:
 Prevalence of DSH in present study was 33%. In socio-demographic profile, younger age group, lower education levels and being single were significant risk factors for DSH (p- value <.001, .016 and <.001 respectively) and among clinical variables, early years of disorder, severe mania, moderate and severe depressive episode in presence of medium to high suicidal intent, family history of mood disorders and co-morbid substance use and medical disorder were significant risk factors for DSH in BPAD with statistical significance (p<.0001).
 Conclusion:
 DSH is considered to be the significant predictor of suicide. BPAD is associated with high risk of DSH, which can be present in either depressive or manic episode. Patients with BPAD in early years of illness, should be evaluated thoroughly for risk factors, so that DSH risk can be minimised

P652 The burden of mental illness, including deliberate self-harm, before and after a diagnosis of IBD, a UK population study

Abstract Background The burden of mental illness among IBD patients is recognised to be greater than among their healthy peers. Due to the bi-directional influence of the gut-brain axis,mental health may be linked to IBD outcomes and vice versa. The aim of this study was to use population level data to describe the incidence of anxiety, depression, insomnia, severe mental illness and deliberate self-harm in patients with IBD. Methods A retrospective cohort study was conducted using The Health improvement Network (THIN) database to estimate the incidence rates of anxiety, depression, insomnia, severe mental illness and deliberate self harm in patients with IBD between 1995 to 2021 and matched controls with no pre-existing mental health illness.The prevalence of pre-existing depression, anxiety and insomnia prior to IBD diagnosis was assessed for IBD patients and matched controls.The association between deliberate self harm and incident mental health diagnoses following IBD diagnosis were estimated using Cox regression analysis. Results We identified 59,613 incident cases of IBD,34,615 (58.1%) had UC and 25,000 (41.9%) had Crohn’s disease. The median age was;41.5 (IQR 29.6–57.5) years,with an equal proportion of males and females with IBD (49.2% vs 50.8%). Patients with a diagnosis of IBD had an increased prevalence of anxiety 10 years (3.0% vs 2.5%,p<0.001) and 2 years prior to diagnosis (6.2% and 5.3%,p<0.001). A similar pattern was seen for insomnia at 10 years (1.0% vs 0.9%, p=0.028) and 2 years (3.4% vs 3.0%, p<0.001) and for depression at 10 years (3.7% vs 4.5%, p<0.001) and 2 years (8.1% vs 9.6%, p<0.001). The incidence of mental illness was higher in IBD patients than controls for; anxiety [6.1 vs 5.3 per 1000 patient years,HR 1.14(1.09–1.20),p<0.001], depression [11.3 vs 7.5 per 1000 patient years,HR 1.34 (1.28–1.39),p<0.001], insomnia [9.6 vs 6.0 per 1000 patient years,HR 1.54(1.5–1.6),p<0.001] and DSH [1.6 vs 1.2 per 1000 patient years,HR 1.20(1.07–1.35),p<0.001]. Associations of deliberate self harm in this patient groups included: IBD (HR 1.20(1.07–1.35),p=0.002),female gender (HR 1.06(1.35–1.60),p<0.001),age quintile <27.4 years (HR 4.48(3.95–5.93),p<0.001) compared to >61.3 years,anxiety (HR 1.57(1.35–1.82),p<0.001),depression (HR 5.97(5.33–6.69),p<0.001),insomnia (HR 2.32(2.02–2.66),p<0.001), and severe mental illness (HR 5.74(4.56–7.22),p<0.001). Conclusion There is an additional burden of mental illness in patients who are later diagnosed with IBD. Following diagnosis,the incidence of depression, anxiety, insomnia and deliberate self harm is higher in individuals with IBD than controls.Patients who develop mental illness in the setting of IBD are at particularly high risk of deliberate self-harm.

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Background:Primary delusions are out of the blue experiences which cannot be understood on the basis of previous patient experiences. Studies are consistent with neurobiological hypothesis that aberrant salience attribution to stimuli is the pathology behind primary delusion. Its significance in course and prognosis needs further systematic evaluation.Aim-To report a case of 16 year old female who had presented with primary delusion.METHOD-Patient was evaluated as in patient. She had a bad dream following which she started believing that she is victim of sexual assault which had happened at age 8. Inspite of her parents disproving her, she continued to believe so. She was brought for admission following deliberate self harm.On examination, Primary - delusional memory was elicited along with second person auditory hallucination & visual hallucination. Imaging and blood investigations were within normal limits. Patient was diagnosed with Unspecified non-organic psychosis and treated with Olanzapine . Later diagnosis was revised to Paranoid Schizophrenia continuous course upon onset of passivity delusions.DISCUSSIONPrimary delusions are very rarely elicited in patients with schizophrenia often due to the long course, causing difficulty in recall. This case throws light in to psychodynamic aspects of delusion.

