Psychiatric aspects of drug overdose in adults
Edwin Harari1974, Anaesthesia and intensive care
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Abstract
Psychiatric aspects of drug overdose in adult suicide and suicide attempts are reviewed. Particular reference is given to studies reported from Australia. The findings of a recent study from the Royal Melbourne Hospital with regard to age-sex distribution, drugs ~tsed in self-poisonings, clinical state of the patient on admission and psychiatric diagnosis are presented and discussed.
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Medical management of deliberate drug overdose: A neglected area for suicide prevention?
Emergency Medicine Journal Emj, 2004
Objectives: Overdoses account for a quarter of all suicides in England. The number of people who survive the immediate effects of their overdose long enough to reach medical attention, but who subsequently die in hospital is unknown. The aim of this study was to determine the proportion of overdose suicides dying in hospital and describe their sociodemographic characteristics. Method: Cross sectional analysis of routinely collected Hospital Episode Statistics data for England (1997England ( to 1999 to identify hospital admissions for overdose among people aged 12+ and the outcome of these admissions. Results: Between 1997 and 1999 there were 233 756 hospital admissions for overdose, 1149 (0.5%) of these ended in the death of the patient such deaths accounted for 29% of all overdose suicides and 7% of total suicides. The median time between admission and death was three days (interquartile range one to nine days). The most commonly identified drugs taken in fatal overdose were paracetamol compounds, benzodiazepines, and tricyclic/tetracyclic antidepressants. Conclusion: Around a quarter of all overdose suicide deaths occur subsequent to hospital admission. Further more detailed research is required to discover if better pre-admission and inhospital medical management of those taking serious overdoses may prevent some of these deaths. 35
A comparison of the drugs taken in fatal and nonfatal self-poisoning
Acta Psychiatrica Scandinavica, 1994
The objective of this study was a) to compare patterns of drug use in fatal and nonfatal overdoses and b) to find out if toxic drugs are overrepresented in overdoses with fatal outcome. A total of 179 cases of fatal overdoses in Switzerland (population 6.6 million) were compared with 269 medically treated self-poisoners from the agglomeration of Berne (population 30 1,630). Because of frequent multiple drug use, all the different compounds taken singly or in combination with other drugs were recorded and grouped according to drug types. The patterns of the frequencies of drugs used were remarkably similar in both groups. The majority of the drugs were psychotropics (8 1 % in fatal and 68 % in nonfatal overdose). Twenty-nine completed suicides were the result of drug combinations specifically recommended by EXIT. In the remaining cases benzodiazepines were used most frequently in both attempted and completed suicide, often in combination with other drugs or alcohol. Barbiturates were the only drugs recorded significantly more often in fatal overdoses (9% V,F 3%). No significant difference was found for tricyclic antidepressants (13 % vs lo%), or other types of drugs. The results are consistent with our assumption that drugs with higher toxicity would be overrepresented in overdoses with fatal outcome. Barbiturates, which are well known to be dangerous in overdose, were clearly associated with fatal overdoses, but not tricyclic antidepressants. This, in our view, suggests that the risk of prescribing tricyclic antidepressants should not be overestimated. The frequent use of benzodiazepines in completed suicide, however, indicates that there are no truly safe drugs in overdose.
Medicolegal Aspects of Suicidal Attempts by Drugs in Cases admitted to Poison Control Center of Ain Shams University Hospitals (2019-2020)
Ain Shams Journal of Forensic Medicine and Clinical Toxicology
Background: A suicide attempt is an act by which the person wants to end his own life, but mostly it is non-fatal. In Egypt people struggle in many aspects of life urging them to desperation and suicidal attempts. Aim of the study: To assess the medicolegal aspects of suicidal attempts through analysis of socio-demographical data, risk factors, common drugs used and outcome. Methods: a cross-sectional study was conducted in the Poison Control Center of Ain Shams University hospitals, Egypt from the first of September 2019 till the end of February 2020. Data were collected from through direct interviewing of patients. Results: The total number of patients in the study were 580 patients aged from 6 to more than 45 years old. Most of the attempters were females (77.24%), aged 19 to 44 years (62.59%), singles (69.31%), students (51.55%), had university educational level (42.59%), living in urban areas (70.69%) and had low-income status (62.07%). About (86.55%) of them had no history of previous attempts with psychiatric problems as the most common cause (55.18%). Patients who used mixed poisons had the highest prevalence (27.24%). (43.28%) of cases were admitted to the ICU of whom (56.57%) were notified to the police station. (74.31%) of cases completely recovered while (24.14%) refused treatment. Conclusion: Suicide attempts by drugs is a serious medical health problem especially among young adults and single females. Psychiatric and family problems are the most common causes.
