Deliberate Self-poisoning Cases Research Articles

Deliberate Self-Poisoning: Real-Time Characterization of Suicidal Habits and Toxidromes in the Food and Drug Administration Adverse Event Reporting System.

Deliberate self-poisoning (DSP) using drugs is the preferred method of suicide at a global level. Its investigation is hampered by limited sample sizes and data reliability. We investigate the role of the US FDA Adverse Event Reporting System (FAERS), a consolidated pharmacovigilance database, in outlining DSP habits and toxidromes. We retrieved cases of 'intentional overdose' and 'poisoning deliberate' from the FAERS (January 2004-December 2021). Using descriptive and disproportionality analyses, we estimated temporal trends, potential risk factors, toxidromes, case-fatality rates and lethal doses (LDs) for the most frequently reported drugs. We retrieved 42,103 DSP cases (17% fatal). Most cases were submitted in winter. Reports of DSP involved younger people, psychiatric conditions, and alcohol use, compared with non-DSP, and fatality was higher in men and older patients. Suspected drugs were mainly antidepressants, analgesics, and antipsychotics. Multiple drug intake was recorded in more than 50% of the reports, especially analgesics, psychotropics, and cardiovascular agents. The most frequently reported drugs were paracetamol, promethazine, amlodipine, quetiapine, and metformin. We estimated LD25 for paracetamol (150g). Worldwide coverage of the FAERS complements existing knowledge about DSP and may drive tailored prevention measures to timely address the DSP phenomenon and prevent intentional suicides.

Clinical features related to alcohol co-ingestion of deliberate self-poisoning patients visiting the emergency department

Purpose: Alcohol is one of the most commonly co-ingested agents in deliberate self-poisoning (DSP) cases presenting at the emergency department (ED). The increased impulsivity, aggressiveness, and disinhibition caused by alcohol ingestion may have different clinical features and outcomes in cases of DSP. This study investigates whether alcohol co-ingestion affects the clinical features and outcomes of DSP patients in the ED. Methods: This was a single-center retrospective study. We investigated DSP cases who visited our ED from January 2010 to December 2016. Patients were classified into two groups: with (ALC+) or without (ALC–) alcohol co-ingestion. The clinical features of DSP were compared by considering the co-ingestion of alcohol, and the factors related to discharge against medical advice (AMA) of DSP were analyzed. Results: A total of 689 patients were included in the study, with 272 (39.5%) in the ALC+ group. Majority of the ALC+ group patients were middle-aged males (45-54 years old) and arrived at the ED at night. The rate of discharge AMA from ED was significantly higher in the ALC+ group (130; 47.8%) compared to the ALC– group (p=0.001). No significant differences were obtained in the poisoning severity scores between the two groups (p=0.223). Multivariate analysis revealed that alcohol co-ingestion (odds ratio [OR]=1.42; 95% confidence interval [CI], 1.01-1.98), alert mental status (OR=1.65; 95% CI, 1.17-2.32), past psychiatric history (OR=0.04; 95% CI, 0.01-0.28), age >65 years (OR=0.42; 95% CI, 0.23-0.78), and time from event to ED arrival >6 hrs (OR=0.57; 95% CI, 0.37-0.88) were independent predictive factors of discharge AMA (p=0.043, p=0.004, p=0.001, p=0.006, and p=0.010, respectively). Conclusion: Our results determined a high association between alcohol co-ingestion and the outcome of discharge AMA in DSP patients. Emergency physicians should, therefore, be aware that DSP patients who have co-ingested alcohol may be uncooperative and at high risk of discharge AMA.

Deliberate self-poisoning with drugs among adolescents in Morocco

Introduction: Suicide is a serious public health problem and one of the leading causes of adolescent death in the world. The aim of this study is to determine the epidemiological profile of suicidal poisoning with drugs among adolescents in Morocco. Methods: This is a retrospective study of deliberate self-poisoning cases, reported to the Moroccan Poison Control Center between 1980 and 2014. Results: A total of 3,856 cases of suicidal poisoning among adolescents 15 to 19 years old were recorded, with 13 cases of successful suicide and 41 repeated suicide attempts. The average age of the patients was 15.5 years. According to the results, 84.7% were female with a female-male ratio of 5.5. The majority of cases occurred at home (97.8%). The signs and symptoms presented by the patients were varied, depending on the amount of drug ingested and the delay before treatment. Conclusion: Suicide and suicide attempts in children and adolescents continue to be a major public health problem, and topical research and surveys have clearly highlighted suicide as one of the commonest causes of death among young people.

