Violence, deliberate self harm, and suicide in emergency departments and hospitals is likely to remain a significant problem for health care systems well into the future. Understanding how to confront, intervene, and manage episodes of patient deliberate self harm is extremely important, and can be life-saving. Here, through a clinical vignette, and a discussion of deliberate self harm we will highlight the importance of the direct observation of such patients, containment procedures (seclusion and physical restraints), and the use of pharmacological adjuncts. We hope that this concise, practically-oriented review will provide our readers with foundational understanding of the topic, including the most important theoretical and clinical considerations.
Part of the book: Vignettes in Patient Safety
Several studies, including the innovative 1998 ACE Study by CDC-Kaiser Permanente, have assessed the association among adulthood chronic disease and the prevalence of maladaptive, health-harming behaviors including: excessive alcohol use, tobacco use, physical inactivity, psychiatric illness including suicidal ideation or attempts, promiscuous sexual behavior (>50 sex partners), history of STI/STD and severe obesity (obesity (BMI > 35 kg/m2)), subsequent to an individual’s exposure to adverse childhood experiences (ACEs). Individuals that have encountered numerous instances of ACEs are almost twice as likely to die before the age of 75, demonstrating a dose-dependent relationship between the instances of ACEs and an increased morbidity/mortality in regard to chronic disease. This excerpt examines the contribution of ACEs to chronic disease and the consequential maladaptive behavior to said adversity, the consequential physiologic and biomolecular changes explained by the Biological Embedding of Childhood Adversity Model in addition to the implications of recounted ACEs on international health security in regard to concepts like conflict, displacement and food insecurity. The apparent association among adulthood chronic disease and ACEs demand changes that promote preventative processes as a means to address the implications these interconnections have on international health.