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National Collaborating Centre for Mental Health (UK). Self-Harm: The Short-Term Physical and Psychological Management and Secondary Prevention of Self-Harm in Primary and Secondary Care. Leicester (UK): British Psychological Society; 2004. (NICE Clinical Guidelines, No. 16.)

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Self-Harm: The Short-Term Physical and Psychological Management and Secondary Prevention of Self-Harm in Primary and Secondary Care.

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Appendix 6Clinical questions

AMedical Topic Group

1.In patients who self-harm, has the current surveillance system improved outcomes compared with that in place 10 years ago?
2.In unconscious trauma patients where there is evidence of self-harm, does a routine paracetamol screen lead to improved outcomes compared with not screening?
3.In trauma patients who have arrived at an emergency department unconscious and for whom there is no clear explanation of their trauma, does a psychosocial assessment improve detection and outcome of self-harm?
4.In patients who self-harm by poisoning, does routine paracetamol levels estimation improve outcome compared with no routine estimation?
5.In a patient who self-harms does restricting the pack size reduce the incidence and/or severity of the non-accidental overdose?
6.In patients who self-harm does labelling, product information or verbal information influence the selection of pharmaceuticals taken as a means of self-harm?
7.In patients who self-poison does any form of gastric emptying/decontamination as opposed to no intervention influence outcome a) after 1 hour of ingestion b) between >60 minutes and < 4 hr c) greater than 4 hr.
8.What is the impact of different triage systems on outcomes?
9.In persons who self-harm by cutting, is there any evidence that a specific type of wound closure significantly influences rates of infections, scarring, etc.?

BPsychosocial Topic

1.Are there factors related to the individual (either characteristics of the individual or of the act of self-harm) that predict outcome (including suicide, non-fatal repetition, other psychosocial outcomes)? How strong are these predictors either singly or in combination and what are their positive and negative predictive power?
2.For people who have harmed themselves, or expressed intent, does formal risk assessment, compared with a non-standardised assessment, alter decision-making, change engagement or affect outcomes?
3.What proportion of people who have self-harmed and attend an emergency department leave after being triaged but before having a psychosocial assessment and what are the consequences? Are certain groups more likely to leave than others?
4.For those people who self-harm and attend an emergency department does a psychosocial assessment lead to a different outcome compared with no psychosocial assessment?
5.For any factors associated with self-harm that have an effect on outcome (see Q1)
5.1.What is the effect of applying an intervention for these factors?
5.2.Which of these factors can and should be assessed in the emergency department?
6.For people who have had a psychosocial assessment after an episode of self-harm, which specific psychosocial interventions improve outcomes compared with no treatment or treatment as usual (e.g. DBT, problem-solving, interpersonal therapy, CBT, counselling, etc.)?
7.For people who have had a psychosocial assessment after an episode of self-harm, which pharmacological interventions improve outcomes compared with no treatment or treatment as usual (e.g. antidepressants, neuroleptics, ECT, lithium, carbamazepine, etc.)?
8.For people who have had a psychosocial assessment after an episode of self-harm, which social interventions improve outcomes compared with no treatment or treatment as usual (e.g. rehousing, crisis intervention, respite, debt counselling, networking, befriending, etc.)?
9.For people who have had a psychosocial assessment after an episode of self-harm, which ‘non-statutory’ or ‘user-defined’ interventions improve outcomes compared with no treatment or treatment as usual (e.g. self-help, voluntary counselling, peer advocacy, harm minimisation, etc.)?
10.Does training of staff in the recognition, assessment and management of people who self-harm, or aimed at improving attitudes to self-harm, have an impact on outcomes, including rates of detection?
11.In services which have specialist teams to make psychosocial assessments of people who self-harm, are there better rates of detection of people who self-harm, better engagement with services and improved outcomes?
12.Are there models of GP care that improve patient outcomes and reduce the need for specialist care?

CService User Experience Topic Group

1.What is the experience of services of people who self-harm, and does this affect outcomes?
Copyright © 2004, The British Psychological Society & The Royal College of Psychiatrists.

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Enquiries in this regard should be directed to the British Psychological Society.

Bookshelf ID: NBK56395
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