DISTRIBUTION OF DELIBERATE SELF-POISONING BY SOCIO-DEMOGRAPHIC FACTORS, PRECIPITATING EVENTS, TYPE OF SUBSTANCE AND MORTALITY IN POPULATION OF HAZARA DIVISION, PAKISTAN

Background: Deliberate self-poisoning is important cause of deaths in younger population. The objectives of this study were to determine the distribution of deliberate self-poisoning by 12 socio-demographic factors, precipitating events, type of substance and mortality in population of Hazara Division, Pakistan. Materials & Methods: This cross-sectional study was conducted in the Department of Medicine, Ayub Medical College, Abbottabad, Pakistan from October 9, 2017 to December 28, 2018. 102 deliberate self-poisoning patients were selected consecutively from population at risk. Variables were 12 socio-demographic factors, precipitating events, type of substance and mortality. All variables being categorical were described by count and percentage for sample and by confidence intervals for proportion for population at 95% confidence level. RESULTS: Deliberate self-poisoning cases (n=102) were higher in women 80.39%, in age group 18-25 years 54.90%, similar in urban 49.02% and rural 50.98%, higher in non-Pathan 74.51%, in married 57.84%, in joint family 79.41%, in up to matric education 85.29% and in housewives 52.94%, 4.90% with previous history of self-harm, 1.96% with family history of self-harm and higher in lower socioeconomic group 81.37%. The most common precipitating event was interpersonal difficulties with spouse, family members or friends 56.86%, while the most common type of substance was organophosphate 62.75%. Mortality was 3.92%. Conclusion: Deliberate self-poisoning was more prevalent in women, younger age group, married, joint family, educated up to matric, housewives and lower socioeconomic status. Family conflict was most common precipitating factor. Organophosphate was most common type of substance and mortality was high 3.92%.

The economic burden of deliberate self-poisoning: insight from a tertiary hospital in the Free State Province, South Africa.

Suicide rate in South Africa is contentiously rated among the top ten highest in the world. Deliberate self-poisoning (DSP) remains one of the common methods for suicide. The management of DSP often impose a significant economic burden on health services with a growing loss of resources. However, studies on the financial implications associated with the management of DSP cases in South Africa are scarce and no known study has investigated the financial implication of managing DSP in a resource strained health system as obtained in the Free State Department of Health (FSDoH). This present study investigated the financial implication of managing DSP in a state regional hospital in the Free State province and proffer efficient ways of utilizing limited available resources in DSP management. This was a descriptive, retrospective cross-sectional study in which clinical records of 212 DSP cases which presented during an 18-month period at the emergency department of a state regional hospital were reviewed. The incidence of DSP was higher among individuals who are females (66% females vs 34% males), unemployed (65.6%) in the age group 20-29 years (44.8%). DSP management cost an average of R50, 000 per month. Wasteful expenditures such as blanket requests for laboratory investigation accounted for 19% of the cost. These findings agree with prior studies that have reported that managing DSP could pose a huge direct financial burden on hospital expenditure and health service delivery. If future cost containment and quality of care are to be achieved in the Free State province, efforts must be made by healthcare personnel to combat wasteful and unnecessary expenditure during patient management. We hope that recommendations proffered by this current study will alleviate the financial burden of DSP management in the province.

The profile of deliberate self-poisoning cases presenting at the emergency department of Pelonomi Regional Hospital, Bloemfontein

Background: A common method engaged in suicide is deliberate self-poisoning (DSP). Substances implicated in DSP include prescription and over-the-counter medicines, drugs, household chemicals, agrochemicals and herbal mixtures. Few studies have been conducted on DSP in South Africa, despite its occurrence and high management cost. This study aimed to determine the profile of patients treated for DSP at the emergency department of Pelonomi Regional Hospital, Bloemfontein, between January 2010 and July 2011. A profile of DSP cases will allow practitioners in this region to be aware of the magnitude, causes and common substances used, which will enable them to plan and execute an adequate management protocol to reduce mortality.Methods: This was a retrospective, descriptive study. All DSP patients treated during the 18-month study period were identified from the emergency department register. The clinical files of these patients were reviewed and relevant information captured.Results: In total, 260 DSP patients presented at the emergency department. Files for 212 (81.5%) patients had sufficient information and were included in the study. Two-thirds (66.0%, n = 140) of the patients were female and the highest percentage was in the age group 20–29 years (44.8%, n = 94). Most patients were black (81.1%, n = 150). Most resided in areas associated with low socioeconomic status, including informal settlements, farms and townships. The highest percentage of patients took paracetamol (21.7%, n = 46), while 19.3% (n = 41) ingested household chemicals and 9.9% (n = 21) antiretroviral medication. Only 81 of the 212 patient files had the reason for the DSP captured. Of these, half (49.4%) reported troubled relationships.Conclusion: This study showed that DSP mostly occurred among females in the age group 20–29 years. Most of the patients resided in areas with poor socioeconomic status, and faced relationship, marital, employment and other psychosocioeconomic problems.

