Self-harm Behaviors Research Articles

Correlates of informant discrepancies in self-harm among youth involved in child protective services

Youth involved with child protective services (CPS) are at elevated risk for engaging in self-harm. Participation in interventions or treatments that may reduce youths’ self-harm behaviors often depends on the accurate reporting of their self-injurious behaviors. However, informants often disagree on the presence or severity of self-harm engagement, making the identification of youth in need of treatment more challenging. The current study aims to characterize discrepancies between youth and caregiver reports of children’s self-harm among a sample of youth with a history of CPS involvement, and to identify factors (e.g., demographics, youth and caregiver psychological impairments, aspects of the caregiving environment) associated with these discrepancies. Participants (N = 258) were drawn from a large, nationally representative sample of youth under the age of 18 (mean age = 13.8) and their caregivers who were investigated by CPS. Multinomial logistic regressions were used to examine correlates of discrepancies in caregiver and youth reports of youth self-harm. Results indicated that 10% of caregiver-child dyads agreed on children’s engagement in self-harm. In 33% of cases, only the child reported self-harm and in 57% of cases, only the caregiver reported youth self-harm. Being a biological caregiver, child female sex, higher levels of internalizing symptoms, greater post-traumatic stress disorder (PTSD) symptoms, and greater caregiver alcohol use was associated with a lower likelihood of caregivers reporting self-harm only. Older child age, lower externalizing symptoms, higher PTSD symptoms, and greater levels of caregiver emotional security and structure were linked to lower odds of children reporting self-harm only. These results underscore important factors to consider when assessing self-harm among youth involved with CPS and have potential implications for practice guidelines in this population.

Influence of nonsuicidal self-injury functions on suicide risk in individuals with eating disorders.

Individuals with eating disorders (EDs) display elevated rates of suicidality (i.e., suicidal ideation and behaviors) as well as nonsuicidal self-injury (NSSI) (e.g., self-harm behaviors without intent to die). NSSI-and particularly the functions of NSSI-predict suicidal ideation in general samples; however, to our knowledge, the relation between NSSI functions and suicidal ideation in ED populations has been unexplored. This study examined whether specific functions of NSSI are relevant to suicidal ideation in a treatment-seeking sample of women with EDs (n = 100). Participants completed self-report measures of suicidal ideation, NSSI, and related psychopathology upon intake to an ED treatment program. Using the four-function model of NSSI, we found that intrapersonal and interpersonal-negative reinforcement, but not interpersonal-positive reinforcement functions, were related to suicidal ideation in women with EDs. Contrary to expectations, we did not find that endorsement of multiple NSSI functions was related to increased suicide risk. Findings imply that some, but not all, functions of NSSI may be relevant to suicide risk in individuals with EDs. Implications for further research are discussed.

The role of aggression in substance use: The prison case

Objectives: Substance use and aggressive behaviour pattern is considered as a serious criminal behaviour threat. This analytical cross-sectional study was designed to determine the level of aggression of convicts with substance use and to determine the variables predicting the substance use characteristics of convicts. Methods: The study was carried out with 255 male convicts in 2 different closed penal execution institutions in Izmir province. In order to measure demographic variables, data were collected using the Information Form, Buss Perry Aggression Questionnaire and Addiction Profile Index. Results: When convicts were examined according to demographic variables, it was found that there was a significant difference between the groups in terms of variables such as age, marital status, domestic violence, history of psychological treatment and self-harm behaviour. The results showed that 85.5% of convicts had used cannabis more than three times in their lifetime. Also there was a significant difference between the total score obtained from the aggression scale and the number of substance types used. Conclusions: Multidisciplinary approach in the field of addiction can go a long way in solving the problem and will play an important role in the protection of society, individuals and victims.

