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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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11. Glossary

Activated charcoal

A substance that can bind many poisons in the stomach thereby reducing their absorption into the body.

Advance directives

Written instructions agreed between a patient and healthcare professional in which the patient specifies in advance of treatment his or her preferred treatments and identifies the treatments he or she does not wish to receive. These are used to guide clinicians in the event that the patient becomes unable to make decisions for him- or herself. Advance directives allow people, for instance, to state their wishes with regard to electroconvulsive therapy, or drugs they know give them bad side effects. The patient should understand the nature of the condition for which treatment may be required, the need for treatment, the expected benefits of the proposed treatment, and the possible adverse consequences. Advance directives cannot be used to refuse treatment altogether when a person is subject to the Mental Health Act.

Behavioural therapy

A therapeutic approach based on the belief that all behaviour, normal and abnormal, is learned and that the objective is to teach people new ways of behaving.

Borderline personality disorder

DSM-IV diagnosis where the individual displays a pattern of marked impulsivity and instability in interpersonal relationships, self-image and affects.

Cathartics

Substances such as laxatives that produce an evacuation of the bowels.

Clinical significance

An effect size may be statistically significant, but it is clinically important only if it is assessed as having clinical significance. That is, that the size of the effect is large enough to make a clinical difference – for example, a reduction in the relative risk of 20% or more of experiencing an ‘event’ such as repetition of self–harm is considered clinically significant.

Cognitive behavioural therapy

A discrete, time-limited, structured psychological intervention, derived from the cognitive behavioural model of affective disorders in which the patient:

  • Works collaboratively with a therapist to identify the types and effects of thoughts, beliefs and interpretations on current symptoms, feelings states and/or problem areas
  • Develops skills to identify, monitor and then counteract problematic thoughts, beliefs and interpretations related to the target symptoms/problems
  • Learns a repertoire of coping skills appropriate to the target thoughts, beliefs and/or problem areas.

Cohort study (also known as follow-up, incidence, longitudinal, or prospective study)

An observational study in which a defined group of people (the cohort) is followed over time and outcomes are compared in subsets of the cohort who were exposed or not exposed, or exposed at different levels, with an intervention or other factor of interest. Cohorts can be assembled in the present and followed into the future (a ‘concurrent cohort study’), or identified from past records and followed forward from that time up to the present (a ‘historical cohort study’). Because random allocation is not used, matching or statistical adjustment must be used to ensure that the comparison groups are as similar as possible.

Dialectical behaviour therapy

A multifaceted and intensive psychological treatment designed for patients with borderline personality disorder.

Electroconvulsive therapy

A therapeutic procedure in which an electric current is briefly applied to the brain to produce a seizure. This is used for treatment of severe depression symptoms or to ease depression that is not responding well to other forms of treatment. Sometimes called convulsive therapy, electroshock therapy or shock therapy.

Emesis

Vomiting – the expulsion of the stomach contents through the mouth.

Endotracheal intubation

Insertion of a rubber or plastic tube through the nose or mouth into the trachea allowing the supply of oxygen or anaesthetic gases to the lungs.

Entero-hepatic elimination

The removal of a drug from the intestine or liver.

Family therapy

Family sessions with a treatment function based on systemic, cognitive behavioural or psychoanalytic principles, which may include psychoeducational, problem-solving and crisis management work and specific interventions with the identified patient.

Gastric lavage

A method of gastric decontamination used in the treatment of poisoning. Lavage involves the passage of a lubricated tube via the mouth and oesophagus into the stomach. Patients are positioned on their side with the head lower than the feet. A small quantity of fluid is passed into the stomach and the contents drained out (by gravity) by lowering the end of the tube. This is repeated until the solution is clear of particulate matter. This procedure should be done only by an experienced health professional.

Gastrointestinal perforation

An opening in the gastrointestinal tract (the passage along which food usually passes).

Haemodiafiltration

A technique similar to haemodialysis, where blood is dialysed using ultrafiltration through a membrane permeable to water and small molecules.

Haemodialysis

A method of removing waste products or poisons from the circulating blood.

Haemoperfusion

The transfer of blood through tissue.

Health Technology Appraisal

The process of determining the clinical and cost effectiveness of a health technology in order to develop recommendations on the use of new and existing medicines and other treatments within the NHS in England and Wales.

Hepatotoxic

Something that poisons the liver.

Histrionic personality disorder

The guideline uses the DSM-IV definition which states that the individual displays a pattern of excessive emotionality and attention seeking.

Hydrocarbons

An organic molecule that consists only of carbon and hydrogen atoms, and no other elements. Volatile hydrocarbons that can be aspirated into the lungs when swallowed include white spirit, turpentine substitute, petrol, lubricating oils, and solvents in some polishes.

Inpatient behavioural therapy

The patient requires a stay in hospital and receives behavioural therapy.

Insight-oriented therapy

Therapies designed to give people a better awareness and understanding of previously unconscious feelings, motivations and actions and how they influence present feelings and behaviours.

Intubation

A simple operation consisting of the introduction, through the mouth into the larynx, of a tube designed to keep the air passage open at this point.

Ipecac (Ipecacuanha)

A substance that produces vomiting when brought into contact with the interior of the stomach.

Osmotic cathartic

Substances that produce an evacuation of the bowel by an osmotic action (drawing fluid into the bowel).

Patient

The term ‘service user’ is preferred to refer to people who have self-harmed in this guideline. The term ‘patient’ is used under the following conditions: (1) a person under the care of a doctor in reports of research or recommendations in which care by doctors is a crucial element (e.g. ‘Recent surveys suggest that about 10%–15% of patients are managed solely in primary care…’), (2) generic and typical usages, such as ‘NICE programmes for patients’, ‘Patient Bill of Rights’, (3) NICE recommendations which are required to be quoted verbatim, (4) frequently used noun compounds (e.g. ‘drug-naïve patients’ ‘patient sample’).

Problem-solving therapy

A discrete, time–limited, structured psychological intervention that focuses on learning to cope with specific problem areas and where the therapist and patient work collaboratively to identify and prioritise key problem areas, break problems down into specific manageable tasks, solve problems, and develop appropriate coping behaviours for problems.

Psychodynamic psychotherapy

Psychological interventions, derived from a psychodynamic/psychoanalytic model in which:

  • Therapist and patient explore and gain insight into conflicts and how these are represented in current situations and relationships including the therapy relationship (such as transference and countertransference)
  • Patients are given an opportunity to explore feelings, and conscious and unconscious conflicts, originating in the past, and the technical focus is on interpreting and working though conflicts
  • Therapy is non-directive and patients are not taught specific skills such as thought monitoring, re-evaluation or problem-solving.

Psychosocial assessment

An assessment that includes several components, the most important of which are the assessment of needs and the assessment of risks. The assessment of needs is designed to identify those personal (psychological) and environmental (social) factors that might explain an act of self-harm; this assessment should lead to a formulation, based upon which a management plan can be developed.

Risk assessment

An assessment of the likelihood of an individual repeating self-harm and, in particular, of attempting suicide.

Salicylates

A group of drugs to which aspirin belongs.

Standard care

‘Standard care’ is the normal care given to those suffering from acute psychiatric episodes in the area concerned; this involved hospital-based treatment for all studies included.

Suicidal ideation

Thoughts about committing suicide.

TOXBASE

The National Information Poison Service’s computerised database, which is available via the internet to healthcare professionals. This database is the primary toxicology information source in the UK for the management of poisoning.

Vasodilatation

A state of increased calibre of the blood vessels.

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: NBK56409

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