Dawaa Reference

chronic

Self-Harm and Suicide Risk

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

NICE Guideline NG225: Self-harm: assessment, management and prevention by non-specialists 2022 · NICE Clinical Guideline CG133: Longer-term management of self-harm 2011 · Suicide: Assessment and Management - StatPearls (NCBI Bookshelf NBK617057) - https://www.ncbi.nlm.nih.gov/books/NBK617057/: "A safety plan is a brief intervention that can be implemented in any clinical setting to address modifiable risk factors." and "High-risk patients requiring more restrictive measures to ensure safety, eg, an inpatient admission, must be deemed to be at imminent and significant risk of harm to themselves."

Verified against1 document
  • Suicide: Assessment and Management - StatPearls (NCBI Bookshelf NBK617057) - https://www.ncbi.nlm.nih.gov/books/NBK617057/: "A safety plan is a brief intervention that can be implemented in any clinical setting to address modifiable risk factors." and "High-risk patients requiring more restrictive measures to ensure safety, eg, an inpatient admission, must be deemed to be at imminent and significant risk of harm to themselves."

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (9)

  • Thoughts of suicide accompanied by a specific method, an intent to act, and access to lethal means signal imminent danger
  • Feeling trapped with no way out, combined with hopelessness, is a warning sign for imminent self-harm [low mood · suicidal thoughts]
  • Anxiety marked by agitation or severe sleep disturbance is a dynamic driver of suicide risk [anxiety · insomnia · irritability]
  • Escalating or uncontrolled anger, rage, or hostility is a warning sign for self-harm [suicidal thoughts]
  • Among warning signs, anger is the one most reliably tied to an actual suicide attempt in people already having suicidal thoughts [suicidal thoughts]
  • The absence of reasons to keep living is itself a recognized warning sign
  • Passive thoughts of suicide carry a risk of death by suicide equal to active suicidal thoughts [suicidal thoughts]
  • Many people who ultimately die by suicide deny having any suicidal thoughts shortly before the death [suicidal thoughts]
  • How severe suicidal thoughts were at their worst point in a person's life predicts death by suicide better than how they feel right now [suicidal thoughts]

Signs — what you find (4)

  • A recent escalation in alcohol or drug use is a warning sign worth noting
  • Pulling back from friends and family networks is a recognized warning sign
  • A jump in high-risk or impulsive behavior is a warning sign for imminent self-harm [suicidal thoughts]
  • Unstable or dysregulated mood is counted among the recognized warning signs

Tests (2)

  • Structured instruments such as the Columbia scale, the ASQ toolkit, or the PHQ-9 help flag people needing a fuller risk work-up
  • Screening instruments carry limited ability to predict an actual suicide attempt or death and cannot substitute for full assessment

If not this — what else fits (3)

  • Suicidal claims aimed at prolonging a hospital stay or delaying discharge point toward contingency-based ideation rather than acute risk
  • Repeat emergency visits with no change in the modifiable risk factors suggest the baseline risk is unchanged rather than a new crisis
  • A pattern of visits timed to disability-payment or financial cycles suggests secondary gain rather than acute crisis

SourceStatPearls "Suicide: Assessment and Management" - disease-level clinical article

Presentation findings are traced to the source above.

1

URGENT PSYCHIATRIC REFERRAL AND CRISIS SAFETY PLANNING (NO PRIMARY CARE DRUG THERAPY)

1st line
Adult dose and duration

Conduct immediate suicide risk and psychosocial assessment. If acute imminent risk or medical self-harm/poisoning is present, arrange emergency department transport immediately. Do NOT prescribe lethal quantities of medications. Develop a collaborative crisis safety plan. - Immediate emergency referral

Paediatric dose

Immediate emergency referral to pediatric psychiatry / CAMHS and emergency department for any child or adolescent presenting with self-harm or suicidal intent.

Dose source

Suicide: Assessment and Management - StatPearls (NCBI Bookshelf NBK617057) - https://www.ncbi.nlm.nih.gov/books/NBK617057/: "A safety plan is a brief intervention that can be implemented in any clinical setting to address modifiable risk factors." and "High-risk patients requiring more restrictive measures to ensure safety, eg, an inpatient admission, must be deemed to be at imminent and significant risk of harm to themselves."

Why

Self-harm and acute suicidal ideation are psychiatric emergencies requiring immediate safety assessment and specialist intervention; drug therapy is not indicated as initial primary care treatment.

Cautions
  • TIME-CRITICAL EMERGENCY: Do not leave patient unattended if acute suicidal intent, active plan, or severe agitation is present.
  • Do not prescribe large quantities of toxic drugs (e.g. TCAs, paracetamol, opioids, lithium); limit prescription duration to 7 days if any medication is essential.
  • Remove access to lethal means (medications, firearms, sharp objects, ropes) immediately in consultation with family/carers.
  • NG225 1.11.10 is explicit that there is no drug for this: do not offer drug treatment as a specific intervention to reduce self-harm. Treat the underlying condition if there is one; do not treat the self-harm.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.