Deliberate Self-poisoning Research Articles

Deliberate self-poisoning: characteristics of patients and impact on the emergency department of a large university hospital

Study objectiveThe epidemiology, management and cost of emergency department (ED) visits for deliberate self-poisoning (DSP) are described.MethodsIn a retrospective study, the medical records of all DSP patients older than 16...

Effect of Deliberate Ingestion of Organophosphate Pesticide on Distortion Product Oto-Acoustic Emissions (DPOAE)

Background: Oto-Acoustic Emissions (OAE) are low intensity sounds produced by the cochlea in response to an acoustic stimulus. Deliberate self-poisoning has become an increasingly common response to emotional distress in young adults (NHS, 1998). Organophosphate (OP) compounds are most commonly involved in 76% of pesticide poisoning especially in the developing countries like India. Several pesticides are neurotoxin which could potentially affect hearing and, animal studies showed that OP treatment leads to change in hearing threshold, outer and inner hair cell loss but human studies on the same are very few. Aim: The present study was aimed at exploring the cochlear changes after self-poisoning with OP pesticides by measuring the Distortion Product Oto-Acoustic Emissions (DPOAE). Method: 114 subjects were participated in the study, with an age range of 18-30 years having pure tone audiometric thresholds within the normal limits and no history of middle ear pathology. They were further divided into two groups, I and II which includes self-poisoned and healthy subjects respectively. Results: The “pass” and “fail” criteria of DPOAE measures in group I were 30% and 70% respectively whereas in group II, it was found 91% and 9% respectively. Discussion: There was a significant failure in DPOAE in Group I (subjects who were self-poisoned) compared to group II (healthy subjects). The two important pathologies behind OP toxicity are the generation of Reactive Oxygen Species and the depletion of NADPH which is necessary for normal function. Conclusion: The results of the present study highlight that; the minute cochlear changes caused due to pesticide poisoning can be effectively measured through DPOAE. Further it can suggest in other clinical targets like Ototoxicity, Noise-induced hearing loss, Meniere’s disease etc., which has an effect on cochlear hair cells can be monitored through DPOAE.

Deliberate self-poisoning: patients’ perceptions of lethality

Journal of Paramedic PracticeVol. 3, No. 11 Spotlight on ResearchDeliberate self-poisoning: patients’ perceptions of lethalityJulia WilliamsJulia WilliamsSearch for more papers by this authorJulia WilliamsPublished Online:16 Aug 2013https://doi.org/10.12968/jpar.2011.3.11.647AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Vlad IA,Fatovich DM, Fenner SG et al. (2011) Patient perceptions of the potential lethality associated with deliberate self-poisoning. Emerg Med Aus 23(5): 580–6 Crossref, Google Scholar FiguresReferencesRelatedDetails 4 November 2011Volume 3Issue 11ISSN (print): 1759-1376ISSN (online): 2041-9457 Metrics History Published online 16 August 2013 Published in print 4 November 2011 Information© MA Healthcare LimitedPDF download

Deliberate self-poisoning: factors associated with recurrent self-poisoning

Objective To investigate potential risk factors associated with the repetition of deliberate self-poisoning (DSP). Methods Retrospective medical record review of all patients who presented to the emergency department of a tertiary teaching hospital after DSP between January 1, 2000, and December 31, 2009. Repetition of a suicide attempt was determined from reported episodes before the index episode or from 2 visits to the same hospital during the study period. Demographic information, clinical variables, and other variables at the first suicide attempt were investigated for factors associated with repetition of DSP. Results Of the 967 patients, 203 (21%) presented with repeated suicide attempts. Patients with repeat suicide attempts differed in sex, occupation, living condition, method of DSP, history of psychiatric treatment, reversibility, and psychiatric diagnosis. In the multivariate regression analysis, the only reliable associated factors for repeat suicide attempt were sex ( P = .001), living condition ( P < .001), method of DSP ( P < .036), and history of psychiatric treatment ( P < .001). Conclusion Early psychological intervention and close observation is required for patients who are female, living without a family, use antidepressants, and have a history of psychiatric treatment.