The profile of deliberate self-poisoning cases presenting at the emergency department of Pelonomi Regional Hospital, Bloemfontein

Background: A common method engaged in suicide is deliberate self-poisoning (DSP). Substances implicated in DSP include prescription and over-the-counter medicines, drugs, household chemicals, agro...

Pattern of deliberate self-poisoning cases admitted to Poison Control Center Ain Shams University Hospitals during the years 2015-2016

Suicide is one of the leading causes of death worldwide. Deliberate self-poisoning (DSP), is the most common method of attempted suicide and accounts for the majority of suicide-related hospital admissions. The incidence in Egypt tends to be under-estimated. Aim: Evaluating the pattern of deliberate self-poisoning cases who were admitted to Poison Control Center Ain Shams University Hospitals (PCC-ASUH) from January 2015 to December 2016. Method: An observational study was conducted including all patients deliberately self-poisoned throughout the study period .Recorded data in the present study included: age, gender, and residence, type of causative agent, severity of poisoning, and mortality. Results: A total of 10035 and 10758 self-poisoned patients were received in 2015 and 2016 respectively. Results remained similar in both years of the study. Cases were predominantly in the age group between 19 and 30 years, females 69% and were received from Cairo. Used substances were mainly drugs: centrally-acting drugs ranked first including Tricyclic antidepressants TCA, Benzodiazepines (BZD), antipsychotics and carbamazepine followed by analgesics and cardiopulmonary drugs. Among non-drug agents, organophosphorus insecticides were the most common .Lower number of cases used phosphides, corrosives and detergents, petroleum distillates, phenol and paraphenylenediamine (PPD). The majority of cases were mild (>70%) in both years of the study. Severe cases constituted 6.8% of DSP cases, with overall in-hospital mortality 0.6%. Organophosphorus insecticides topped the agents responsible for mortality followed by unknown drugs with small contributions by other drug and non-drug agents. Conclusion: Deliberate self-poisoning is a common presentation to PCC-ASUH .General trends show significant predominance of adolescents and young adults especially females, usage of drugs mainly centrally-acting agents, and low case fatality which is mainly in relation to organophosphorus compounds

Exploring Complexity of Deliberate Self-Poisoning through Network Analysis.

The purpose of this research was to examine the complexity of circumstances that result in deliberate self-poisoning cases. For the purposes of this paper, the cases were patients that presented for care and were admitted to the specialty hospital in Northwest of Iran. The research examined the problems preceding deliberate self-poisoning and the interrelations among them by applying network analysis methods. The network was scored for degrees of centrality and betweenness centrality. Structural analysis of network also was conducted using block modelling. The results showed that family conflicts had the highest score for degree of centrality among women, while the highest score for degree of centrality among men belonged to those dealing with drug addiction. Analysis for degree of betweenness centrality revealed that drug addiction had the highest score among men, whereas the highest score for women on betweenness centrality was related to physical illness. Structural analysis of the network showed differences in role that various problems played in intentional self-poisoning. The findings from this research can be used by public health authorities to create prevention programs that address the problems leading to deliberate self-poisoning.

Adolescent deliberate self-poisoning in South-East Melbourne.

To describe the characteristics of adolescents presenting with deliberate self-poisoning (DSP) to a large Australian healthcare network. This is a retrospective chart review of 12-17 year olds presenting to three Monash Health EDs with self-poisoning from January 2012 to December 2014. There were 35 207 adolescent presentations in the study period. A total of 721 cases were for DSP (2%), and 501 (1.4%) presented with recreational or accidental self-poisoning. The most common DSP toxicants were paracetamol (28%), non-steroidal anti-inflammatory agents (15%) and serotonin reuptake inhibitors (10%). Of the DSP presentations, 96% were impulsive events; 23% of patients (n = 129) presented on multiple occasions, and 67% of all DSP cases had a past psychiatric history, particularly depression (57%). Disposition for DSP patients included 60% discharged home, 6% short stay unit, 19% medical admission, 13% psychiatric admission and 2% intensive care unit admission. There were no mortalities. Adolescent DSP presentations frequently involved impulsive ingestion of over-the-counter medications, suggesting less access to prescription medications. Additionally, pre-existing mental health history and re-presentation were common. Initiatives to prevent DSP might include an increased focus on the early identification and management of mental health problems in adolescents in the community.