SAT661 Bypass-oma Or Medication-oma: A Clinical Dilemma About Hypoglycemia

Abstract Disclosure: C.A. Perez Hernandez: None. M.J. Pesantez Borja: None. Introduction With the ongoing worldwide obesity epidemic, the number of bariatric procedures rises every year. Although complications have decreased in the last 20 years, they can result in significant morbidity and mortality. Hypoglycemia is a complication that usually occurs 1-3 years after a Roux-en-Y gastric bypass, and is caused by increased postprandial incretin secretion. Although reported incidence is 0.1%, it is likely underdiagnosed and underestimated cause of hyper insulinemic hypoglycemia. Clinical Case A 33-year-old male with history of pancreatic cancer status post partial pancreatectomy and Roux-en-Y gastric bypass performed 10 years ago, and type 2 diabetes on insulin was admitted for severe persistent hypoglycemia refractory to treatment. He stopped using insulin 6 months ago after passing out while driving 1-2 hours postprandially. Only 2 hours after starting a 72-hour fasting test, the patient had a venous blood glucose of 39 mg/dl. Laboratory results showed: C-peptide:3.3, Insulin:9.3, cortisol:2.6, BHB: 0.5 and proinsulin:3.7; and negative sulfonylurea screening. Dotatate scan was unremarkable. He has started diazoxide, acarbose, octreotide and Everolimus with no improvement to his symptoms. Plan was to repeat the work up, however, the patient refused to cooperate. He also declined a Calcium stimulation test, endoscopic US and bariatric surgery reversal. Review of his imaging studies which, showed no signs of pancreatic surgery. When re-interrogated, medical history inconsistencies were noticed. Hypoglycemia episodes occurred exclusively after being transferred out of ICU, patient was placed in a one-to-one monitoring. During the night shift, he was found injecting himself an unknown medication via PICC line and several medications were found in his room. After being confronted by staff, the Patient left the AMA only to be readmitted the same day for hypoglycemia at another institution. Conclusion Our patient was diagnosed with Munchausen's syndrome, substance abuse and depressive disorder upon evaluation by psychiatry. It was found that 4 years prior to current admission, he completed a 72-hour fasting test in another hospital, without hypoglycemia episodes. However, due to concerns for insulinoma, his oncology team was contacted who reported never having seen the patient or diagnosing with pancreatic cancer. Also, patient was found self-injecting with an unknown medication, and when confronted, he left AMA just like he did while he was under our care. History of self-harm behavior and inconsistencies in medical history may call for atypical presentations of Post Bariatric Surgery hypoglycemia and should prompt a detailed anamnesis and psychiatric assessment. This case represents a clinical dilemma and illustrates the therapeutic challenges encountered with a patient diagnosed with post bariatric surgery hypoglycemia and Munchausen syndrome. Presentation: Saturday, June 17, 2023

Childhood adversity and adolescent acting-out behaviors: the mediating role of mentalizing difficulties and epistemic vigilance.

Childhood adversity is a well-established risk factor for adolescent acting-out behaviors such as self-harm, bingeing, substance abuse, and aggressive behavior. From a mentalizing perspective, acting-out behaviors are understood as resulting from a combination of impairments in mentalizing and epistemic vigilance that are a consequence of childhood adversity. Yet, few studies have investigated these assumptions. The current study investigated the potential mediating role of mentalizing impairments and epistemic vigilance in the relationship between childhood adversity and acting-out behaviors in adolescents, oversampled for risk status for psychopathology (N = 451, mean age = 15.40years). Structural equation modeling showed a strong, direct relationship between childhood adversity and acting-out behaviors, confirming the importance of traumatic childhood experiences for adolescent acting-out behaviors. This relationship was partially mediated by both mentalizing difficulties and epistemic vigilance, explaining about 40% of the total variance. These results support the importance of focusing on strengthening mentalizing abilities and lowering epistemic hypervigilance in psychotherapeutic work with adolescents who have experienced childhood trauma.

