Deliberate Self Research Articles

Nonsuicidal self-injury, potentially addictive behaviors, and the Five Factor Model in undergraduates

Nonsuicidal Self-Injury (NSSI) is the deliberate inflicting of physical injury to one’s own body that is not due to accident or conscious attempt at suicide. This study examined NSSI, other excessive or potentially addictive behaviors, and borderline personality features. Undergraduates ( N = 151) completed the Deliberate Self Harm Inventory ( Gratz, 2001), the NEO PI-R ( Costa & McCrae, 1992), and the Shorter PROMIS Questionnaire (SPQ; Christo et al., 2003). The SPQ measures impulsive or compulsively motivated behavior, such as symptoms of substance use disorder, disordered eating, and involvement in dysfunctional intimate relationships. The sample was divided according to the number and type of NSSI incidents reported, and 41 (27%) of the students had self-injured, including 20 (13%) who had self-injured 10 or more times or who had practiced 3 or more methods of NSSI. These severe self-injurers had significantly elevated rates of alcohol and drug abuse, disordered eating, sexual compulsivity, and dysfunctional interpersonal relationships. They also scored higher on facets of Neuroticism, with lower scores on facets of Agreeableness and Conscientiousness. Personality facet profiles suggested that borderline personality features may be elevated among those who practice frequent and varied NSSI, and these results suggest involvement of maladaptive strategies for emotional self-regulation.

Factors associated with nonbenzodiazepine antiepileptic drug intoxication: Analysis of 9,809 registered cases of drug poisoning

Antiepileptic drug (AED) intoxications are common due in part to wide clinical application and availability. Because AEDs usually depress central nervous system function, overdosing may be potentially life-threatening or lead to a range of adverse outcomes. The aim of this study was to identify risk factors for nonbenzodiazepine AED (NBAED) intoxication. In this cross-sectional study, all consecutive adult and adolescent (>12 years old) poisoned patients who presented to the Loghman-Hakim Poison Hospital (LHPH) during a 6-month period were evaluated. Patients with NBAED intoxication were identified and compared to a control group of those other pharmaceutical intoxications. The risk factors for AED intoxication were identified using univariate analyses and multivariate modeling. Among 9,809 cases of pharmaceutical agent overdose, there were 474 cases (4.8%) with NBAED intoxication. Mean age of the subjects was 24.5 +/- 8.9 years. The most frequent NBAED was carbamazepine (n = 117), followed by phenobarbital (n = 77) and sodium valproate (n = 51). The most frequent motivation was intentional intoxication (95.3%). Multivariate analysis revealed that presence of medical disorders, a history of psychological events, and loneliness were associated with AED intoxication, whereas educational level had a protective effect. There was no association between previous history of parasuicide, sex, age, occupation status, and AED intoxication. In conclusion, this study showed that the majority of AED intoxications are due to deliberate self poisoning. The presence of psychological events, medical disorders, and loneliness are risk factors for AED intoxication, whereas higher education level has a protective effect.

Deliberate self harm with mercury injection in forearm

Deliberate self harm with mercury injection in forearm

Internet Gamblers: A Latent Class Analysis of Their Behaviours and Health Experiences

In order to learn about the behaviours and health experiences of people who gamble on the Internet, we conducted an international online survey with respondents recruited via gambling and gambling-related websites. The mean (SD) age of the 4,125 respondents completing the survey was 35.5 (11.8) years, with 79.1% being male and 68.8% UK residents. Respondents provided demographic details and completed validated psychometric screening instruments for problem gambling, mood disturbances, as well as alcohol and substance misuse, and history of deliberate self harm. We applied latent class analysis to respondents' patterns of regular online gambling activities, and identified subgroups of individuals who used the Internet to gamble in different ways (L (2) = 44.27, bootstrap P = 0.07). We termed the characteristic profiles as 'non-to-minimal gamblers'; 'sports bettors'; 'casino & sports gamblers'; 'lottery players'; and 'multi-activity gamblers'. Furthermore, these subgroups of respondents differed on other demographic and psychological dimensions, with significant inter-cluster differences in proportion of individuals scoring above threshold for problem gambling, mood disorders and substance misuse, and history of deliberate self harm (all Chi (2)s > 23.4, all P-values <0.001). The 'casino & sports' and 'multi-activity-gamblers' clusters had the highest prevalence of mental disorder. Internet gamblers appear to be heterogeneous but composed of several subgroups, differing markedly on both demographic and clinical characteristics.

