Hello and welcome to the Zero to Finals podcast.

My name is Tom and in this episode I'm going to be talking to you about self-harm and suicide.

And you can find written notes on this topic at zero tofinals.com slash self-harm and suicide or in the

psychiatry section of the 0-to-finals more medicine book. So let's get straight into it.

Self-harm involves intentional self-injury without suicidal intent.

Cutting of the skin is the most common method of self-harm.

It's more common in females and patients under 25.

It's often a response to emotional distress and acts as a way for the person to cope with their emotions.

Self-harm is not always associated with depression, anxiety or suicide, although it does increase the risk of these

conditions. Suicide involves a person causing their own death. Death by suicide is around three times more common in men

and most common around the age of 50 years.

It also increases in advanced age, for example above 90 years.

Let's talk about the cycle of self-harm.

The cycle of self-harm involves the following six steps which are repeated. The first step is emotional suffering, followed by emotional

overload, followed by panic, followed by self-harming, which is followed by temporary relief, and finally, shame and

guilt. And then the cycle continues with further emotional suffering. Next let's talk about

suicide risk assessment. Suicidal thoughts range from a passing idea that's quickly dismissed and involves

no intention to robust and persistent thoughts with intentions and a plan. They need to be

explored in detail to determine the risk and the suitable management strategy. They can change over time, so a safety plan and reassessment when required are necessary.

Presenting features that increase the risk of suicide include previous suicide attempts,

escalating episodes of self-harm, impulsiveness, hopelessness,

feelings of being a burden to others, making plans, and writing a suicide note.

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