Presentations and Psychiatric Diagnosis in A Psychiatric Out-Patient Clinic of Tertiary Care Hospital in Eastern Nepal

INTRODUCTION This study aimed to see common presenting complaints and psychiatric diagnoses among the patients visiting for the first time to the Psychiatric Out-patient Department (OPD) of a tertiary care hospital in Eastern Nepal. METHODOLOGY A cross-sectional study was conducted in the OPD of B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal during the study period of 3 weeks after the institute ethical approval. Patients were selected via convenience sampling technique. Face to face interview was conducted to collect socio-demographic data and the presenting complains (up to 5) according to the patients and their attendants. Psychiatric diagnoses were recorded as per the clinician. RESULT Among the first contact psychiatry out-patients; various physical/ somatic, anxiety and mood related symptoms were the commonest presenting complaints, as per the patients, attendants and clinicians. Behavioural symptoms were others mostly observed and reported. The commonest diagnoses were: Depression, Recurrent Depressive Disorder, Dysthymia (18.6%); Phobia, Other Anxiety and Obsessive Compulsive Disorder (17.9%); Schizophrenia, schizotypal and delusional disorders (13.8%) and Mental and Behavioural disorders due to Substance use (8.3%). Deliberate self harm and seizures were present in 7% each. CONCLUSION The commonest presenting complaint in psychiatry outpatient clinic was related to physical and somatic symptoms, followed by anxiety and mood related ones. Common diagnoses were Depression, Anxiety, Schizophrenia and Substance use/ related disorders.

Sociodemographic Profiles And Psychiatric Comorbidities Among Patients With Alcohol Dependence In Western Nepal

Introduction: Alcohol is a potent drug that causes acute and chronic changes in almost all neurochemical systems and heavy drinking can produce serious temporary psychological symptoms including depression, anxiety and psychoses. Alcoholism is clinically heterogenous disorder with variable age of onset, drinking patterns, severity and comorbidity with other mental disorders. There is a gender difference in many aspect of alcohol use. The aim of the study was to study the sociodemographic profile, severity, gender difference and psychiatric comorbidities in patient with alcohol dependence syndrome in Nepalese population.
 Material And Method: This is a hospital based study done in patients coming to Nepalgunj Medical College, Kohalpur over a period of one year from June 2019 to May 2020 on consecutive serial basis. Diagnosis of alcohol dependence was made based on International Classification of Disease-10 (ICD-10) criteria. Semi structured proforma and Severity of Alcohol Dependence Questionnaire (SADQ) was applied in those patients and recorded accordingly. The data was analyzed using SPSS.
 Results: Out of 40 patients studied (N-40), 37 (92.5 %) were male and 3 (7.5 %) were female. Alcohol dependence is most common in the age bracket of 30-39 (43.1%) followed by 40-49 (33.4 %) with mean age of 40.3 years and the mean age of duration of alcohol use being 13.45 years. The mean amount of alcohol consumed per day is 92.25 grams. The SADQ scores, age of first alcohol use, duration of alcohol use in years and daily amount of alcohol use in grams is significantly different between male and female. Similarly there is severe alcohol dependence in 75 % while moderate level in 25 % of study population. Regarding psychiatric comorbidities, 90 % have comorbid other substance use disorder followed by anxiety disorders in 37.5 %, personality disorders in 35 %, mood disorders in 32.5 %, deliberate self harm in 30 % and psychotic disorders in 12.5 %.
 Conclusion: Alcohol dependence is most commonly found in young and adults of various age group. Age of first alcohol use, duration of alcohol use in years and daily amount of alcohol use in grams is significantly different between male and female. Alcohol dependence is comorbid with multiple psychiatric entities.

Analysis of Identity Construction through Positioning Acts in Nigerian Vice-Presidential Debate Discourses

More often in political debates, participants do not readily expound their identities and attitudes; they employ language structure that requires the analysis of the placing of self/other in certain positions for comprehension. Hence, this study aims at exploring identity construction through positioning act strategies and the identities projected in the discourse practices by two vice presidential debate candidates in defining selves/others, parties’ stance and group categorization. The study used Langenhove and Harre (1999) positioning theory. The data for the study are delimited to five excerpts randomly selected from thirty-two online-transcribed discourses between two debate participants. Findings reveal that the candidates made use of first and second order performative and accountive positioning acts to implicate self/party’s moral order and positive stance and the other’s immoral attributes. The modes of positioning are moral, personal, intentional, deliberate self and other and forced self-positioning. The discursive practices involved are such that are strategically manipulated to divulge the individual’s attitudes to the socio-economic and political development of the nation, thereby portraying the following identities: Scrupulous, dogged, competent, loyalist and committed (self/group) identity and corrupt minded, incompetent, failure and uncommitted (others) identity. In conclusion, the knowledge of the concepts of positioning and its applicability to the understanding of political debates is essential for the understanding of the politicians’ ideologies and identities as well as their stance on the nation’s growth.