Traumatic chemical oral ulceration: a case report and review of the literature

A 34-year-old man experienced extensive oral ulceration as a consequence of attempted ingestion of sulphuric acid as part of an act of deliberate self harm. All oral lesions healed within 28 days after local and systemic therapy. Oral ulceration has many potential causes ranging from physical trauma to malignancy. Chemicals are a less common cause of traumatic ulceration. Most chemical burns are characterised by mild to moderate tissue damage that heals spontaneously within seven to 15 days without scarring.

Differences in Reporting of Violence and Deliberate Self Harm Related Injuries to Health and Police Authorities, Rawalpindi, Pakistan

BackgroundThe aim of study was to assess differences in reporting of violence and deliberate self harm (DSH) related injuries to police and emergency department (ED) in an urban town of Pakistan.Methods/Principal FindingsStudy setting was Rawalpindi city of 1.6 million inhabitants. Incidences of violence and DSH related injuries and deaths were estimated from record linkage of police and ED data. These were then compared to reported figures in both datasets. All persons reporting violence and DSH related injury to the police station, the public hospital's ED, or both in Rawalpindi city from July 1, 2007 to June 30, 2008 were included. In Rawalpindi city, 1 016 intentional injury victims reported to police whereas 3 012 reported to ED. Comparing violence related fatality estimates (N = 56, 95% CI: 46–64), police reported 75.0% and ED reported 42.8% of them. Comparing violence related injury estimates (N = 7 990, 95% CI: 7 322–8 565), police reported 12.1% and ED reported 33.2% of them. Comparing DSH related fatality estimates (N = 17, 95% CI: 4–30), police reported 17.7% and ED reported 47.1% of them. Comparing DSH related injury estimates (N = 809, 95% CI: 101–1 516), police reported 0.5% and ED reported 39.9% of them.ConclusionIn Rawalpindi city, police records were more likely to be complete for violence related deaths as compared to injuries due to same mechanism. As compared to ED, police reported DSH related injuries and deaths far less than those due to other types of violence.

Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial

Objectives To evaluate the effectiveness of integrated motivational interviewing and cognitive behavioural therapy in addition to standard care for patients with psychosis and a comorbid substance use problem.Design Two centre,...

P03-297 - Differences and similarities of number of life events among patients admitted after attempted suicide

ObjectiveTo examine associations between current diagnostic profile, suicidal intent, functional impairment and history of deliberate self harm (DSH) and life events among patients admitted to a general hospital after an act of attempted suicide.Materials and methodsParticipants (n = 86) were patients consecutively admitted to a general hospital emergency care unit over the inclusion period of 26 months after an act of attempted suicide. They were interviewed within 2 days using the EPSIS protocol, the MINI and SCID-II interviews and a range of scales measuring life events (Brugha's scale), depression (MADRS), alcohol abuse (AUDIT), substance abuse (DAST), suicidal intent (SIS) and functioning levels (GAF). Simple regression analyses (linear and logistic) and t-tests were used in data analyses.ResultsMen [4.9(2.6)] reported significantly more life events than women [3.6(2.0)], t(47.7) = 2.2, p &lt; .05. Functional impairment was inversely associated with the number of life events among men, explaining more than 25% of the variance, F = 10.2(1, 28), p &lt; .01. Number of life events was not associated with any diagnostic group, mean scores of depression severity, alcohol abuse, substance abuse, suicidal intent or with a history of an act of DSH.ConclusionsNot only did men report more life events, their functioning was also affected by number of life events, indicating vulnerability to psychosocial aspects beyond psychological or psychiatric aspects in men admitted to a general hospital after attempted suicide.

Liaison psychiatry and Indian research

Liaison in Psychiatry refers to the branch of Psychiatry involving assessment and treatment in the general hospital of referred patients, like in the casualty, or patients of deliberate self farm. The Indian scene also reveals major reference from medicine, surgery, surgical super specialty and orthopedics with psychiatric disorders like anxiety, depression and / or organic brain syndromes seen in about 40 to 50 % of the medical or surgical patients. Though the Indian published data is limited, most tertiary hospitals in India carry out liaison work with various departments like Neurology, Organ transplant, Intensive Care Units and Cosmetic Surgery, so as to give comprehensive health services to patients. Liaison in Psychiatry has thus brought the emphasis on the teaching of psycho-social aspects of medicine and also increased research possibilities.