Extreme γ-Butyrolactone Overdose With Severe Metabolic Acidosis Requiring Hemodialysis

γ-Hydroxybutyrate (GHB) and its precursor γ-butyrolactone (GBL) are commonly abused drugs with a narrow therapeutic index. Therefore, overdoses occur readily with recreational use, and severe poisoning can occur after deliberate self-poisoning. We report the sequelae in a patient who ingested a massive dose of GBL, with suicidal intent. Severe metabolic acidosis and an asystolic cardiac arrest were successfully treated with standard resuscitation, supportive care, and continuous venovenous hemodiafiltration. Plasma GHB concentrations were the highest reported to date. The acidosis was attributed to rapid systemic absorption of GBL, followed by rapid metabolism to GHB.

P03-452 - Differences in the prevalence of insomnia and their predictive value in patients with deliberate drug self-poisoning

IntroductionEvidence suggests a relationship between sleep disturbances and suicidal ideation. The temporal appearance of insomnia has been proposed as a warning sign of imminent suicidal acts. However, there is little information on the temporal relation of insomnia with acts of deliberate self-poisoning (DSP) in particular.ObjectivesThis study aimed to identify the insomnia prevalence in DSP patients and test its predictive value in relation to current psychiatric diagnosis and history of previous DSP acts.MethodsSeventy consecutive patients with DSP admitted from February to September 2010 into three general hospitals had a psychiatric consultation and their sleeping pattern during the week before the DSP act was assessed using the Athens Insomnia Scale.ResultsPatients, with a mean age of 34 ± 2 years, predominantly women (70%), were diagnosed with personality disorders (68%), depression (22%) and psychosis (10%). The overall insomnia prevalence was 69%. A chi-square analysis showed that patients with an Axis I diagnosis were significantly more likely to present insomnia than patients with an Axis II diagnosis. Interestingly, when the number of previous DSP acts was included into the analysis, patients with an Axis I diagnosis with and without previous DSP acts had an equal prevalence of insomnia. On the contrary, in patients with an Axis II diagnosis and previous DSP acts, insomnia was three times more prevalent than in those with no previous DSP acts.ConclusionsThese results suggest that insomnia may be a valid proximal warning sign, particularly in patients with personality disorders and previous DSP acts.

Suicidal behaviour among those who attempted suicide and their close relatives/friends

ObjectivesTo describe the repetition of suicidal attempts and the awareness of suicidal behaviour among close people.MethodsFrom 668 attempted suicides presented to National Hospital of Sri Lanka (April to December 2002),...

Poisoning and Overdose

Poisoning is a significant public health concern in the UK. Accidental poisoning and deliberate self-poisoning may involve drugs, household products, environmental contaminants or occur as a result of occupational exposure. This article aims to provide a strategy for GPs to use for assessment and management of patients presenting in the community with a history of exposure to poisons.

A cross‐sectional observation of the factors associated with deliberate self‐poisoning with acetaminophen: impact of gender differences and psychiatric intervention

The objectives of this study were to determine the risk factors and life stressors that are prevalent among the acetaminophen deliberate self-poisoning (DSP) cases, to identify gender differences in the associated factors, and to determine the prevalence of psychiatric diagnosis and the patterns and types of psychotherapeutic interventions provided by psychiatrists. This is a cross-sectional study, a retrospective descriptive case review of hospital admissions for acetaminophen DSP. There were 177 incidences of DSP during the study period. The mean age of the cases was 23.1 +/- 7.3 years and 84.1% of them were females. The risk factors were more significantly associated with males: chronic ethanol intake (p = 0.04), higher reported dose ingested (p = 0.01), higher latency time (p = 0.04) and longer hospital stay (p = 0.03). The most commonly reported psychotherapeutic interventions used by psychiatrists were psychoeducation of the patient, followed by referral to a psychiatric clinic, family psychoeducation and psychotropic medication. Sertraline (SSRI) was the most frequently prescribed antidepressant. Males have been shown to use more toxic doses and to delay treatment due to high latency time. Most DSP patients have different life stressors and psychiatric diagnoses that may be associated with varying degrees of suicidal intent. All patients presenting following DSP need to be carefully screened for psychiatric illness. Randomized controlled studies need to be conducted on DSP patients with psychiatric illness to determine which treatments are effective.