Incidence and Lethality of Suicidal Overdoses by Drug Class
JAMA Network Open, 2020
Prior lethality analyses of suicide means have historically treated drug poisoning other than alcohol poisoning as a lumped category. Assessing risk by drug class permits better assessment of prevention opportunities. OBJECTIVE To investigate the epidemiology of drug poisoning suicides.
Striking increases in postmortem compared to antemortem drug concentrations in a suicidal overdose: A case report
Australian Journal of Forensic Sciences
ABSTRACT
Pattern and Outcome of Self- Poisoning among Adult population Admitted in a Tertiary Care Hospital
Journal of Medicine, 2019
Background: Attempted suicide or deliberate self-harm by self-poisoning among adult males and females are a major public health problem to be addressed like any other medical condition. In recent years, patterns of self-poisoning are changing. So it is important to know about the substances used in self poisoning and its outcome. Materials and Methods: It was a descriptive type of cross sectional study done in Department of Medicine, Dhaka medical college hospital, Dhaka on100 patients with a history of self-poisoning. Study period was six months. A semi structured questionnaire was used for collection of data. Results: In our study self-poisoning was more prevalent among young age group with female preponderance. Family disharmony (45%) was the commonest cause of self poisoning and most commonly used substance was pharmaceutical drugs. Anxiolytics were the commonest (42 %), organo phosphorus compound (OPC) 20%, mixed drugs 12%, harpic 11%, rat killer 8%, NSAIDs 3%, Dettol 3% and Wh...
Self-Poisoning by Drugs and Chemicals: Variations In Demographics, Associated Factors and Final Outcomes
General hospital psychiatry, 2008
Objective: Drug overdose exposures were compared with chemical poisoning in terms of demographics, associated factors and final outcomes. Method: Deliberate self-poisoning (DSP) cases admitted to Penang General Hospital during the years 2000-2004 were ...
DRUGS OVERDOSE AND POISONING
Self-poisoning creates 10% of the workload of Accident and Emergency departments in the UK. Opioids (diamorphine (heroin), morphine and methadone), compound analgesics (e.g. codeine plus paracetamol), paracetamol alone and antidepressants are the most common drugs used in fatal overdose. Temazepam, cocaine, MDMA/ecstasy, lithium, paraquat, salicylates, digoxin and aminophylline continue to cause fatalities. This list of agents that cause death from overdose does not reflect the drugs on which individuals most commonly overdose. Self-poisoning often involves multiple drugs and alcohol. Benzodiazepines (often taken with alcohol) are commonly taken in an overdose, but are seldom fatal if taken in isolation. Around 75% of deaths from overdose occur outside hospital, with the mortality of those treated in hospital being less than 1%. The majority of cases of self-poisoning fall into the psychological classification of suicidal gestures (or a cry for help). However, the prescription of potent drugs with a low therapeutic ratio can cause death from an apparently trivial overdose.