P02-74 - A critical review of patients under section 5(2) of the mental health act

Patients who suffer from mental illness, and are a risk to themselves, to other people or at risk of self neglect. Such patients can be detained under section 5(2), if they are already admitted to hospital and express their wish to leave against medical advice.44 patients were identified. 40% were men, 65% above the age of 50 years, 52% were sectioned after hours or at the weekends. Measures to persuade patients to stay as an informal patient were taken in 16%. 55% were sectioned by the on call doctor.68.5 % exhibited threatening behaviour.30% had self neglect, 13% were a risk to others, 26% had a deliberate self harm risk.60% had moderate to severe suicidal risk and ideation.68% didn’t have mental health capacity to give consent for admission.60% had been assessed in the first 24 hours of their section.60% were converted to section 2,3 of the Mental Health Act.25% stayed as informal patients and 7% were discharged.Female patients were more, which was against expectation. Older people were more which was again against expectation. Majority of patients were a risk to themselves and only 13% were a risk to other people. Nearly two third were assessed within 24hrs from the section which was something we commend our services on. 60% needed to be transferred to different sections which indicates that 40% of the sample could have been managed more efficiently, in a way which had not warranted the use of section 5(2).

Managing irritability and aggression in autism spectrum disorders in children and adolescents

Children with autism and autism spectrum disorders have a high rate of irritability and aggressive symptoms. In one study up to 20% of children with autism have symptoms of irritability and aggression including aggression, severe tantrums, and deliberate self injurious behavior (Lecavalier [2006] J. Autism Dev. Disord. 36:1101-1114.). These symptoms can lead to impairment and distress in both home and school settings. Medications to treat the irritability will be discussed across categories of antipsychotics, antidepressants, antihypertensive agents, and others. Emphasis will be placed on medications with the most safety and efficacy and FDA approval.

Emergency Departments Are Underutilized Sites for Suicide Prevention

Each year approximately 1,000,000 people die by suicide, accounting for nearly 3% of all deaths and more than half (56%) of all violent deaths in the world (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002). Suicide ideation and suicide attempts are strongly linked to death by suicide and powerfully predict further suicidal behavior (Institute of Medicine, 2002). There are an estimated 100–200 suicide attempts for each completed suicide in young people, and 4 attempts for each completed suicide in the elderly (Institute of Medicine, 2002). Emergency departments (EDs) are the most important site, epidemiologically speaking, for treating those who make suicide attempts. EDs in the United States, for example, record over 500,000 suicide-related visits annually (Larkin, Smith, & Beautrais, 2008). The majority of suicide attempt patients are discharged after medical stabilization and psychosocial evaluation, but carry a significant risk of recidivism (Larkin, Smith, & Beautrais, 2008). Similarly, ED patients who present with suicide ideation (without attempt) have risks of returning to the ED with further ideation or with suicide attempts which are as high as those who present with attempts (Larkin, Beautrais, Gibb, & Laing, 2008). In addition, a significant fraction of those who present to EDs for nonmental health reasons often have occult or silent suicide ideation (estimated at 8–12%) (Claassen & Larkin, 2005). The worldwide economic tsunami and sky-rocketing healthcare costs have ensured that mental health-related visits and presentations for suicidal behavior will continue to rise in the foreseeable future. The closure of psychiatric inpatient facilities, reductions in inpatient beds, moves to treat people in the community, and increased costs of general practitioner visits have coincided with – and likely account for – increased ED attendances by psychiatric and suicidal patients who previously might have been admitted or seen in primary care. The ED is now the default, de facto option for urgent and acute contact for suicidal patients within the health system – and in many countries the ED is the only access to 24/7 healthcare (Fields et al., 2001).

Study protocol: the development of a randomised controlled trial testing a postcard intervention designed to reduce suicide risk among young help-seekers

BackgroundSuicidal behaviour and deliberate self harm are common among adolescents. Limited evidence exists regarding interventions that can reduce risk; however research indicates that maintaining contact either via letter or postcard with at-risk adults following discharge from services can reduce risk. The aim of the study is to test a postcard intervention among people aged 15-24 who presented to mental health services but are not accepted, yet are at risk of suicide.Methods/designThe study is a 3-year randomised controlled trial conducted at Orygen Youth Health Research Centre in Melbourne Australia. Participants are young help-seekers aged 15-24 who are at risk of suicide. Participants will be recruited over a 12 month period. The intervention comprises a regular postcard to be sent monthly for 12 months. The postcard enquires after their well being and includes information regarding individual sources of help and evidence-based self help strategies. Participants are assessed at baseline, 12 and 18 months.DiscussionThis paper describes the development of a study which aims to reduce suicide risk in a sample of young help-seekers. If effective, this intervention could have significant clinical and research implications for a population who can be hard to treat and difficult to research.Trial RegistrationThe study was registered with the Australian Clinical Trials Registry; number: ACTRN012606000274572.