A Comparison of Venlafaxine and SSRIs in Deliberate Self-poisoning

To compare the clinical features of deliberate self-poisoning with venlafaxine and selective serotonin reuptake inhibitors (SSRIs) presenting to the emergency department of an Australian tertiary referral hospital. A retrospective cohort study comparing all 36 patients who presented with venlafaxine self-poisoning with 44 randomly selected patients with SSRI self-poisoning between 1997 and 2006. Patients who had overdosed on venlafaxine were older (mean age 37.4 versus 28.8 years, p ≤ 0.001) and generally exhibited a higher degree of suicidal intent (p ≤ 0.017). Median venlafaxine dose taken was 35 defined daily doses (DDDs) compared with SSRIs 19.4 DDDs. Those who ingested venlafaxine were more likely to become confused (25% versus 0%; p = 0) and have mydriasis (19.4% versus 2%; p ≤ 0.02), than those who took SSRIs. One patient from the venlafaxine group died. Compared with SSRI self-poisoners, patients who deliberately ingested venlafaxine were more likely to exhibit serious suicide intent. They were also more likely to be older, take a higher DDD of the drug, and have confusion and mydriasis. This has implications for management of severely depressed and suicidal patients.

Detailed analyses of self‐poisoning episodes presenting to a large regional teaching hospital in the UK

The primary aim of this paper is to provide comprehensive contemporaneous data on the demographics, patterns of presentation and management of all episodes of deliberate self-poisoning presenting to a large regional teaching hospital over a 12 month period. We undertook detailed, retrospective analyses using information from electronic patient records and local patient-tracking, pathology and administrative databases. Statistical analyses were performed using Chi-squared tests, anova and two-tailed t-tests (Graphpad Prism). One thousand five hundred and ninety-eight episodes of deliberate self-poisoning presented over the year. Demographic data and information on the month, day and time of admission are provided. 70.7% presented to the emergency department (ED) within 4 h of ingestion. 76.3% of patients had only one episode in an extended 29 month follow-up period. A mean of 1.72 drugs were taken per episode with just over half of all episodes involving a single drug only. Paracetamol and ibuprofen were the two most commonly ingested drugs involved in 42.5% and 17.3% of all overdoses respectively. 56.3% of patients taking paracetamol reported ingesting over 8 g (one over the counter packet). Detailed mapping of the patients' pathway through the hospital allowed an estimation of the hospital cost of caring for this patient group at pound 1.6 million pounds per year. We present comprehensive and contemporary data on presentations to hospital resulting from deliberate self-poisoning. We include demographic information, presentation patterns, drugs used, a detailed analysis of episodes involving paracetamol and an estimate of the financial burden to hospitals of overdose presentations.

Salivary paracetamol: evaluation of a colorimetric method in assessing deliberate self-poisoning

In the laboratory evaluation of suspected paracetamol poisoning, a non-invasive sample type that avoids venepuncture would be an attractive alternative to plasma, particularly in the paediatric setting. Salivary paracetamol measurement has not previously been evaluated in the published medical literature in the setting of deliberate self-poisoning (DSP). In-house validation experiments (recovery, stability and lower limit-of-detection) were performed on pooled saliva samples using a Roche Acetaminophen assay on a Roche/Hitachi 917 analyser. A clinical study of comparison of paired saliva and plasma samples was also conducted involving adult patients presenting with DSP of paracetamol, the results of which were published previously. The validation experiments using pooled saliva samples showed: (i) mean recovery (paracetamol concentration 37.5-525 mg/L) 100.01% (+/-0.02 SD); (ii) precision of repeated assay over 24-h period CV <4%; (iii) lower limit-of-detection 0.9 mg/L. The clinical study of 21 patients with mean plasma paracetamol concentration of 48 mg/L (range 0-130) and mean saliva concentration 62 mg/L (range 0-183) showed good correlation between saliva and plasma concentrations (r(2) = 0.91). The Roche Hitachi 917 Acetaminophen assay is suitable for the measurement of paracetamol in saliva. Further studies comparing plasma and saliva samples from patients with DSP and plasma paracetamol concentrations in the hepatotoxic range are warranted. If salivary samples are suitable for risk-stratifying patients with paracetamol DSP, venepuncture may be avoided, which would be attractive, especially in the paediatric setting.

Emergency management and resuscitation of poisoned patients: perspectives from "down under".