Upward trends in eating disorders, self-harm, and suicide attempt emergency admissions in female adolescents after COVID-19 lockdown

IntroductionIncreased mental health problems have been reported in children and adolescents related to the COVID-19 lockdown and its immediate aftermath, especially among adolescent females. However, the longer-term impact of persistent quarantine measures and social restrictions on this population is yet to be further explored. Materials and methodsWe compared the number of children/adolescents admissions to the psychiatric emergency department (ED) of Hospital Clínic de Barcelona during the COVID-19 lockdown and the following year with the numbers of admissions the year before lockdown, adjusting for variations in the population. We also conducted separate analyses by gender, age group, and diagnostic categories. Finally, we also repeated the analyses considering the cumulated deficit/excess since the start of the lockdown. Statistical significance was estimated using binomial tests with Bonferroni correction. ResultsA total of 2425 admissions were recorded. Globally, admission rates decreased during the lockdown (46%) and progressively increased during the one-year aftermath (43% by spring 2021). This increase was particularly high in adolescent females (85%) while unclear in children and/or males. The main diagnostic categories involved were anxiety, depressive, and eating disorders, as well as self-harm behavior, suicidal ideation, and suicide attempts. The increase in eating disorders, self-harm behavior, and suicide attempts admissions in female adolescents remained statistically significant when considering the cumulated deficit/excess. ConclusionsWe found increased ED admissions during the aftermath of the COVID-19 lockdown among adolescent females. We recommend strengthening the attention to this population to provide adequate specialized care and prevention strategies.

4.20 Suicidal Ideation, Suicidal Attempts, and Self-Harm Behaviors in Children and Adolescents With Psychiatric Disorders

4.20 Suicidal Ideation, Suicidal Attempts, and Self-Harm Behaviors in Children and Adolescents With Psychiatric Disorders

6.93 Suicidality and Self-Harm Behavior of Adolescents During the Early Phase of War in Ukraine

6.93 Suicidality and Self-Harm Behavior of Adolescents During the Early Phase of War in Ukraine

The Social Media Trend of TikTok Tics: The Rise of Functional Tic-like Disorders During the COVID Pandemic

Alicia (fictional patient name) was a 14-year-old female admitted to the inpatient child psychiatry unit due to suicidal ideation and a complex past psychiatric history that included self-harming behaviors, depression, and anxiety. During the hospitalization, the patient was seen irregularly jerking her arms, bobbing her head, and making vocalizations that included whistling and swearing. She had not been previously diagnosed with tics, and her parents explained these were new phenomenon. Her mother worried that Alicia had developed Tourette’s syndrome (TS). During this time, TikTok videos with the hashtag #tourettes were trending. Popular influencers, with millions of likes, filmed themselves with their “Tourette’s”, with movements including arm and head jerking, as well as sudden vocalizations, all perfectly matching what Alicia was exhibiting.

Resting-State EEG Microstates and Power Spectrum in Borderline Personality Disorder: A High-Density EEG Study

Borderline personality disorder (BPD) is a debilitating psychiatric condition characterized by emotional dysregulation, unstable sense of self, and impulsive, potentially self-harming behavior. In order to provide new neurophysiological insights on BPD, we complemented resting-state EEG frequency spectrum analysis with EEG microstates (MS) analysis to capture the spatiotemporal dynamics of large-scale neural networks. High-density EEG was recorded at rest in 16 BPD patients and 16 age-matched neurotypical controls. The relative power spectrum and broadband MS spatiotemporal parameters were compared between groups and their inter-correlations were examined. Compared to controls, BPD patients showed similar global spectral power, but exploratory univariate analyses on single channels indicated reduced relative alpha power and enhanced relative delta power at parietal electrodes. In terms of EEG MS, BPD patients displayed similar MS topographies as controls, indicating comparable neural generators. However, the MS temporal dynamics were significantly altered in BPD patients, who demonstrated opposite prevalence of MS C (lower than controls) and MS E (higher than controls). Interestingly, MS C prevalence correlated positively with global alpha power and negatively with global delta power, while MS E did not correlate with any measures of spectral power. Taken together, these observations suggest that BPD patients exhibit a state of cortical hyperactivation, represented by decreased posterior alpha power, together with an elevated presence of MS E, consistent with symptoms of elevated arousal and/or vigilance. This is the first study to investigate resting-state MS patterns in BPD, with findings of elevated MS E and the suggestion of reduced posterior alpha power indicating a disorder-specific neurophysiological signature previously unreported in a psychiatric population.