Self-harm behaviour, psychopathological distress and suicidal ideation in normal and deliberate self-harm outpatient's adults.

To identify the association among suicidal ideation, deliberate self-harm, and psychopathological distress in normal and deliberate self-harm adults. The cross-sectional study was conducted at the Department of Psychiatry, Military Hospital, Rawalpindi, Pakistan, from January to July 2017, and comprised deliberate self harm and normal adults aged 18-25 years. Psychiatric evaluation involved a semi-structured interview based on mental status examination. The self-harm tendency was assessed on the basis of self-harm inventory of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Beck scale for suicide ideation and he depression anxiety and stress scale were also used for data collection. Data was analysed using SPSS 22. There were 200 subjects with a mean age of 20.89±9.06 years; 100(50%) each in deliberate self-harm and normal groups. Deliberate self-harm was significantly positively associated with suicidal ideation and mental health problems, including depression, anxiety and stress (p<0.05). Deliberate self-harm tendency was also positively associated with mental health problems in normal adults (p<0.05). Normal adults had higher level of mental health problems, such as depression and stress, compared to deliberate self harm adults (p<0.05). Adults having self-harm behaviour were more inclined to have suicidal ideation compared to normal adults behaviour (p<0.05). Deliberate self-harm was found to be strongly related to suicidal behaviour and mental health issues in both normal and deliberate self-harm adults.

Referrals to liaison services for older adults with deliberate self harm during the SARS-CoV-2 national lockdown - a collaborative service evaluation using liaison referral data

AimsSocial isolation and living alone have been associated with increased suicidality in older adults. During the SARS-CoV-2 pandemic, older adults were advised to keep isolated and maintain social distancing. Lockdown periods in England may have led to increased isolation and loneliness in older people, possibly resulting in an increased rates of DSH and suicide. This study aimed to explore whether numbers of older adults referred to liaison services with deliberate self harm changed during the SARS-CoV-2 pandemic.MethodReason for referral and total number of referrals to liaison services for older adults data were collected across 6 mental health trusts who had access to robust data sets. Data were collected prospectively for three months from the start of the UK national lockdown and for the corresponding 3 month period in 2019, via trust reporting systems. This study was registered as service evaluation within each of the participating mental health trusts.ResultOverall numbers of referrals to older adult liaison services went down, but the proportion of referrals for older adults with DSH increased. Across the six mental health trusts there there were a total of 2167 referrals over the first three month lockdown period in 2020, and 170 (7.84%) of these referrals were for deliberate self harm. During a corresponding time period in 2019, there were a total of 3416 referrals and 155 (4.54%) of these referrals were for deliberate self harmConclusionAlthough numbers of referrals for older adults with delberate self harm appeared to stay the same, the severity of these presentations is not clear. Outcomes of referrals and severity of self harm could be explored by examining individual case records. As there have been subsequent lockdowns the data collection period should also be extended to include these. Triangulation with national and local datasets on completed suicide is planned.

On the Road Leading to Non-Suicidal Self-Injury: Brief Report on Narcissistic Vulnerability and Shame

Background: Recent empirical research showed that pathological narcissism is related to Non-Suicidal Self-Injury (NSSI). However, both narcissistic vulnerability and narcissistic grandiosity were resulted related to NSSI and the differences between them and their role in NSSI remains unclear. Some authors underlined the potential role of shame in the genesis of self-directed aggression. Objectives : This study investigates the role of shame in the relationship between both vulnerable and grandiose narcissism and self-harm severity. Methods : We administered Pathological Narcissism Inventory (PNI), Test of Self-Conscious Affect (TOSCA) and Deliberate Self Harm Inventory (DSHI) to a sample of 149 community participants (42% males) with a mean age of 27.55 years ( SD =12.3). Results : Controlling for age and gender, we found that DSHI scores correlated significantly with the vulnerable dimension of narcissism but not with the grandiose one. But, both the vulnerable and grandiose dimension of narcissism correlated with interpersonal shame levels. Finally, we found a positive interaction between PNI vulnerable factor and shame levels in predicting Non-suicidal self-injury (NSSI) severity. Conclusions : Differentiating the grandiose from the vulnerable facet of narcissism appears central when investigating the relationship between NSSI and narcissistic personality. Moreover, our study suggests that shame experiences have a remarkable influence importantly account for this relationship. Future directions and clinical implications are discussed.