Drug Overdoses Seen in the Emergency Department: Assessment, Disposition, and Follow-up
Annals of Clinical Psychiatry, 1991
Data were collected during a 3-month period on 177 consecutive cases of drug overdose (OD) evaluated in the emergency department (ED). Fifty-three percent of the patients were alert, 22% were lethargic, 15% were agitated, 7% were stuporous, and 3% were comatose. Sixty-six percent admitted that they were trying to either kill or harm themselves while 18% stated that their intent was to get hi h. The most commonly detected primary fmgs confirmed by toxic screen were benzodiazepines (23%), alcohol (21%), non-narcotic anal esics (20%), antidepressants (lo%), and %arbiturates (7%). Forty-seven percent of the patients were admitted to a hospital for further care-28% to psychiat 14% to medicine, 3% to pediatrics, a n y i % to surgery. Follow-up data were obtained on 79% a mean of 42 days after their ED visit. Only one death occurred; it was the result of acute complications from an antidepressant O D durin the admission for the index ED visit. #wo OD readmissions were noted for a recidivism rate of 3%. In our ED population, the serious medical complications of drug OD occurred in a minority of patients (16% or less), although admission to the hospital was often required. Although the short-term recidivism rate was low, the escalating trend towards suicide and dru OD in adolescents and youn adults i emands careful assessment in t i e ED.
Toxicologic Findings in Suicide
The American Journal of Forensic Medicine and Pathology, 2006
Toxicologic analysis is an integral component in the investigation of suicide and requires correlation with a detailed scene inspection, with an extensive exploration into the decedent's medical and social background to uncover suicidal ideation or intent and a postmortem examination of the body. In this review, the authors analyzed 2864 cases classified as suicide upon autopsy and toxicologic examinations between 1993 and 2002 in the Kentucky Division of Medical Examiner's Services. Blood and urine were collected in 95.0% and 72.3% of cases, respectively. A total of 32.5% of the victims had negative blood toxicologic results, and 52.7% of urine toxicology screens yielded no drugs. Analysis of the data indicated that 3 times as many women had taken antidepressants and more than twice as many had consumed opioids. Drug toxicity ("overdose") ranked as the third (9.9%) leading cause of suicide after firearm injury (67.5%) and hanging (13.7%). Women succumbed to drug toxicity more than men (27.5% versus 5.9%). Of the overdose deaths, 66.5% had a negative blood alcohol concentration (BAC), while antidepressants, opioids, and benzodiazepines were detected in blood in 54.4%, 37.4%, and 29.2% of the subjects, respectively. The collection of these data serves the goals of public health and clinicians in devising strategies for suicide prevention.
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Lessons To Be Learned: Identifying High-Risk Medication and Circumstances In Patients At Risk For Suicidal Self-Poisoning
2021
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Suicide attempts by self-poisoning in elderly
2012
BACKGROUND: Suicide is a major public health concern. This investigation assessed elderly patients treated for self-intoxication in a poisoning referral center. METHODS: A retrospective and descriptive study was performed from the point of view of demographic, psychiatric and clinical factors related to the self-poisoning for suicide attempts in subjects aged over 65 years. RESULTS: The examined population consisted of 43 subjects including 30 males and 13 females with an age of 65 to 83 years (mean age = 72.5 years in males and 73.5 years in females). The majority of subjects were retired [35(81.4%)] and, many cases lived with their family [39(90.6%)]. 27.9% of subjects had been undergoing psychiatric treatment. Depressive disorders (reactive) and endogenic depression (affective) were recognized in 8 subjects (66.7%). 51% suffered from chronic diseases including hypertension (33.3%), coronary artery decease (30.4%), chronic obstructive pulmonary disease (15.9%) and diabetes (10.1%). Two cases had a history of previous suicidal attempt. The most frequently used substances in the attempts were medications (58%), opioids (23.2%), pesticide (11.6%) methanol (4.6%) and hair remover (2.3%). The mean duration of hospitalization was 1.3 days. CONCLUSIONS: The high rate of depression and chronic diseases in elderly with suicidal attempt necessitates preventive interventions.