Deliberate self poisoning (DSP) is a common presentation to an emergency department (ED), being an acute medical exacerbation of a chronic psychosocial disorder. At Sir Charles Gairdner Hospital (SCGH) in Perth Western Australia, DSP and intoxication accounts for 4.6% of all ED presentations, the Austin Hospital in Melbourne, reported 650 presentations per year (2% of their ED presentations). In the UK, Kappur estimated an annual rate of presentation to a UK hospital of 310/100000 population and estimated 170 000 presentations to EDs in the UK. One American study estimated an annual rate of ED presentation of self harm in 7 – 24 years old at 225.3 per 100 000 population. With such a caseload it is important that there is a structured process to the management and disposition of cases, as Boyle and her colleagues have described in their review article on the management of the critically poisoned patient. As Boyle discussed resuscitation is an essential part of the management of the poisoned patient, and often this and good supportive care is all that is required in the patients management.

Lifetime and current costs of supporting young adults who deliberately poisoned themselves in childhood and adolescence

Background: Little is known about the long-term economic consequences of child and adolescent mental health problems, despite concerns that costs in later life may be significant.Aims: To evaluate current and lifetime costs of young adults who deliberately poisoned themselves in childhood.Method: Prospective cohort study of 129 young adults (mean age 21) who as teenagers had taken part in a randomized trial following deliberate self-poisoning. Lifetime and current costs of public sector services were calculated and compared to those of a matched general population control group.Results: The self-poisoning group incurred significantly greater lifetime costs than the controls. They used more service-provided accommodation, special education and hospital services, incurred greater criminal justice costs and received more social security benefits. Higher costs in the self-poisoning group were significantly associated with conduct disorder, hopelessness, previous suicide attempts, being male and being in care prior to the self-poisoning event.Conclusions: Child and adolescent mental health problems predict significant costs compared to general population controls. This study provides indications of those groups of young people who incur high costs and for whom early intervention should be considered.

Acute arsenic self-poisoning for suicidal purpose in a dentist: a case report

Arsenic is a classical poison that has been historically used since ancient times for homicidal purposes. More recently, episodes of deliberate or unintentional arsenic self-poisoning have been increasingly reported. We describe here a case of a 77-year old male patient with a history of major depression, who attempted suicide by ingestion of 4 g of arsenic trioxide. The man, a dentist by profession, used arsenic preparations for pulp devitalization. The patient was admitted to our hospital 5 h after arsenic ingestion with nausea and vomiting. Plain radiograph of the abdomen showed radio-opaque material in the stomach and small intestine. Nasogastric lavage, activated charcoal, and chelators were used to remove arsenic. On day 3, endoscopy disclosed the presence of gastritis and superficial ulcers. The patient developed significant anemia (Hb: 8.7 g/dL on day 7) without significant signs of hemolysis. He gradually recovered from anemia within 5 months. The patient did not suffer any adverse outcome in spite of having ingesting 4 g of arsenic, approximately 20 times the lethal dose.

Variability in the quality of overdose advice in Summary of Product Characteristics (SPC) documents: gut decontamination recommendations for CNS drugs

Deliberate self-poisoning is a major cause of morbidity and mortality. The Summary of Product Characteristics (SPC) document is a legal requirement for all drugs, and Section 4.9 addresses the features of toxicity and clinical advice on management of overdose. The quality and appropriateness of this advice have received comparatively little attention. Section 4.9 of the SPC was examined for all drugs in the central nervous system (CNS) category of the British National Formulary. Advice concerning gut decontamination was examined with respect to specific interventions: induced vomiting, oral activated charcoal, gastric lavage, and other interventions. Data were compared with standard reference sources for clinical management advice in poisoning. These were graded 'A' if no important differences existed, 'B' if differences were noted but not thought clinically important, and 'C' if differences were thought to be clinically significant. SPC documents were examined for 258 medications from 67 manufacturers. The overall agreement was 'A' in 23 (8.9%), 'B' in 28 (10.9%) and 'C' in 207 (80.2%). Discrepancies were due to inappropriate recommendation of induced emesis in 21.7% (95% confidence interval 17.1, 27.1), gastric lavage in 38.4% (32.7, 44.4), other gut decontamination in 5.8% (3.6, 9.4) and failure to recommend oral activated charcoal in 57.4% (51.1, 63.4). Gut decontamination advice in SPC documents with respect to CNS drugs was inadequate. Possible reasons for the observed discrepancies and ways of improving the consistency of advice are proposed.

