On shift, when a person presents with an overdose, what do you do?
Check TOXBASE (for recommendatiosn about treating an overdose for any substance)
Give ACTIVATED CHARCOAL within 1 hour of overdose to reduce absorption (e.g. aspirin, SSRIs, TCAs, antipsychotic drugs, benzos, quinine
Treatment of overdose / toxicity of paracetamol
Acetylcysteine
Treatment of overdose / toxicity of opioids
Naloxone
Treatment of overdose / toxicity of benzodiazepines
Flumazenil
Treatment of overdose / toxicity of beta blockers
- Glucagon - for heart failure or cardiogenic shock
- Atropine - for symptomatic bradycardia
Treatment of overdose / toxicity of calcium channel blockers
Calcium chloride or calcium gluconate
Treatment of overdose / toxicity of cocaine
Diazepam
Treatment of overdose / toxicity of cyanide
Dicobalt edetate
Treatment of overdose / toxicity of methanol (e.g. solvents or fuels) and ethylene glycol (e.g. antifreeze)
Fomepizole or ethanol (alcohol)
Treatment of overdose / toxicity of carbon monoxide
100% oxygen
Define self-harm
Intentional self-injury without suicidal intent
Epidemiology of self-harm and suicide in men and women.
Self-harm: More common in females under 25
Suicide: 3x more likely in men, especialy around 50 (increases with age)
Cycle of self-harm
- Emotional suffering
- Emotional overload
- Panic
- Self-harming
- Temporary relief
- Shame and guilt
Name some presenting features that increases the risk of suicide
- Previous suicidal attempts
- Escalating self-harm
- Impulsiveness
- Hopelessness
- Feelings of being a burden
- Making plans
- Writing a suicide note
Name some background factors that increase the risk of suicide
- Mental health conditions
- Physical health conditions
- History of abuse or trauma
- Family history of suicide
- Financial difficulties or unemployment
- Criminal problems (prisoners have a high rate of suicide)
- Lack of social support (e.g., living alone)
- Alcohol and drug use
- Access to means (e.g., firearms)
Name some protective factors that may help to reduce the risk of suicide
- Social support + community
- Sense of responsibility to others (e.g. children or family)
- Resilience, coping and problem-solving skills
- Access to mental health support
Management for self-harm and suicide risk
- Safety-netting
- Safety plan
- Follow-up
- Consider safeguarding issues
Suicide attempt:
* Informal admission (patient agrees)
* Mental Health Act (1983) (admission against will)
Management considerations for self-harm include:
* Empathy, supportive communication and building rapport
* Identifying triggers for episodes
* Separating the means of self-harm (e.g., removing blades or medications from the environment)
* Discussing strategies for avoiding further episodes (e.g., distractions, alternative coping strategies and getting help)
* Providing details for support services in a crisis (e.g., mental health services, Samaritans and Shout)
* Treating underlying mental health conditions (e.g., depression and anxiety)
* Cognitive behavioural therapy
What legal framework is used to admit patients to hospital against their wishes for a mental health disorder when required for treatment or safety?
The Mental Health Act (1983)
