Factors associated with increased suicidality risk following referral for isotretinoin commencement

Objective: To establish whether there is a significant change in suicidality risk following psychiatric assessment for commencement of isotretinoin and identify factors that underpin any potential risk change. Method: Retrospective cohort study. Suicidality risk was defined as a combination of the following: (i) actual/intended self-harm and/or attempted/completed suicide, and (ii) increased service utilisation associated with suicidal ideation/behaviour. All patients referred to Psychiatry for assessment prior to commencement of isotretinoin between 2014 and 2019 were examined. Inclusion criteria: >16 years of age, assessed for commencement of isotretinoin, complete clinical records. Data were collected by reviewing the Electronic Patient Records. Fifty-seven patients were eligible. We employed descriptive statistics, parametric/non-parametric/normality tests and logistic regression analysis, using socio-demographic and clinical characteristics as independent parameters, and suicidality risk as the dependent parameter. Results: Actual/intended self-harm/attempted suicide decreased significantly following assessment without significant change in service utilisation. Female gender, absence of protective factors and assessment by Consultation-Liaison Psychiatry were linked to increased suicidality risk, after controlling for age, ethnicity, recommendation for isotretinoin, and substance misuse. Conclusions: Psychiatric assessment is helpful before commencing isotretinoin. Female gender, and absence of ongoing psychopharmacological and/or psychological intervention and/or regular psychiatric follow-up predict increased suicidality risk among patients assessed for prescription of isotretinoin.

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Self-harm

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0622 ◽

2020 ◽

pp. 6457-6460

Author(s):

Kate E.A. Saunders ◽

Keith Hawton

Keyword(s):

Mood Disorder ◽

Psychiatric Disorders ◽

Emotional Disturbance ◽

Suicide Risk ◽

Psychological Intervention ◽

Hospital Emergency ◽

Psychiatric Assessment ◽

Self Harm ◽

Hospital Emergency Departments ◽

Careful Assessment

Self-harm is one of the commonest reasons people present to hospital emergency departments and the most frequent form of self-harm is overdose. Most patients who self-harm have an emotional disturbance, commonly an adjustment or mood disorder, often in a context of situational or relationship stresses, and personality difficulties. Some have more severe psychiatric disorders. Intoxication with alcohol is common. All patients presenting with self-harm require both a medical and a psychiatric assessment. The latter should include an assessment of problems, needs and suicide risk. Children require particularly careful assessment. In assessing suicide risk, it should be noted that the medical dangerousness of the act does not necessarily reflect the intent, and that repeat self-harm greatly increases the risk of eventual suicide. Psychiatric management depends on the patient's problems and diagnosis. There is some evidence that brief psychological intervention can decrease the risk of repeat self-harm.

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What precipitates deliberate self-harm?

Australian Health Review ◽

10.1071/ah980194 ◽

1998 ◽

Vol 21 (3) ◽

pp. 194 ◽

Cited By ~ 10

Author(s):

Mark Ryan ◽

Michael Parle ◽

Nick Babidge

Keyword(s):

Inner City ◽

Clinical Audit ◽

Psychological Intervention ◽

Patient Characteristics ◽

Consecutive Series ◽

Liaison Psychiatry ◽

Deliberate Self Harm ◽

Working Model ◽

Self Harm ◽

Age Range

Objective: To develop a working model that provides an understanding of the processof deliberate self-harm and a framework for psychological intervention in anemergency department setting.Method: A retrospective clinical audit of a consecutive series of 51 deliberate self-harmpatients referred to the liaison psychiatry service by the emergency departmentof an inner city hospital.Results: Patient characteristics were diverse. The age range was 17?92 years, with79% between 15 and 35 years. Most were single and unemployed and the majorityhad a psychiatric disorder. Characteristically, there was at least one immediate stressorand intoxication immediately before the attempt.Conclusions: The diversity of deliberate self-harm patients requires strategicintervention in a setting such as the emergency department. The working model forintervention presented here may be transferable to other settings such as generalpractice or community mental health centres using an educational and skillsdevelopment approach with ongoing supervision.

