Pharmacological interventions for self-harm in adults

Witt, Katrina; Hetrick, Sarah; Rajaram, Gowri; Hazell, Philip; Salisbury, Tatiana Taylor; Townsend, Ellen; Hawton, Keith

doi:10.1002/14651858.cd013669.pub2

Cited by 18 publications

(21 citation statements)

References 118 publications

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“…There is preliminary evidence regarding the protective effect of opioid agonist treatment for people with, and without, opioid dependence 96,97 . Ketamine has shown promise in rapidly reducing suicidal ideation in the short term for people with psychiatric disorders, however its effectiveness in suicide and self-harm prevention is unknown 98 .…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

Suicide and self-harm

et al. 2022

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Section: Pharmacological Interventionsmentioning

confidence: 99%

Suicide and self-harm

et al. 2022

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“…Two recent Cochrane reviews, both published in 2021, attempted to quantify the evidence for pharmacological intervention strategies for self-harm in adults [9] and children and adolescents [10]. The findings were interesting: among adults, antipsychotics showed statistically significant, but weak, positive effects for self-harm reduction compared to placebo; these differences disappeared when compared against an active comparator [9]. On the other hand, newer generation antidepressants, mood stabilizers, and natural products did not demonstrate superiority over placebo.…”

Section: Pharmacological Interventions For Attempted Suicidementioning

confidence: 99%

Interventions for attempted suicide

Menon

Vijayakumar

2022

Current Opinion in Psychiatry

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Purpose of reviewSuicide is a major, global, public health issue. Those who attempt suicide represent a high-risk subgroup for eventual death by suicide. We provide an update on emerging evidence for interventions for attempted suicide to reduce subsequent suicidal behavior. Recent findingsMajor approaches that have been examined recently include pharmacological, psychosocial, brief active contact and outreach interventions, and digitally driven interventions. Notwithstanding the limited evidence base for most of these approaches, brief contact and follow-up interventions appear to have more robust effects on reduction of repeat suicidal behavior, including attempts; such approaches may have especial significance in emergency settings because of their brevity. Digital interventions for self-harm appear promising in the short-term whereas the evidence for pharmacological and psychosocial strategies remain inconclusive.

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“…Its physical repercussions such as scarring and blood loss10 add to the rationale of self-harm management to reduce risk and mortality. The evidence-based management of self-harm is hindered by the inconclusive evidence to support the effectiveness of psychosocial and pharmacological interventions for self-harm 11–13. Cessation may not be realistic for individuals who use self-harm as a coping mechanism, and efforts to stop self-harm can be counterproductive, unhelpful14 or even harmful 15…”

Section: Introductionmentioning

confidence: 99%

Harm minimisation for self-harm: a cross-sectional survey of British clinicians’ perspectives and practices

et al. 2022

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ObjectiveHarm minimisation for self-harm is an alternative to preventive strategies and focuses on maximising safety when self-harming. We explored the views of clinicians on harm minimisation for self-harm to describe reported use and acceptability in clinical practice.DesignA cross-sectional study using an online survey consisting of fixed-choice and open-ended questions.SettingPrimary and secondary care practices in England, Scotland and Wales.ParticipantsSnowball sampling of UK-based clinicians (n=90; 67% female) working with people who self-harm and who have or have not previously recommended harm minimisation methods to patients.ResultsOf the 90 clinicians sampled, 76 (84%) reported having recommended harm minimisation techniques to people in their care who self-harm. Commonly recommended techniques were snapping rubber bands on one’s wrist and squeezing ice. Other techniques, such as teaching use of clean instruments when self-harming, were less likely to be recommended. Perceived client benefits included harm reduction and promotion of the therapeutic relationship. Perceived potential limitations of a harm minimisation approach for self-harm were (a) potential worsening of self-harm outcomes; (b) ethical reservations; (c) doubts about its effectiveness and appropriateness; and (d) lack of training and clear policies within the workplace.ConclusionsIn our sample of UK-based clinicians in various settings, harm minimisation for self-harm was broadly recommended for clients who self-harm due to perceived client benefits. However, future policies on harm minimisation must address clinicians’ perceived needs for training, well-defined guidelines, and clear evidence of effectiveness and safety to mitigate some clinician concerns about the potential for further harm.

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Pharmacological interventions for self-harm in adults

Cited by 18 publications

References 118 publications

Suicide and self-harm

Suicide and self-harm

Interventions for attempted suicide

Harm minimisation for self-harm: a cross-sectional survey of British clinicians’ perspectives and practices

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