Patient characteristics associated with nonprescription drug use in intentional overdose
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2003
Over-the-counter (OTC) medications remain freely available to suicidal patients, despite their potential lethality and common use in suicide. The study's main objective was to identify patient characteristics, particularly psychiatric diagnosis associated with the use of OTC medications in intentional overdose. We retrospectively reviewed 95 charts from patients who presented to St Paul's Hospital from August 1, 1997, to July 31, 1998, with a discharge diagnosis of intentional drug overdose. Univariate analysis was carried out to identify potential risk markers for OTC medication use, and logistic regression was performed using these variables. When the variables age, sex, and concurrent psychiatric diagnoses were controlled, use of OTC medications in overdose was significantly lower in patients with a DSM-IV diagnosis of substance abuse (OR 0.11, P = 0.005) and in those who possessed prescription medications at the time of overdose (OR 0.18, P = 0.007). Most patients in thi...
Drug suicide: a sex-equal cause of death in 16 European countries
BMC Public Health, 2011
Background: There is a lack of international research on suicide by drug overdose as a preventable suicide method. Sex-and age-specific rates of suicide by drug self-poisoning (ICD-10, X60-64) and the distribution of drug types used in 16 European countries were studied, and compared with other self-poisoning methods (X65-69) and intentional self-injury (X70-84).
Risk factors for suicide and other deaths following hospital treated self-poisoning in Australia
Australian and New Zealand Journal of Psychiatry, 2004
Objective: To analyze the risk factors for suicide, premature death and all-cause death in a representative population of hospital-treated deliberate self-poisoning patients. Results: There were 4105 subjects, of whom 228 (5.6%) died, 122 (2.9%) by premature death and 58 (1.4%) by suicide. The probability of suicide after 10 years follow-up was 2%. The adjusted hazard ratios (95% CI) for suicide were: 'disorders usually diagnosed in infancy, childhood and adolescence', 5.28 (95% CI = 2.04-13.65): male gender, 4.25 (95% CI = 2.21-8.14); discharge to involuntary psychiatric hospital admission, 3.20 (95% CI = 1.78-5.76); and increasing age, 1.02 (95% CI = 1.01-1.04). Men and women showed different patterns of multivariate risks, although increased risk with increasing age and discharge to an involuntary psychiatric admission was true for both. The standardized all-cause mortality ratio (95% CI) was: for men, 6.42 (95% CI = 5.44-7.57), and for women 4.39 (95% CI = 3.56-5.41). The standardized suicide mortality ratio (95% CI) was: for men, 20.55 (95% CI = 15.24-27.73), and for women 22.95 (95% CI = 13.82-38.11). Conclusions: Men and women have different risk factors for subsequent suicide after selfpoisoning. Hospital-treated self-poisoning patients have increased risk of subsequent suicide, premature and all-cause death. Psychiatric assessment, leading to discharge decisions, is worthwhile in identifying patients at long-term risk of suicide, premature and all-cause death.
Suicide verdicts as opposed to accidental deaths in substance-related fatalities (UK, 2001–2007)
Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2011
Substance-related deaths account for a great number of suicides. To investigate levels and characteristics of suicide verdicts, as opposed to accidental deaths, in substance misusers. Psychological autopsy study of cases from the UK National Programme on Substance Abuse Deaths (np-SAD) during the period 2001-2007. Between January 2001 and December 2007, 2108 suicides were reported to the np-SAD. Typical suicide victims were White and older than 50 (respectively 95% and 41% of cases). Medications, especially antidepressants (44%), were prescribed to 87% of victims. Significantly fewer suicide victims than controls presented positive blood toxicological results for illicit drugs (namely: cocaine, heroin, amphetamines, ecstasy-type drugs, cannabis, and GHB/GBL) and alcohol. Suicide prevention programmes should devote specific attention to deaths among substance misusers who are at high risk of fatal intentional self-harm. Specific characteristics distinguish those at risk; caregivers should be better educated as to what these factors are. Limitations of the current study included lack of provision of comprehensive information relating to the victims' psychosocial variables. Furthermore, no differentiation between different classes of antidepressants in terms of involvement in suicide was here provided.