Benzodiazepine therapy in psychiatric outpatients is associated with deliberate self-poisoning events at emergency departments—a population-based nested case–control study

Deliberate self-poisoning (DSP), the most common form of deliberate self-harm, is closely associated with suicide. Identifying risk factors of DSP is necessary for implementing prevention strategies. This study aimed to evaluate the relationship between benzodiazepine (BZD) treatment in psychiatric outpatients and DSP cases at emergency departments (EDs). We performed a retrospective nested case-control study of psychiatric patients receiving BZD therapy to evaluate the relationship between BZD use and the diagnosis of DSP at EDs using data from the nationwide Taiwan National Health Insurance Research Database. Regression analysis yielded an odds ratio (OR) and 95% confidence interval (95% CI) indicating that the use of BZDs in psychiatric outpatients was significantly associated with DSP cases at EDs (OR = 4.46, 95% CI = 3.59-5.53). Having a history of DSP, sleep disorders, anxiety disorders, schizophrenia, depression, or bipolar disorder was associated with a DSP diagnosis at EDs (OR = 13.27, 95% CI = 8.28-21.29; OR = 5.04, 95% CI = 4.25-5.98; OR = 3.95, 95% CI = 3.32-4.70; OR = 7.80, 95% CI = 5.28-11.52; OR = 15.20, 95% CI = 12.22-18.91; and OR = 18.48, 95% CI = 10.13-33.7, respectively). After adjusting for potential confounders, BZD use remained significantly associated with a subsequent DSP diagnosis (adjusted OR = 2.47, 95% CI = 1.93-3.17). Patients taking higher average cumulative BZD doses were at greater risk of DSP. Vigilant evaluation of the psychiatric status of patients prescribed with BZD therapy is critical for the prevention of DSP events at EDs.

Guidelines for the management of paracetamol poisoning in Australia and New Zealand — explanation and elaboration

Paracetamol is involved in a large proportion of accidental paediatric exposures and deliberate self-poisoning cases, although subsequent hepatic failure and death are both uncommon outcomes. The optimal management of most patients with paracetamol overdose is usually straightforward. However, several differing nomograms and varying recommendations regarding potential risk factors for hepatic injury introduce complexity. In order to reconcile management advice with current Australasian clinical toxicology practice, revised guidelines have been developed by a panel of clinical toxicologists consulting to the poisons information centres in Australia and New Zealand using a workshop and consultative process. This article summarises the rationale for the recommendations made in these new guidelines.

Attempted suicide by drug overdose and by poison-ingestion methods seen at the main general hospital in the Fiji islands: a comparative study

Objective: This study examined the prevalence and the characteristics of deliberate self-poisoning patients seen at the main general hospital in the Fiji Islands. Method: Thirty-one consecutive patients with deliberate drug-overdose and 27 others with nonoverdosed self-poisoning were compared on sociodemographic and clinical variables. Results: Deliberate self-poisoning cases represented 0.3% of the hospital admissions, and had a rate of 25.9 per 100,000 population. The overdose group was significantly older ( P< .05), whereas the poison-ingestion group had significantly greater proportion of males ( P< .03). The rate of psychiatric morbidity was significantly higher in the overdose group ( P=.04), whereas the history of alcohol abuse was significantly higher in the other group ( P=.04). Paracetamol (35.5%) and paraquat (29.7%) were the most commonly used agents. Conclusions: Age, gender, rate of psychiatric morbidity, or history of alcohol abuse could be predictive of whether drug overdose or poison ingestion would be used for deliberate self-poisoning. This information could be relevant in the formulation of suicide preventive strategies.

An accident and emergency department's view of self-poisoning: a retrospective study from the United Norwich Hospitals 1978-1982.

This 5-year review of deliberate self-poisoning cases seen in an accident and emergency department revealed that about 700 patients were seen per year. Three-quarters of these needed admission (forming some 15% of all hospital admissions). Of these 65% were referred to the psychiatrist. The remaining quarter were dealt with in the accident and emergency department. Analysis of the data identifies problems where further research is needed. In particular the question is raised as to whether these patients would not be better dealt with in an acute medical unit now that accident departments are turning their attention increasingly to the management of trauma.