Trait Emotional Intelligence, Social Desirability and Non-Suicidal Self-harm Behavior among Adolescents: A Cross-Sectional Study

Non-suicidal self-injury (NSSI) is the intentional and acute harm done to one's body without the intention of committing suicide. Suicidal behavior (SB) and non-suicidal self-injury (NSSI) are the two primary health issues affecting teenagers. Despite increasing attention to such issues, very little work is done regarding these issues in Pakistan. The objective of this research was to determine the incidence of non-suicidal self-harm in adolescents and to find an association between non-suicidal self-injury and traits of emotional intelligence and social desirability in Pakistani adolescents who made up a typical sample of the general community. For this purpose, 195 participants were selected from different hospitals and areas of Islamabad and Rawalpindi. The non-suicidal self-injury student questionnaire, the trait emotional intelligence questionnaire (TEIQue-SF), and the social desirability scale (SDS-17) were used to collect data. According to the findings, people who were more socially desirable and have lower emotional intelligence traits were more likely to engage in NSSI. The results of this research provide insight into the intricate interactions among these factors and how they affect NSSI. Mental health practitioners can improve their capacity to recognize and assist people who are experiencing NSSI, thereby, supporting their well-being and recovery, by developing a deeper understanding of these aspects.

Exposure to patient aggression and health outcomes for forensic mental health nurses: A cross-sectional survey.

The aims of the study were to determine the types and prevalence of forensic mental health nurse exposure to patient aggression and explore the impact of these exposures on their physical and mental health and work absences. Cross-sectional survey conducted January to April 2020. All 205 nurses working in an Australian high-security inpatient forensic mental health hospital were invited to participate. An online survey included the Perception of Prevalence of Aggression Scale to measure respondent exposure to types of patient aggression, and the SF-36v2 to measure mental and physical health. Absence from work and other work and individual characteristics were also explored. Sixty-eight respondents completed the survey. Verbal abuse was the most experienced aggression type, followed by physical violence and observing violence, patient self-harming behaviours and sexual violence. Nurses who worked in acute units experienced significantly more exposure to overall aggression than nurses in non-acute units. Higher level of aggression was associated with number of days sick leave taken and days off due to aggression or violence. Higher level of aggression was associated with poorer mental health, and patient self-harming behaviour was associated with poorer physical health. Nurses in acute units experience higher levels of inpatient aggression and are therefore at increased risk of being impacted by the exposure. Findings indicate a psychological impact of exposure to frequent aggression and potential for an accumulative effect of exposure to traumatic events on nurse well-being. Nurses who are victim of, or witness, physical violence are most likely to take time off work. This study provides further evidence that forensic mental health nurses are frequently exposed to various forms of patient aggression. For some nurses, this exposure to patient aggression negatively impacted their mental and physical health. Employing organizations should therefore prioritize provision of formal support for nurses. No patient or public contribution.

Transformation of internet addiction on the background of social isolation and security crisis

