Psychiatric Bulletin (2008) 32: 274. doi: 10.1192/pb.32.7.274a
© 2008 The Royal College of Psychiatrists
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Correspondence

Pain and self-harm

Megan Theodoulou, Consultant Old Age Psychiatrist

*Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust, Shrublands Day Hospital, Queen’s Road, High Wycombe HP13 6PT, email: megan.theodoulou{at}obmh.nhs.uk

Christopher Bass, Consultant Psychiatrist

Department of Psychological Medicine, John Radcliffe Hospital, Oxford OX3 9DU

Some older people with pain-related physical problems are at high risk of suicide (Psychiatric Bulletin, March 2008, 32, 92-95). This is a neglected field of research.

We carried out a retrospective case note study of all individuals admitted to a general hospital after presenting to accident and emergency with self-harm and concurrent medical problems. Pain contributed to the episode of self-harm in 4% of cases. The mean age of these individuals was 46 years; 60% had experienced pain for over 6 months and 35% had a history of psychiatric disorder. They had a significantly higher suicidal intent associated with their acts of self-harm than those with non-painful physical problems (44% v. 30% respectively).

We recommended closer collaboration between general hospital services and local pain clinics for treating individuals with painful disorders who self-harm. Furthermore, we would encourage all clinicians to assess suicidal ideation and risk of self-harm when prescribing for this group. This is particularly important when considering prescribing analgesics or tricyclic antidepressants.

References

  1. THEODOULOU, M., HARRISS, L., HAWTON, K., et al (2005) Pain and deliberate self-harm: an important association. Journal of Psychosomatic Research, 58, 317 -320.[CrossRef][Medline]

Related articles in PB:

Characteristics of suicides in recent contact with NHS Direct
Michael Bessant, Elizabeth A. King, and Robert Peveler
PB 2008 32: 92-95. [Abstract] [Full Text]  




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