Impulsive: acting momentarily; doing things suddenly without careful thought or planning

For example:

• A reckless action taken following the consumption of alcohol and/or illegal drugs
• A sudden act following a fight and/or emotional upset
• A sudden act during a period of mania or hyper arousal associated with mental illness

The possibility a person has engaged in self-harm or a suicide attempt should be considered when looking at impulsive acts that cannot readily be classified as accidental.

Connor (13) defines impulsive suicide attempts as acts of self-harm involving little preparation or premeditation; non-impulsive suicide attempts are preceded by preparation and forethought.

Impulsivity is difficult to classify. If in doubt consult with your system manager.

 

The following vignette demonstrates an impulsive act of intentional self-harm in reaction to a stressful event.

Action  =  Include

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Vignette Example – Impulsive Act Admission Notes: 20-year-old man BIBA following road traffic accident. Witness who called ambulance reported that the car suddenly swerved across the road and drove straight into a wall. Behaviour: Unconscious on admission but was conscious at the scene. Ambulance crew report that he said he was arguing on the phone with his girlfriend and she ended the relationship. Said he just didn’t want to feel anymore and aimed his car at the wall.

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The following vignette demonstrates a very clear impulsive act driven by anger where the patient, in a moment of rage, impulsively lashes out in an act that results in self-harm but could not be regarded as intentional self-harm.

Action  =  Exclude

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Vignette Example – Impulsive Act Admission Notes: 49-year-old man presents with injury to right hand. Suspected fracture – index and middle finger and possibly thumb. Says he punched a wall following a fight with his girlfriend. Behaviour: Laughing but apologetic. Says he has a bit of a temper.

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The next vignette presents a scenario that is more difficult to classify.

Action  =  Seek Further Information

Vignette Example – Impulsive Act Admission Notes: 25-year-old man BIBA following rescue from river at 2am in morning. People exiting a nightclub saw a man in the river nearby. Called ambulance and threw a life preserver to the man which he caught. Rescue services noted that he was intoxicated and hypothermic. Behaviour: Monosyllabic. Says he was going for a swim. When asked who he would like staff to contact, said he didn’t know anyone locally and didn’t want family contacted as they lived very far away.

 

 

This may be a case, but more information than admission notes alone would be required to determine whether it is a case of intentional self-harm or not.