Prevention of Suicidal Behaviour among Army Personnel: A Qualitative Study

ObjectivesTo examine the context of suicidal behaviour among soldiers in the United Kingdom and identify factors that could reduce the risk of such behaviour.MethodA series of in-depth interviews with service...

Self-injury, psychiatric symptoms, and defense mechanisms: Findings in an Italian nonclinical sample

Introduction This study provides data on the rates, characteristics, and correlates of self-injury (SI) in an Italian nonclinical sample, a population previously unexamined within the SI literature. This study examined the associations between SI and defense mechanisms, as well as the differences between self-injurers (episodic and recurrent) and non self-injurers with regard to the severity and variety of their psychiatric symptoms and psychological distress. Materials and methods Five hundred and seventy-eight university students (82.5% female; mean age = 22.3; S.D. = 3.4) were administered a battery of self-report questionnaires, including the “Deliberate Self Harm Inventory” for SI, the Response Evaluation Measure-71 for defense mechanisms, and the “Symptom Checklist-90-Revised” for psychological distress and psychiatric symptoms. Results One hundred and nineteen participants (20.6%) reported having engaged in SI at least once during their lifetime. Individuals with recurrent SI (SI ≥ 5) reported significantly higher levels of all psychiatric symptoms and many maladaptive defense mechanisms than individuals without SI. Results also provided evidence for differences between individuals with recurrent and episodic SI. Conclusion Results suggest that recurrent self-injurers are distinguished from both episodic self-injurers and non self-injurers by their greater use of maladaptive defense mechanisms, rather than their lesser use of adaptive defenses. Further, results suggest that recurrent self-injurers differ from episodic self-injurers not in terms of the severity of their psychiatric symptoms, but the variety and number of these symptoms.

The Toxic Laundry Detergent Powder ‘Prinso’ Is Gaining Notoriety Amongst Villagers For Deliberate Self- Poisoning In And Around The Matara District

Introduction: The washing powder ‘Prinso' consists of 2 sachets, one containing pink crystals and the other white granules which has become a popular agent amongst the youth for self poisoning. Objectives: To document clinical and biochemical features of ‘prinso' poisoning. To analyze the chemical constituents of prinso. Patients and methods: We present a series of 7 patients who were admitted to General hospital Matara following ‘Prinso' poisoning, from 01.06 2006 to 01.10.2007. We chemically analyzed the two sachets in faculty of science university of Ruhuna. Results: The male: female ratio was 3:4.Out of the 7 patients, 1 patient developed acute renal failure. Conclusion: The readily available household product ‘Prinso' has come to recognition in the array of poisons responsible for deliberate self poisoning among young with a preponderance among females ingesting it in the southern province of Sri Lanka.Keywords: poisoning; detergentCitation: Munasinghe MAAK, Fernando WKBKM. The Toxic Laundry Detergent Powder ‘Prinso’ Is Gaining Notoriety Amongst Villagers For Deliberate Self- Poisoning In And Around The Matara District. Sri Lanka Journal of Critical Care 2009;1:29-32DOI: 10.4038/sljcc.v1i1.940

A pilot study evaluating a support programme for parents of young people with suicidal behaviour

