Psychiatric assessment and management of deliberate self-poisoning patients
Deliberate self-poisoning is one of the most common for general hospital presentation. The majority of the individuals involved are young, with females outnumbering males. Self-poisoning occurs in people from a variety of social backgrounds, but is associated with socio-economic deprivation and social fragmentation. Common precipitants include relationship problems, often in the context of depression and alcohol abuse. Analgesics and psychotropic drugs are the substances most frequently involved in self-poisoning in the UK. The risks of repetition of self-harm and of suicide following self-poisoning are substantial. General hospitals should have special self-harm services for clinical management. Psychosocial assessment of patients should include investigation of the events and problems preceding the act, suicidal intent and other motives for the act, psychiatric disorder, personality traits and disorder, family and personal history, psychiatric history, including of self-harm, risk of further self-harm and suicide, and coping resources and support. Aftercare should be arranged according to the patient's needs and risk. There is good evidence that psychological therapy is effective. Prevention of self-poisoning and its consequences should be based on a range of initiatives, including school-based programmes, detection of those at risk in primary care, reduced availability of toxic amounts of therapeutic drugs, and effective aftercare for those who have self-poisoned. © 2007 Elsevier Ltd. All rights reserved.