Personal and professional challenges in the management of deliberate self-poisoning patients in rural Sri Lanka: a qualitative study of rural hospital doctors' experiences and perceptions

BackgroundDeliberate self-poisoning is a major public heath issue in developing countries. In rural Sri Lanka deliberate self-poisoning is one of the leading causes of hospital death. The majority of patients with poisoning present to rural hospitals for initial treatment that are staffed by non-specialist and often relatively junior doctors. The treatment of self-poisoning patients poses numerous clinical challenges and further difficulties are experienced if patients are uncooperative and aggressive, intoxicated with alcohol or suffering mental illness. Previous research in developed countries has examined self-poisoning patients and their treatment but little is know about self-poisoning patient care in the context of rural health provision in developing countries. This study provides the first focused exploration of the experiences and perceptions of primary care rural hospital doctors in Sri Lanka toward the treatment of self-poisoning patients.MethodsSemi-structured in-depth interviews were conducted with fifteen doctors from rural hospitals in the North Central Province, Sri Lanka. All interviews were recorded and transcribed and subject to thematic analysis.ResultsParticipating doctors did perceive that treating self-poisoning patients in a primary care rural hospital as potentially confidence-building. However, resource issues such as the lack of medication, equipment and staffing were seen as important challenges to treating self-poisoning patients. Other challenges identified included disparity with community and other staff members regarding expectations of care, a sense of professional isolation and a lack of continuing education programs.ConclusionAddressing professional isolation through educational and trainee programs for doctors and reducing the variance in expectations between professional groups and the community has the potential to improve delivery of care for self-poisoning patients.

Adverse drug reactions and deliberate self-poisoning as cause of admission to the intensive care unit: a 1-year prospective observational cohort study

The aim of the present study was (1) to determine the prevalence of intensive care unit (ICU) admissions due to an adverse drug reaction (ADR), and (2) to compare affected patients with patients admitted to the ICU for the treatment of deliberate self-poisoning using medical drugs. Prospective observational cohort study. Fourteen bed medical ICU including an integrated intermediate care (IMC) section at a tertiary referral center. A total of 1,554 patients admitted on 1 January 2003 to 31 December 2003. Ninety-nine patients were admitted to the ICU with a diagnosis of ADR (6.4% of all admissions), 269 admissions (17.3%) were caused by deliberate self-poisoning. Patients admitted for treatment of ADR had a significantly higher age, a longer treatment duration in the ICU, a higher SAPS II score, and a higher 6-month mortality than those with deliberate self-poisoning. Most patients (71.7%) suffering from ADR required advanced supportive care in the ICU while the majority of patients (90.7%) with deliberate self-poisoning could be sufficiently treated in the IMC area. All diagnostic and therapeutic procedures in the ICU except mechanical ventilation were significantly more often performed in patients with ADR. This study provides further evidence that ADR is a frequent cause of admission to medical ICUs resulting in a considerable use of ICU capacities. In the present setting patients with ADR required longer and more intense medical treatment in the ICU than those with deliberate self-poisoning.

Self-poisoning by drugs and chemicals: variations in demographics, associated factors and final outcomes

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 studied. Chi-square, independent t-test and binary logistic were used whenever applicable. Results Indian patients were more likely to use household products, whereas Malay and Chinese patients were more likely to take drug overdoses ( P=.001). Drug overdose victims experienced more socioeconomic problems ( P=.05) and were more likely to be admitted to the intensive care unit ( P=.052). Chemical poisoning patients presented earlier ( P=.011), were hospitalized for shorter time ( P=.001) and had a higher rate of mortality ( P=.01). Conclusion The present study has identified a unique ethnic variation in the choice of suicide attempts from toxic substances. DSP associated with drug overdose showed significant morbidity, but increased mortality was seen in chemical poisoning.

Retrospective study of patients following deliberate self-poisoning admitted to Cardiff and Vale NHS critical care services between April 2006 and December 2007

There is a paucity of data regarding the demographics and the type of drugs ingested by patients who require admission to critical care following deliberate self-poisoning (DSP). Critical care admissions place a large economic burden on the health care system, and potential measures to prevent critical care admissions should be taken. Ingestion of antihypertensive medication, coma upon presentation, and presentation to the emergency department less than 2 hours after ingestion are predictive of ICU admission. Our aim was to establish the incidence of DSP, to assess the demographics, and to identify factors that may contribute to multiple admissions for DSP.