Aim — based on the analysis of the characteristics of Internet addiction, identify its peculiarities on the background of social isolation and security crisis. Materials and methods. The study was conducted on a contingent of 120 respondents (students of higher education) aged 18 to 23, who have experience of permanent stay in conditions of social isolation in Ukraine (2020—2023), with established Internet-addiction according to Internet Addiction Test (K. Young, 1998) and Internet Use Disorders Identification Test (Linskiy I. V., Minko A. I., Artemchuk A. P. et al., 2009). The distribution of the contingent by gender was symmetrical. The research method is a structured psychological interview. Study results. In our analysis, it becomes evident that the excessive utilization of the Internet does not merely align with a series of non-chemical addictions; rather, it operates as a facilitative mechanism for a broad range of behavioral and psychological transgressions, which arise as an interconnected functional entity. Within this multifaceted spectrum, we discern two discrete categories: the formation of compulsive behavior patterns and the justification of pre-existing behavior abnormalities. Compulsive behavior patterns include compulsive gaming and gambling behavior, compulsive social media use, compulsive pornography consumption, news-related compulsive behavior. Formation of compulsive behavior patterns associated with problematic excessive use of Internet have such mechanisms: openness and accessibility of hyper-stimulating content, reinforcement and rewards with feedback loops, social comparison, escapism and avoidance, information overload. Justification of pre-existing behavior abnormalities associated with problematic excessive use of Internet include reinforcement of attention-seeking and provocative behaviors; reinforcement of rude and violent behaviors, reinforcement of self-harm and destructive behaviors, progressive reinforcement of deviant sexuality, reinforcement of cult-like behavior. Noticed underlying mechanisms: echo chambers, disinhibition due to anonymity, group polarization and competitive dynamics. Conclusions. Behavioral and psychological disorders linked to problematic excessive Internet use do not fit neatly into a singular pathological disorder classification within current assessment frameworks that may trivialize Internet addiction as a mere form of non-chemical addiction. Instead, in the contemporary context, it is imperative to examine and thoroughly evaluate the intricate array of behavioral and psychological disorders that manifest through Internet usage. Key words: Internet, addiction, Internet addiction, compulsions, behavior violations

Brain-gut axis mechanism of subthreshold nonsuicidal self-injury addictive features in adolescents.

Nonsuicidal self-injury (NSSI) is associated with an increased risk of suicide. As the diagnostic criteria outlined in DSM-5 and other related clinical studies, a patient must have engaged in self-injurious behavior at least 5 times within the past year. However, patients with fewer than 5 self-injury behaviors should not be ignored. Our study included 46 adolescents aged 10-19 years with subthreshold NSSI (sNSSI), along with a control group of 50 healthy adolescents matched for age and other factors. We collected resting-state functional magnetic resonance imaging data and stool samples. The Ottawa Self-Injury Inventory and Deliberate Self-Harm Inventory were used to evaluate self-harm behaviors and addictive features. Local brain activity was assessed using fractional amplitude of low-frequency fluctuations (fALFF), and brain regions with abnormal fALFF were selected as seeds for whole-brain functional connectivity analysis. Stool samples were identified using 16S rDNA amplicon sequencing, and the LDA Effect Size method was used to explore significant differences between grouped samples. Mediation analysis was performed to investigate the brain-gut axis mechanisms of addictive features in sNSSI. We found that compared with healthy controls, sNSSI patients have abnormal fALFF in left thalamus and posterior cingulate cortex, dysconnectivities of left thalamus, and decreased Prevotellaceae. Our results suggested that addictive features of sNSSI may have a brain-gut mechanism. Furtherly, patients with 1-4 NSSI behaviors in the past year should have separate name for identification, such as "subthreshold NSSI".

Sub-threshold or full-syndrome borderline personality disorder in adolescents with recurrent self-harm – distinctly or dimensionally different?

BackgroundBorderline personality disorder (BPD) is a severe mental disorder frequently seen in individuals with recurrent self-harm behaviour. To what extent there are distinguishing characteristics between self-harming adolescents who meet the criteria for a full diagnosis of BPD, a sub-threshold number of BPD criteria and those who don’t have BPD, with respect to clinical characteristics, is still uncertain and could have important clinical implications.MethodsData from 103 adolescents with recurrent self-harm behaviour recruited from child and adolescent psychiatric outpatient clinics were collected through clinical interviews and self-reports. Bivariate analyses comparing participants with or without a diagnosis of BPD were performed. Group differences based on the number of BPD criteria fulfilled (few-if-any BPD: 0–2 criteria, sub-threshold BPD: 3–4 criteria, full-syndrome BPD: 5 or more criteria) were tested and regression analyses performed.ResultsAdolescents with a diagnosis of BPD (28.2%) had significantly higher numbers of co-morbid DSM-5 disorders, suicide attempts and self-harm methods. They also reported significantly higher levels of suicidal ideation, depression, anxiety and impulsivity, compared with adolescents without BPD. Adolescents with sub-threshold BPD (20.4%) place themselves in the intermediate position between participants with full-syndrome BPD and participants with few-if-any BPD, in terms of these symptoms. Higher levels of emotional regulation difficulties and a lower level of global functioning were significantly associated with fulfilling a higher number of BPD criteria.ConclusionAdolescents with recurrent self-harm who meet diagnostic criteria for a full-syndrome BPD or sub-threshold BPD seem to have difficulties within the same spectrum. They seem dimensionally, but not categorically, different with respect to the severity of their difficulties. These adolescents need interventions aimed at their dysfunctional self-harm behaviour, emotional regulation difficulties and BPD symptoms at an earlier, rather than at a later stage of symptom development.