BackgroundDeliberate self harm (DSH) is a major public health concern and has increased among young people in Ireland. While DSH is undoubtedly the result of interacting factors, studies have identified an association between DSH and family dysfunction as well as the protective role of positive family relationships. Following a focus group meeting held to identify the needs of parents and carers of young people with DSH, a support programme (SPACE) was developed. The aims of the current study are to evaluate the effectiveness of the SPACE programme in decreasing parental psychological distress, reducing parental report of young peoples' difficulties, increasing parental satisfaction and increasing parents' ratings of their own defined challenges and goals.MethodsParticipants were recruited from a Mental Health Service within a paediatric hospital, Community Child and Adolescent Mental Health Teams and family support services. All services were located within the greater Dublin area in Ireland. Forty-six parents of children who had engaged in or expressed thoughts of self harm attended the programme and participated in the evaluation study. The programme ran once a week over an 8-week period and included topics such as information on self harm in young people, parenting adolescents, communication and parental self-care. Seventy percent (N = 32) of the original sample at Time 1 completed measures at Time 2 (directly following the programme) and 37% (N = 17) of the original sample at Time 1 completed them at Time 3 (6 months following the programme).A repeated measures design was used to identify changes in parental wellbeing after attendance at the programme as well as changes in parental reports of their children's difficulties.ResultsParticipants had lower levels of psychological distress, increased parental satisfaction, lower ratings of their own defined challenges and higher ratings of their goals directly after the programme. These changes were maintained at 6-month follow up in the 37% of participants who could be followed up. Furthermore the young people who had engaged in or expressed thoughts of self harm had lower levels of difficulties, as reported by their parents, following the programme.ConclusionThese findings suggest that the SPACE programme is a promising development in supporting the parents of young people with suicidal behaviour. The programme may also reduce parental reports of their children's difficulties. Further evaluation using a randomized controlled trial is indicated.

Concurrent cocaine and alcohol use in individuals presenting to an addiction treatment program

National population surveys and information from the National Drug Treatment Reporting System indicate cocaine use is increasing. There is a paucity of studies focusing on comorbid cocaine and alcohol use in Ireland. The aims of the study are to examine comorbid cocaine and alcohol use patterns in those under 45 years, presenting to a national addiction treatment unit for alcohol and drug dependence. A retrospective review of the substance misuse behavior of 465 individuals participating in an addiction rehabilitation programme for alcohol dependence. Cocaine use among this population rose significantly between 1995 (8%) and 2006 (37.9%). There was a significant association between lifetime reported cocaine use and both psychotic disorders and deliberate self harm. Overall, the use was highest among younger age group and this declined steadily with age. Cocaine use among the alcohol-dependent population is an increasing problem in the Republic of Ireland, and poses a problem of higher toxicity associated with concurrent cocaine and alcohol use.

Prevalence and correlates of physical and emotional abuse among late adolescents

To estimate the prevalence of physical and emotional abuse reported by late adolescent school children in southern Sri Lanka, and to identify demographic and behavioural correlates of such abuse. A cross-sectional survey was administered to a sample of 1099 male and 1290 female late adolescents, through schools in the southern province. Self-report anonymous questionnaires were used. Study variables included age, gender, body mass index (BMI), socioeconomic status, deliberate self harm, substance use, school absenteeism and family conflicts. Of the total, 22.4% (n = 246) of males and 15.7% (n = 202) of females reported having been subjected to physical abuse at least a few times in the 3 months preceding the survey (p<0.05), and 31.3% (n = 324) of males and 25.4% (n = 328) of females reported having been subjected to emotional abuse at least a few times in the 3 months preceding the survey (p<0.05). Logistic regression analyses revealed that school absenteeism, deliberate self-harm, substance use, and family conflict were associated with physical and emotional abuse. Socio-economic status and BMI were not found to be associated with physical and emotional abuse. Physical and emotional abuse are important health issues among late adolescent school children in Sri Lanka. Further research is needed to better understand the causal direction of the associations between physical and emotional abuse experiences, and health-related behaviours.

A community-based study of case fatality proportion among those who carry out suicide acts

To investigate the case fatality proportion and associated factors in those carrying out suicide acts in Nantou, Taiwan. Data from 1,171 suicide acts (including 973 with deliberate self harm and 198 completed suicides), identified between July 2000 and February 2003, were collected from a population suicide register in Nantou County, Taiwan. Case fatality proportion and the independent effects of demographic factors and suicide method on case fatality were investigated. The overall case fatality proportion was 16.9%, with higher proportions in men (26.3%) and in those aged 65 and over (37.9%). Hanging was the most lethal method (fatality proportion = 81.5%); pesticide was both commonly used and associated with a high case fatality (fatality proportion = 26.3%). Only age (increased with age) and suicide method were found to be independently associated with the risk of fatality. Suicide method and older age are independent predictors of the fatality of suicide acts. Suicide prevention strategy and clinical assessment ought to take into account of these two factors. Diminution of pesticide toxicity and control of access to pesticides are important considerations for suicide prevention in rural Taiwan.