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The prevalence and treatment of mental health conditions documented in general practice in Ireland

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2018.48 ◽

2018 ◽

Vol 37 (1) ◽

pp. 24-31

Author(s):

Jane O’Doherty ◽

Ailish Hannigan ◽

Louise Hickey ◽

David Meagher ◽

Walter Cullen ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Psychological Intervention ◽

Female Gender ◽

Mental Health Disorders ◽

Pharmacological Intervention ◽

Consultation Rate ◽

Psychological Condition ◽

Health Disorders ◽

Clinical Records

ObjectivesAs prevalence of mental health disorders increases worldwide, recognition and treatment of these disorders falls increasingly into the remit of primary care. This study investigated the prevalence and management of adults presenting to their general practitioner (GP) in Ireland with a psychological condition.MethodsA random number function was used to select 100 patients with a consultation in the previous 2 years from 40 general practices around Ireland. The clinical records of these patients were examined using a standardised reporting tool to extract information on demographics, eligibility for free care, prevalence and treatment of psychological conditions.ResultsFrom a sample of 3845 ‘active’ patients, 620 (16%, 95% confidence interval 15–17%) had a documented psychological condition in the previous 2 years. The most common diagnoses were depression (54%) followed by stress and anxiety (47%). The following patient characteristics were associated with having a documented mental health condition: female gender; higher GP consultation rate; a referral or attendance at secondary care and eligibility for free GP care. Of those with a psychological condition, 34% received a psychological intervention and 81% received a pharmacological intervention.ConclusionsThe overall prevalence estimate of mental health disorders for this sample was lower than previously documented in primary care. Patients diagnosed with mental health disorders had higher utilisation of health services and pharmacological treatment was common.

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Improving safety-planning in patients admitted with self-harm

BJPsych Open ◽

10.1192/bjo.2021.557 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S208-S209

Author(s):

Vatsala Mishra ◽

Kathryn Hughes ◽

Alexander Sunderland ◽

Marilia Calcia ◽

Martin Parsons

Keyword(s):

Quality Improvement ◽

Training Session ◽

Safety Planning ◽

Liaison Psychiatry ◽

Pdsa Cycle ◽

Number Of Patients ◽

Increased Risk ◽

Self Harm ◽

Clinical Records ◽

Crisis Plan

AimsSelf-harm is a common presentation to acute hospitals, associated with increased risk of completed suicide. Safety plans are increasingly recommended to help patients recognise and prevent escalation of self-harm behaviours.This project aimed to improve quality and documentation of safety planning for patients admitted at an acute general hospital due to self-harm, who were assessed by Liaison Psychiatry. We aimed to increase the number of patients given written safety plans on discharge by 50%.MethodThe PDSA cycle model of quality improvement was used. A retrospective audit of clinical records was conducted over 3 months to establish baseline documentation of safety planning (n = 51). A template for a self-harm crisis plan, used in other areas of the Trust, was adopted, to be adapted to each patient. A leaflet for sources of crisis support and patient feedback form were developed and distributed to clinicians in the team. Data collection was repeated one month later (n = 48). The second set of interventions involved a training session for clinicians on developing safety plans in collaboration with patients, and a poster highlighting the process to be undertaken when discharging a patient admitted with self-harm.ResultFollowing initial interventions, 20% of patients had completed safety plans and 50% received advice, an increase of 20% and 40% respectively. The second PDSA cycle showed increase in numbers to 38% and 67% respectively.ConclusionCreating a crisis plan with a hospital-specific leaflet for the Liaison Psychiatry team increased the number of patients discharged with safety plans in place. 86% of patients who participated in safety-planning found the process helpful and felt likely to use the plan in future crises. This is an area of ongoing quality improvement which can be implemented in other hospitals to better equip patients with skills and support to reduce self-harm/suicide attempts.