Risk on Demand? A Quantitative Content Analysis of the Portrayal of Risky Health Behaviors in Popular on Demand Content

ABSTRACT Video on Demand (VOD) has become the most popular way for adolescent viewers to consume entertainment media, often without parental supervision. Given the potential for modeling, this study aims to investigate the prevalence and nature with which risky health behaviors are portrayed in popular VOD programs. A quantitative content analysis of trending programs (N = 529) from popular VOD-platforms investigated the prevalence, co-occurrence, tone, social context, and consequences with which alcohol use, tobacco use, drug use, unsafe sexual behavior, reckless behavior, and self-harm behaviors are portrayed in popular VOD programs. In addition, we analyzed the demographic characteristics of the characters who portrayed the risk behaviors Risk behaviors were portrayed frequently, with substance use behaviors (i.e. alcohol, smoking, drugs) being most prevalent and most likely to co-occur. Reckless behavior, self-harm behaviors, and explicitly unsafe sexual behaviors were much less common. Findings show that risk behavior was often portrayed in a normalized manner, with alcohol and smoking, in particular, being portrayed as neutral behaviors that rarely have consequences. Most risk-taking characters were (young) adult white males, mirroring the general overrepresentation of this demographic in popular media. Risk behavior was rarely problematized in popular on demand content. Potential consequences for adolescent viewers are discussed.

VEGF, IGF-1 and FGF-2 Serum Levels in Children and Adolescents with Autism Spectrum Disorder with and without Bipolar Disorder.

To investigate serum levels of VEGF, IGF-1 and FGF-2, and relationships with several clinical characteristics in children and adolescents with autism spectrum disorder (ASD) with and without bipolar disorder (BD). 40 subjects with ASD + BD as study group, and 40 subjects with ASD as control group were included. Serum levels of VEGF, IGF-1, and FGF-2 were measured using commercial enzyme-linked immunosorbent assay kits. The study group was significantly higher than the control group in terms of ASD severity, self-harming behavior and sleep disturbance. Serum VEGF and FGF-2 levels were significantly higher in the ASD + BD group than in the control group. There was no significant difference in serum IGF-1 levels between the two groups. There was no correlation between VEGF, IGF-1 and FGF-2 serum levels and ASD severity in the study group. However there was a negative correlation between VEGF levels and age at first diagnosis of BD, and a positive correlation between IGF-1 levels and the number of bipolar episodes in the study group. Growth factors like VEGF and FGF-2 may be potential biomarkers of bipolar disorder in young subjects with ASD. Given the difficulty of clinical management of BD in young subjects with ASD, potential biomarkers would help clinicians in the diagnosis and follow up of BD in this special population. Further research is needed whether VEGF and FGF-2 can be potential biomarkers in the clinical management of young subjects with ASD and BD.

Maladaptive Personality Traits of Inpatients with Self-Harm Behavior and Its Association with Suicide Intent Severity.

