Dr Diane Mullins, RCSI Tutor in Psychiatry, St Itas Hospital, Portrane

Deliberate self-harm / assessment of deliberate self-harm / assessment of suicide

risk
History
o Events prior and leading up to the overdose
Psychosocial stressors/mental illness
o Degree of preparation
Planning
Suicide note
Last acts
o Features of the overdose
Quantity of tablets consumed
Alcohol/illicit substances taken with the overdose
o Circumstances of overdose or other form of deliberate self-harm
Alone
Intervention unlikely
Precautions against discovery
o Expectations by taking the overdose (i.e. death) & perceived lethality of
overdose
o After the act
Did not seek help
Stated wish to die
Believed the act would result in death
Regrets its failure
o Recent history of depressive and/or psychotic symptoms
o Relevant past psychiatric history
Past history of self-harm
Past psychiatric history
o Family history
Family history of self-harm
Family psychiatry history
o Drugs & alcohol history
Misuse of drugs/alcohol
o Current medications (? compliance)

Mental state examination

o Appearance & behaviour (evidence of self neglect, reduced eye contact,
limited rapport)
o Speech ( rate, tone & volume of speech?)
o Mood (depression obj & subj)
o Abnormalities of thought (delusions, suicidal & homicidal thoughts)
o Perception (hallucinations)
o Cognition ( concentration, short-term memory, orientation in
time/place/person)
o Insight (does she feel that she is ill & needs treatment)

Physical examination (including neurological examination)

o Any physical damage resulting the current/past episodes of deliberate self-
ham (i.e. lacerations)
o Rule out organic illness

Investigations
o Biological
1
Dr Diane Mullins, RCSI Tutor in Psychiatry, St Itas Hospital, Portrane
Bloods: FBC, RFT, LFT, TFT, fasting glucose, B12 & folate
ECG, EEG, CT/MRI brain scan
Urine drug screen
Alcohol history
o Psychological
Risk assessment
Tuckman and Youngmans Scale for Assessing Suicide Risk
(SASR)
Tool for Assessment of Suicide Risk (TASR)
Depression rating scale (e.g. Beck or Hamilton)
Suitability for psychotherapy
o Social
Collateral history (from partner, family, GP, psychiatric services if
she has had previous contact)
Documentation (GP records, psychiatric case notes)

Need for admission?