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Psychosocial and pharmacological treatments for deliberate self harm

Deliberate self‐harm is a major health problem associated with considerable risk of subsequent self‐harm, including completed suicide. This systematic review evaluated the effectiveness of various treatments for deliberate self‐harm patients in terms of prevention of further suicidal behaviour. From the results of 23 randomized controlled trials the reviewers concluded that more evidence is required to indicate what the most effective care is for this large patient population. Promising results were found for problem‐solving therapy, provision of a card to allow emergency contact with services, depot flupenthixol for recurrent repeaters of self‐harm and long‐term psychological therapy for female patients with borderline personality disorder and recurrent self‐harm. However, insufficient numbers of patients in nearly all trials limit the conclusions that can be reached. More evidence is required to determine the most effective treatment for deliberate self‐harm patients and larger trials are badly needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

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

This guideline has been developed to advise on the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. The guideline recommendations have been developed by a multidisciplinary group of healthcare professionals, patients and their representatives, and researchers after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high quality care for those people who self-harm while also emphasising the importance of the experience of care for service users and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2004
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Self-Harm: Longer-Term Management

This is the first NICE guideline on the longer-term management of both single and recurrent episodes of self-harm.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2012
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Hospital management of self-harm patients and risk of repetition: systematic review and meta-analysis

BACKGROUND: Self-harm is a common reason for hospital presentation; however, evidence to guide clinical management of these patients to reduce their risk of repeat self-harm and suicide is lacking.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

A systematic review of psychometric assessment of self-harm risk in the emergency department

This review concluded that many tools to assess the potential for suicide or self harm, in patients in the emergency department, had strong psychometric properties, but there was little evidence to support their use. There was a lack of good quality evidence and large variation across studies, so this cautious conclusion appears to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Specific psychological treatment versus treatment as usual in adolescents with self-harm: systematic review and meta-analysis

This review concluded that there was no evidence that specific psychological treatments were superior to treatment as usual in improving engagement with therapy in young people who have self harmed. Due to concerns with the dichotomisation of the data and clinical heterogeneity between studies it is not clear how reliable this conclusion is.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Psychosocial interventions following self-harm: systematic review of their efficacy in preventing suicide

This review concluded that there was no evidence that additional psychosocial interventions following self-harm have a marked effect on the likelihood of subsequent suicide. The conclusions appear to reflect the review findings but limitations, such as the lack of a quality assessment of the included studies, make it difficult to confirm the reliability of the results.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Clinical management of deliberate self-harm in young people: the need for evidence-based approaches to reduce repetition

This review assessed clinical interventions for reducing the recurrence of deliberate self-harm in adolescents and young people. The authors concluded that there was limited evidence and that further good-quality research is required. The evidence presented appears to support the conclusions, but the insufficient reporting of the review methods makes it difficult to confirm the robustness of these conclusions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Can we predict suicide and non-fatal self-harm with the Beck Hopelessness Scale: a meta-analysis

This review concluded that standard cut-off point on the Beck Hopelessness Scale was capable of identifying those at risk of future self-harm and identified a high-risk group for potential suicide, but the magnitude of the risk was lower than previously reported estimates. Limitations in the review mean that the pooled estimates and conclusions should be treated with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Borderline Personality Disorder: Treatment and Management

The guideline on Borderline Personality Disorder, commissioned by NICE and developed by the National Collaborating Centre for Mental Health, sets out clear, evidence- and consensus-based recommendations for healthcare staff on how to treat and manage borderline personality disorder.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2009
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Suicide Prevention Interventions and Referral/Follow-Up Services: A Systematic Review [Internet]

Suicide is the tenth leading cause of death in the United States (US), with nearly 100 suicides occurring each day and over 36,000 dying by suicide each year. Among Veterans and current military, suicide is a national public health concern. Recent estimates suggest current or former military represent 20 percent of all known suicides in the US and the rate of suicides among Veterans utilizing Veterans Health Administration (VHA) services is estimated to be higher than the general population. The enormity of the problem has led to several major public health initiatives and a growth in research funding for suicide prevention.

Evidence-based Synthesis Program - Department of Veterans Affairs.

Version: March 2012
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First- and Second-Generation Antipsychotics for Children and Young Adults [Internet]

To review and synthesize the evidence on first-generation antipsychotics (FGA) and second-generation antipsychotics (SGA) for the treatment of various psychiatric and behavioral conditions in children, adolescents, and young adults (ages ≤ 24 years).