Introduction: Inpatients with self-harm behavior utilize a high proportion of health care resources, and determining their suicide risk may be challenging. This study examines how maladaptive personality traits in people who self-harm are associated with suicide intent severity. Methods: This was a 5-month cross-sectional study. The International Personality Disorders Examination (IPDE) ICD-10 questionnaire, Beck's Suicide Intent Scale (SIS), and the Depression Anxiety Stress Scale (DASS) 21 were administered. Sociodemographic and clinical data were recorded with STATA version 10.1 for statistical analyses. Results: Thirty-seven out of 40 (92.50%) inpatients participated in this study. About two-thirds (n = 24, 64.86%) were first-time self-harmers, with self-poisoning (n = 33, 89.19%) being the most common method. About two-thirds (n = 24, 64.86%) had low to moderate suicide intent. The most common diagnosis was adjustment disorder (n = 21, 56.76%). Around one-third had at least severe ratings for depressive, anxiety, and stress symptoms. All screened positive for at least one class of maladaptive personality traits, with the majority (n = 33, 89.19%) having more than one class of maladaptive personality traits. The three most prevalent classes of maladaptive personality traits were anankastic (n = 28, 75.68%), schizoid (n = 25, 67.57%), and paranoid (n = 23, 62.16%). Only dissocial traits were positively correlated with suicide intent severity (regression coefficient = 1.37, p = .017) following adjustment for the most important confounder, DASS 21. Discussion: Maladaptive personality traits were common in inpatients with self-harm behavior, with dissocial traits being positively correlated with suicide intent severity. This finding may inform suicide prevention strategies for patients who self-harm.

토픽모델링을 활용한 ‘자해’관련 유튜브 댓글의 내용분석

Objectives In this study, YouTube video comments were collected and analyzed to confirm the impact of YouTube related to “self-harm” on those who do not self-harm and to find effective ways to help those who do self-harm.
 Methods To this end, comments on the top nine videos derived by searching for the keyword “self-harm” on YouTube were collected, and 10 topics were derived by topic modeling comments from users who did not seem to have self-harm experience. Topic modeling is an analysis method that finds hidden topics based on statistics that analyze big data.
 Results The topics of the selected topics are “You need empathy and comfort to help self-inflicted people live in the world.”, “Concerns and discomfort towards self-harming people who worry about scars on their bodies.”, “Presenting a religious solution to self-harm.”, “We should consider self-harm as a social problem and find alternative ways together.”, “Thank you for telling me the reactions that people around you can do.”, “I remember my experiences related to self-harm that I experienced in my adolescence.”, “Need safe and professional counseling on self-harm,” “The way adults deal with self-harm.”, “Reaction to posting self-harm photos.”, “to be aware of one's psychological difficulties through an understanding of others' self-harm.”.
 Conclusions In the comments on YouTube related to “self-harm,” users' efforts and supportive actions to sympathize with and understand those who harm themselves were confirmed. On the other hand, concerns and concerns about self-harm scars appeared at the same time, and although I understand the hard feelings, it was confirmed that there was a negative opinion on self-harm behavior. Finally, we proposed a way to help those who harm themselves through the contents of 10 topics.

Actualización clínica y terapéutica de las urgencias en psiquiatría

A psychiatric emergency is any abnormal thoughts, feelings, or behaviors that require an immediate treatment intervention. The most common reasons for a psychiatric emergency consultation are anxiety, depressive symptoms, self-harming behavior or ideation, psychotic phenomena, and psychomotor agitation. All can be manifestations of an underlying psychiatric disease, though they may also emerge in the context of an organic disease. Therefore, faced with these healthcare needs, it is necessary to perform a differential diagnosis among the potential somatic, toxic, and psychiatric causes. To do so, it is recommended to take a full case history, conduct a physical and psychopathological examination, take vital signs, and perform basic additional tests: a blood test (biochemistry, complete blood count) and urine toxicology test. Occasionally, more specific tests may be necessary based on the diagnostic suspicion (electrocardiogram, computed tomography scan of the head, thyroid hormones, etc.). Its management is urgent and treatment will be for symptoms and for the underlying organic or psychiatric cause. Later, it would be necessary to evaluate referral to a psychiatry specialist on either an emergency or outpatient basis.