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Long-term hospital attendance of children and adults who have undergone removal of normal or inflamed appendices

The British Journal of Psychiatry ◽

10.1192/bjp.181.6.526 ◽

2002 ◽

Vol 181 (6) ◽

pp. 526-530 ◽

Cited By ~ 3

Author(s):

Nicola J. Dummett ◽

Nicola J. Maughan ◽

Anne Worrall-Davies

Keyword(s):

Health Care ◽

Health Care Systems ◽

Attendance Rates ◽

Liaison Psychiatry ◽

Abdominal Symptoms ◽

Secondary Health Care ◽

Care Systems ◽

Self Harm ◽

Males And Females

BackgroundEarly studies suggested that presentations with unexplained acute abdominal pain were associated with increased long-term rates of hospital attendance and self-harm, especially in women, but few studies were large enough for definitive findings.AimsTo test the hypothesis that such presentations are followed by higher long-term utilisation rates of secondary health care even excluding further abdominal symptoms, and particularly for self-harm, than presentations with acute appendicitis.MethodNew hospital attendance rates, liaison psychiatry attendances and self-harm attendances of patients with normal appendices at emergency appendicectomy were compared with those of appendicitis patients.ResultsAttendance rates of all kinds were significantly higher for normal appendix patients than for appendicitis patients, with equal strengths of finding for males and females.ConclusionsPeople with normal appendices at emergency appendicectomy show higher long-term rates of hospital attendance. This has implications for how these patients are best managed by health care systems.

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Predictive accuracy of risk scales following self-harm: Multicentre, prospective cohort study

The British Journal of Psychiatry ◽

10.1192/bjp.bp.116.189993 ◽

2017 ◽

Vol 210 (6) ◽

pp. 429-436 ◽

Cited By ~ 35

Author(s):

Leah Quinlivan ◽

Jayne Cooper ◽

Declan Meehan ◽

Damien Longson ◽

John Potokar ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Predictive Accuracy ◽

Area Under The Curve ◽

Global Scale ◽

National Guidelines ◽

Liaison Psychiatry ◽

Predictive Values ◽

Self Harm

BackgroundScales are widely used in psychiatric assessments following self-harm. Robust evidence for their diagnostic use is lacking.AimsTo evaluate the performance of risk scales (Manchester Self-Harm Rule, ReACT Self-Harm Rule, SAD PERSONS scale, Modified SAD PERSONS scale, Barratt Impulsiveness Scale); and patient and clinician estimates of risk in identifying patients who repeat self-harm within 6 months.MethodA multisite prospective cohort study was conducted of adults aged 18 years and over referred to liaison psychiatry services following self-harm. Scale a priori cut-offs were evaluated using diagnostic accuracy statistics. The area under the curve (AUC) was used to determine optimal cut-offs and compare global accuracy.ResultsIn total, 483 episodes of self-harm were included in the study. The episode-based 6-month repetition rate was 30% (n = 145). Sensitivity ranged from 1% (95% CI 0–5) for the SAD PERSONS scale, to 97% (95% CI 93–99) for the Manchester Self-Harm Rule. Positive predictive values ranged from 13% (95% CI 2–47) for the Modified SAD PERSONS Scale to 47% (95% CI 41–53) for the clinician assessment of risk. The AUC ranged from 0.55 (95% CI 0.50–0.61) for the SAD PERSONS scale to 0.74 (95% CI 0.69–0.79) for the clinician global scale. The remaining scales performed significantly worse than clinician and patient estimates of risk (P < 0.001).ConclusionsRisk scales following self-harm have limited clinical utility and may waste valuable resources. Most scales performed no better than clinician or patient ratings of risk. Some performed considerably worse. Positive predictive values were modest. In line with national guidelines, risk scales should not be used to determine patient management or predict self-harm.

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Liaison psychiatry

Oxford Handbook of Psychiatry ◽

10.1093/med/9780198795551.003.0018 ◽

2019 ◽

pp. 839-880

Author(s):

David Semple ◽

Roger Smyth

Keyword(s):

Medically Unexplained Symptoms ◽

Physical Illness ◽

Anxiety Symptoms ◽

Differential Diagnoses ◽

Psychotic Symptoms ◽

Liaison Psychiatry ◽

Medically Unexplained ◽

Medical Population ◽

Self Harm ◽

Unexplained Symptoms

This chapter concerns liaison psychiatry and the assessment and management of psychiatric and psychological illnesses in the general medical population. It covers the 12 most common referral types, assessment of depressive and anxiety symptoms, psychotic symptoms and confusion, depression in physical illness, delirium, and management after self-harm. Focusing on capacity and consent, as well as differential diagnoses and potential management principles for medically unexplained symptoms, it covers the basis of working as a psychiatrist in a hospital.