Overview of young people attempting suicide by drug overdose and prevention and protection services
Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2017
Overview of young people attempting suicide by drug overdose and prevention and protection services Objective: Suicide is the second leading cause of death among 15-29 year-old-people in the world. The aim of this study is to present the characteristics of children and adolescents attempting suicide by drug overdose and to draw attention to preventive measures that can be taken in Turkey. Method: Records of the patients who admitted to a training and research hospital in one year period due to a suicide attempt by drug overdose were reviewed retrospectively. Sociodemographic data and psychiatric evaluation records of attempters were documented. Results: During the study period, 163 adolescents applied to the hospital with suicidal drug overdose. Child psychiatry consultation was ordered for 61.3% (n=100) of them. It was the first attempt of 90% of the cases. The frequency of having previous psychiatric diagnosis was significantly higher in patients with recurrent suicide attempts. In both impulsive and planned suicide attempts, the most preferred times were evening and night time. Women more often attempted suicide due to family conflict, while men attempted due to emotional relationship problems. All cases without psychiatric disorder or with externalizing problems attempted impulsive suicide. The most preferred drugs for suicide were, nonsteroidal anti-inflammatory drugs, antidepressants, paracetamol, antibiotics and antipsychotics. Of the all cases, 22.5% attempted suicide by self medications. It has not been possible to maintain pediatric psychiatric follow up of the 71% of the cases. Conclusion: It is considered that public attention should be drawn to the increasing number of adolescent suicide attempts in order to prevent this issue. Family-oriented protective approaches, school-based preventive programs and new legal regulations on drug safety could help to reduce the frequency of suicide attempts..
A profile of acute self drug poisoning: Our experience in a Tertiary Care Medical College Teaching Hospital
Background: Drug overdose can be accidental or deliberate posing a significant source of morbidity, mortality and health care burden. Drug over doses may be seen at any age and is particularly common among teenagers. It is estimated that approximately 2-3 million drug poisonings occur every year in the United States. In India the true incidence of self drugpoisoning is unknown due to under diagnosis and under reporting. Acute self drug poisoning is mostly due to benzodiazepines, antidepressants, antiepileptics and polypills containing NSAIDs. There is scarcity of data from the Indian subcontinent regarding the profile and outcome of patients presenting with acute self drug poisoning. We undertook this retrospective analysis to assess the course and outcome of such patients admitted in our tertiary care teaching hospital. Methods: This retrospective study was conducted between Jan 2008-Dec 2011 in the Department of medicine, Sri Devaraj Urs Medical College, Kolar. The data retrieved from the medical records section was analyzed for 155 patients who were admitted with acute self poisoning for, type of poisoning, time of presentation, reason for the consumption of drugs, ICU admission if required and outcomes. Results: The majority were females 103 (66.4%) patients and 52 were males and majority 90 (58 %) of admissions were from age group 21 to 30 years. The most common drugs consumed was benzodiazepines 54(34.8%), followed by antiepileptics 41(26.4%), and poypills 33(21.3). Thirty (19.4%) consumed two or more drugs. Commonest cause for drug consumption was suicidal (90%), and was mainly oral. The highest incidence of toxicity was due to benzodiazipines (34.8%) followed by antiepileptics (26.4%). Ten patients (15.5%) required ICU management for ventilatory support and average stay was seven days. None of our patients in the study required ionotropes or dialysis. Conclusions: The present data is an insight of the trends in self drug poisoning in rural south India as a result of low socioeconomic status, illiteracy and easy availability of drugs over the counter. Therefore strict regulations enforced on the medical drug outlets with mental health awareness counselling/programmes can go a long way in curtailing this problem.
The Defining Features of the Patients with the Diagnosis of Depressive Disorder Who Committed Suicide with the Drug Being Examined by Forensic Medicine
Bulletin of Clinical Psychopharmacology, 2013
An analysis of age and gender influences on the relative risk for suicide and psychotropic drug self-poisoning
Acta Psychiatrica Scandinavica, 1996
analysis of age and gender influences on the relative risk for suicide and psychotropic drug self-poisoning.
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