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: February 2012
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Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders

This guideline has been developed to advise on the identification, treatment and management of the eating disorders anorexia nervosa, bulimia nervosa and related conditions. The guideline recommendations have been developed by a multidisciplinary group of health care professionals, patients and their representatives, and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high quality care for those with eating disorders while also emphasising the importance of the experience of care for patients and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2004
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Screening for Suicide Risk in Primary Care: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]

In the United States, the annual burden of suicide is substantial, accounting for almost 37,000 deaths and an estimated 1.4 million years of potential life lost in recent years.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: April 2013
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Bipolar Disorder: The Management of Bipolar Disorder in Adults, Children and Adolescents, in Primary and Secondary Care

This guideline has been developed to advise on the treatment and management of bipolar disorder. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, patients and guideline methodologists after careful consideration of the best available evidence. It is intended that the guidelines will be useful to clinicians and service commissioners in providing and planning high quality care for those with bipolar disorder while also emphasising the importance of the experience of care for patients and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2006
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Violence: The Short-Term Management of Disturbed/Violent Behaviour in In-Patient Psychiatric Settings and Emergency Departments

The National Institute for Health and Clinical Excellence (NICE) commissioned the National Collaborating Centre for Nursing and Supportive Care (NCC-NSC) to develop guidelines on the short-term management of disturbed/violent behaviour in adult psychiatric in-patient settings and emergency departments for mental health assessments. This follows referral of the topic by the Department of Health and Welsh Assembly Government. This document describes the methods for developing the guidelines and presents the resulting recommendations. It is the source document for the NICE short-form version, the Quick reference guide (the abridged version for health professionals) and the Information for the public (the version for patients and their carers), which will be published by NICE and be available on the NICE website (www.nice.org.uk). The guidelines were produced by a multidisciplinary Guideline Development Group (GDG) and the development process was undertaken by the NCC-NSC.

NICE Clinical Guidelines - National Collaborating Centre for Nursing and Supportive Care (UK).

Version: February 2005
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Strategies for Suicide Prevention in Veterans [Internet]

Suicide is a devastating outcome of major public health importance. Suicide rates for patients abusing alcohol and other substances, or suffering from other mental health conditions may be elevated. Because suicide prevention is a priority of the Veterans Health Administration, the VA wishes to expand and enhance use of evidence-based prevention or reduction methods. The Key Questions were: Key Question 1. What are the new or improved suicide prevention strategies (e.g. hotlines, outreach programs, peer counseling, treatment coordination programs, and new counseling approaches) that show promise for Veterans? Key Question 2. What solid evidence base supports the most promising strategies? Key Question 3. What evidence is still needed to establish various strategies as the most promising (framed as research questions to guide and focus continued research to expand knowledge regarding the effectiveness of suicide prevention approaches)?

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: January 2009
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Drug Class Review: Atypical Antipsychotic Drugs: Final Update 3 Report [Internet]

Atypical antipsychotic agents are used to treat the symptoms of schizophrenia and bipolar disorder. The purpose of this review is to help policy makers and clinicians make informed choices about their use. Given the prominent role of drug therapy in psychiatric disease, our goal is to summarize comparative data on efficacy, effectiveness, tolerability, and safety. Ten atypical antipsychotics are currently available in the United States and Canada. Clozapine, the prototypic atypical antipsychotic, was introduced in 1989. Since then, 9 other atypical antipsychotics have been brought to market: risperidone (1993), risperidone long-acting injection (2003), olanzapine (1996), quetiapine (1997), ziprasidone (2001), aripiprazole (2002), extended-release paliperidone (2006), asenapine (2009), iloperidone (2009), and paliperidone long-acting injection (2009).

Drug Class Reviews - Oregon Health & Science University.

Version: July 2010
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Screening for Child and Adolescent Depression In Primary Care Settings: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]

Depression among youth is a relatively common, disabling condition that is associated with serious long-term morbidities and risk of suicide. The majority of depressed youth, however, are undiagnosed and untreated, despite opportunities for identification in settings such as primary care.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: April 2009
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Drug Class Review: Second-Generation Antidepressants: Final Update 5 Report [Internet]

We compared the effectiveness and harms of second-generation antidepressants in the treatment of major depressive disorder (MDD), dysthymia, subsyndromal depression, seasonal affective disorder, generalized anxiety disorder, obsessive compulsive disorder, panic disorder, post-traumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder.

Drug Class Reviews - Oregon Health & Science University.

Version: March 2011
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