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The psychiatric assessment of the medical patient

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0620 ◽

2020 ◽

pp. 6447-6453

Author(s):

Jane Walker ◽

Roger Smyth ◽

Michael Sharpe

Keyword(s):

Psychiatric Illness ◽

Clinical Signs ◽

Medical Patient ◽

Psychiatric Assessment ◽

Medically Ill ◽

Additional Information ◽

Need For Treatment ◽

Self Harm ◽

Harm To Others ◽

Medically Ill Patients

Medically ill patients often have psychiatric illness. Physicians can and should detect and diagnose these illnesses during their standard medical assessment. All that is required is knowledge of key questions to ask patients, awareness of the clinical signs that may be observed, and an appreciation of the value of additional information from relatives, other clinicians, and the medical record. The aims are to detect and diagnose psychiatric disorders; assess the risk of self-harm or harm to others; establish the need for treatment or referral for a psychiatric opinion; provide the basis for clear and effective communication with a psychiatrist; and to communicate to the patient that you are interested in all aspects of their suffering and thereby establish a clinically effective relationship with them.

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Psychiatric assessment

Oxford Handbook of Psychiatry ◽

10.1093/med/9780199693887.003.0002 ◽

2013 ◽

pp. 33-82

Keyword(s):

Depressed Mood ◽

Mental State ◽

Psychiatric Patients ◽

Clinical Interview ◽

Anxiety Symptoms ◽

Psychiatric Assessment ◽

Case Summary ◽

Self Harm ◽

State Examination

The clinical interview Setting the scene Interviewing psychiatric patients Discussing management History Mental state examination Case summary Observations of appearance and behaviour Speech Abnormal mood Asking about depressed mood Asking about thoughts of self-harm Asking about elevated mood Anxiety symptoms Asking about anxiety symptoms Abnormal perceptions...

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Children, seen and heard: a descriptive study of all children (aged 12 years and under) referred for acute psychiatric assessment in Tallaght University Hospital over a 10-year period

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2020.85 ◽

2020 ◽

pp. 1-9

Author(s):

E. Maguire ◽

K. Glynn ◽

C. McGrath ◽

P. Byrne

Keyword(s):

Female Gender ◽

University Hospital ◽

Categorical Variables ◽

Review Of The Literature ◽

Suicidal Thoughts ◽

Chi Squared ◽

Mental Health Difficulties ◽

Self Harm ◽

Worrying Trend ◽

Over Time

Abstract Objectives: A review of the literature demonstrates that relatively little is known about acute psychiatric presentations in children (0–12 years), compared with adolescents or young adults (12 years+). This study aims to review psychiatric presentations of children to a CAMHS Liaison Service at Children’s Hospital Ireland (CHI) at Tallaght University Hospital over a 10-year period. Methods: A retrospective study was undertaken of case notes of all children aged 12 years and under who were referred to the CAMHS Liaison Service between January 2009 and December 2018 (n = 318). Data were anonymised and inputted into SPSSv25 for analysis. The relationships between presentations and methods of self-harm over time were measured using Pearson’s correlation. Associations between categorical variables were analysed using chi-squared tests. Results: There was a significant increase in presentations of under-12s over the 10-year period (r(8)=0.66, p = 0.02). There was also a significant increase in children presenting with a disturbance of conduct and/or emotions over time (r(8) = 0.79, p < 0.001). There was a significant association between female gender and ingestion (X2 = 12.73, df = 1, p < 0.05) and between male gender and ligature as a method of self-harm (X2 = 5.54, df = 1, p < 0.05). Over half (53%) of children presented with suicidal thoughts and 22% presented with suicidal behaviours. The reported use of ligature as a method of self-harm emerged only from 2012 among cases studied. Conclusions: Children aged 12 years and under are presenting in increasing numbers with acute mental health difficulties, including suicidal thoughts and behaviours. There is a worrying trend in methods of self-harm, particularly in high lethality behaviours such as attempted strangulation.

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