BACKGROUND: Previous self-harm is one of the strongest predictors of future self-harm and suicide. Increased risk of repeated self-harm and suicide exists amongst patients presenting to hospital with high-risk self-harm and major self-harm repeaters. However, so far evidence-based training in the management of self-harm for mental health professionals is limited. Within this context, we aim to develop, implement and evaluate a training programme, SAMAGH, Self-harm Assessment and Management Programme for General Hospitals in Ireland. SAMAGH aims to (a) reduce hospital-based self-harm repetition rates and (b) increase rates of mental health assessments being conducted with self-harm patients. We also aim to evaluate the training on self-harm knowledge, attitudes, and skills related outcomes of healthcare professionals involved in the training.
METHODS: The study will be conducted in three phases. First, the SAMAGH Training Programme has been developed, which comprises two parts: 1) E-learning Programme and 2) Simulation Training. Second, SAMAGH will be delivered to healthcare professionals from general hospitals in Ireland. Third, an outcome and process evaluation will be conducted using a pre-post design. The outcome evaluation will be conducted using aggregated data from the National Self-Harm Registry Ireland (NSHRI) on self-harm repetition rates from all 27 public hospitals in Ireland. Aggregated data based on the 3-year average (2016, 2017, 2018) self-harm repetition rates prior to the implementation of the SAMAGH will be used as baseline data, and NSHRI data from 6 and 12 months after the implementation of SAMAGH will be used as follow-up. For the process evaluation, questionnaires and focus groups will be administered and conducted with healthcare professionals who completed the training.
CONCLUSIONS: This study will contribute to the evidence base regarding the effectiveness of an evidence informed training programme that aims to reduce repeated hospital self-harm presentations and to improve compliance with self-harm assessment and management. This study is also expected to contribute to self-harm and suicide training with the possibility of being translated to other settings. Its feasibility will be evaluated through a process evaluation.

Experiences of engaging with healthcare services following a self-harm presentation to hospital of high lethality or high suicidal intent have not been examined previously, despite this subgroup of self-harm patients being at high risk of suicide. Therefore, this study addressed this issue by documenting patients\' experiences of engaging with healthcare services after a high-risk self-harm (HRSH) presentation to hospital. Demographic, psychiatric and psychosocial factors associated with variations in perceptions of care received were also examined. Quantitative information was obtained by interview administered questionnaires 0-3 months following a HRSH presentation to hospital. Semi-structured follow-up interviews, conducted, 6-9 months later, provided qualitative data (n = 32). Satisfaction with aftercare varied. Positive experiences of care included \"supportive and compassionate relationships\" and \"timely and comprehensive follow-up care.\" The establishment of trust in the services encouraged help-seeking and psychotropic treatment adherence. Conversely, \"superficial and unsupportive relationships\" and \"care lacking continuity and comprehensiveness\" left some participants feeling isolated, contributing to inhibited help-seeking and resistance to psychotropic treatment. Participants with a history of self-harm and mental health service engagement were more likely to report dissatisfaction with care provided. Those who described unsupportive relationships more frequently reported repeated self-harm, alcohol misuse, and hopelessness at follow-up. Our findings show that satisfaction with services, help-seeking and treatment adherence may be improved by ensuring the consistent provision of timely, comprehensive and supportive aftercare following a HRSH presentation. Absence of these aspects of care may contribute to ongoing distress and further suicidal behavior.

BACKGROUND: There is an increasing amount of stress in undergraduate dental students leading to anxiety, depression, and suicidal attempts/suicide.
OBJECTIVE: This study aims to evaluate anxiety, depression and suicidal intent in undergraduate dental students and to find out the various areas of stress.
METHODS: A cross-sectional study was conducted using a semi-structured questionnaire (to assess academic and nonacademic areas of stress) and three scales-Hamilton scale for anxiety (HAM-A); Hamilton depression rating scale (HDRS) and Beck\'s Suicide Intent Scale (BSI). Descriptive statistics; Pearson\'s Chi-square test; Multiple ANOVA; Kruskal-Wallis test and Mann-Whitney test were used to analyze the data at the significant level of P ≤ 0.05.
RESULTS: In a total of 258 dental undergraduate students, academic areas of stress that were found to be statistically significant were long teaching hours (P = 0.002); high workload (P ≤ 0.001); frequency of tests (P ≤ 0.001) and competition/fear of failure (P = 0.009). Lack of interest in the profession was a statistically significant nonacademic area for stress (P ≤ 0.001). The students of first and final year reported higher anxiety (HAM-A 13.93 ± 6.908 and 16.44 ± 7.637 respectively) and depression (HDRS 14.29 ± 6.302 and 14.22 ± 5.422); whereas suicidal intent was reported almost the same throughout the study sample (BSI 5.65 ± 5.465).
CONCLUSIONS: An increasing level of anxiety, depression and suicidal intent due to various stressors in undergraduate dental students indicate a need to modify current education system and timely help to have psychological healthy dental professionals in future.

OBJECTIVE: This study\'s objective is to assess the safety of non-therapeutic atomoxetine exposures reported to the US National Poison Database System (NPDS).
METHODS: This is a retrospective database study of non-therapeutic single agent ingestions of atomoxetine in children and adults reported to the NPDS between 2002 and 2010.
RESULTS: A total of 20 032 atomoxetine exposures were reported during the study period, and 12 370 of these were single agent exposures. The median age was 9 years (interquartile range 3, 14), and 7380 were male (59.7%). Of the single agent exposures, 8813 (71.2%) were acute exposures, 3315 (26.8%) were acute-on-chronic, and 166 (1.3%) were chronic. In 10 608 (85.8%) cases, exposure was unintentional, in 1079 (8.7%) suicide attempts, and in 629 (5.1%) cases abuse. Of these cases, 3633 (29.4 %) were managed at health-care facilities. Acute-on-chronic exposure was associated with an increased risk of a suicidal reason for exposure compared with acute ingestions (odds ratio 1.44, 95% confidence interval 1.26-1.65). Most common clinical effects were drowsiness or lethargy (709 cases; 5.7%), tachycardia (555; 4.5%), and nausea (388; 3.1%). Major toxicity was observed in 21 cases (seizures in nine (42.9%), tachycardia in eight (38.1%), coma in six (28.6%), and ventricular dysrhythmia in one case (4.8%)).
CONCLUSIONS: Non-therapeutic atomoxetine exposures were largely safe, but seizures were rarely observed.