Medication Overdose Research Articles

PERFIL EPIDEMIOLÓGICO DE ADOLESCENTES COM TRANSTORNOS PSIQUIÁTRICOS ATENDIDAS EM UM PRONTO SOCORRO INFANTIL

The study investigates the epidemiological profile of adolescents with psychiatric disorders treated in a pediatric emergency room, identifying clinical and socioeconomic characteristics of the main psychiatric disorders, based on the assumption of adolescents' vulnerability to mental health issues. A retrospective analytical documentary study was conducted using electronic medical records of patients treated between January 2019 and December 2021 at the Regional Hospital of Taguatinga. Data on age, sex, reasons for attendance, diagnoses, and comorbidities were analyzed to identify patterns and correlations, contributing to the improvement of care and prevention in mental health. A total of 2000 attendances were evaluated for ages 0 to 17 years. Information was collected from the electronic medical records of patients aged 2 to 17 years. A total of 183 hospitalizations were identified over the studied period, with frequent psychotic episodes occurring in adolescents, especially at ages 12 and 13. These episodes often involved aggression, hallucinations, and self-harm, requiring multidisciplinary interventions. Anxiety disorders were also significant, with adolescents displaying early physical symptoms. Suicide attempts commonly involved medication overdose and were linked to family conflicts and trauma. The conclusion emphasizes the need for a multidisciplinary approach and early interventions to minimize risks and promote mental health.

Qualitative analysis of blood from patients engaging in deliberate self‐harm: Differences between prescribed and detected drugs

AbstractBackgroundWhile drugs are sometimes taken during deliberate self‐harm (DSH), no study has attempted to analyze drugs in the blood of DSH patients and compare them with prescribed medications or other drugs. In this study, drugs were analyzed from the blood of DSH patients, and the detected, prescribed, and suspected drugs were documented.MethodsPatients who practiced DSH and were transferred to the emergency sites of Fukuoka University Hospital between April 2021 and September 2022 participated in the study. Psychiatrists assessed information such as the history of psychiatric treatment and recent methods of DSH, as well as prescribed drugs within 1 month of presenting to the hospital. Blood samples were analyzed using LC–MS/MS. Participants were divided into groups according to whether or not they were prescribed psychotropics within 1 month.ResultsFifty‐five patients were enrolled in the study. Forty had been prescribed psychotropics within 1 month of hospital admission. However, non‐prescribed drugs (NPD) were detected in 42 of the 55 participants (76%). The detection of NPD was significantly high among patients with overdose of medications and OTC drugs (p = 0.036), but NPD were also detected in patients who engaged in other methods (n = 14), and in patients without prescribed medication (n = 10).DiscussionThis is the first study focused on the drug analysis of blood from patients engaging in DSH. Approximately 80% of the DSH patients in this study had taken NPD, revealing a large discrepancy between prescribed medications and those detected in the blood.

First Suicide Attempts in Early Adolescents: A Descriptive Outcomes Study

ObjectiveIn 2021, suicide was the second leading cause of death in early adolescent Americans ages 10-14. Research into suicidal behavior in this age group is limited. We report on prior psychiatric care, attempt method, and attempt outcomes in a cohort of 164 early adolescents accrued by first suicide attempt coming to medical attention. MethodsOur cohort constitutes a subsample from a previously reported retrospective-prospective study identified through the Rochester Epidemiology Project that recruited individuals making first suicide attempts coming to medical attention (index attempt, IA) during a 22-year period (1/1/1986-31/12/07). Among 1490 all-age index attempters followed until 12/31/2010, 164 (11.0%) were aged 10-14. Results3/164 died on IA (1.8% of the cohort; 2 females, 1 male). Nearly half (72/164, 43.9%) had no prior psychiatric history. Females were less likely than males to have seen a mental health provider (p=0.029) or been prescribed psychiatric medications (p<0.001) prior to IA. Medication overdose was the most common attempt method in females (81/128, 63.3%), while cutting or piercing wounds were the most common method in males (13/36, 36.1%). Females were significantly more likely than males to overdose (p=0.001). Of IA survivors, 19.9% (32/161) were initially medically hospitalized, 52.8% (85/161) were psychiatrically hospitalized—initially or in transfer—and 37.2% (60/161) were discharged without hospitalization. ConclusionMedication overdoses accounted for over half of all IAs and were significantly more common in females. While IA mortality was low relative to older patients from the all-age-cohort, morbidity was substantial with nearly a fifth of attempts severe enough to warrant medical hospitalization and more than half initial or eventual psychiatric hospitalization. These findings emphasize the importance of both means restriction and identification of early adolescents at risk before they make their first attempt.

Means to an end: Characteristics and follow-up of emergency department patients with a history of suicide attempt via medication overdose.

Availability and accessibility of a wide range of medications may be a contributing factor to rising medication-related overdose (OD) rates. Treatment for both suicide attempts (SAs) and ODs often occurs in the emergency department (ED), highlighting its potential as a screening and intervention point. The current study aimed to identify sociodemographic and clinical characteristics of individuals who reported SA via medication OD compared to other methods and to examine how these patients' suicide severity and behaviors differed over 12-month post-ED follow-up. Data were analyzed from Phases 1 and 2 of the Emergency Department Safety Assessment and Follow-up Evaluation multicenter study (N = 1376). Participants with a history of SA (n = 987) were categorized based on whether they indicated a past medication-related SA via OD. Of participants with history of SA, 62.7% (n = 619) reported medication OD for either their most serious or their most recent SA. Multivariate analyses indicated female birth sex, diagnosis of bipolar disorder, and having some college education were significantly associated with membership in the medication OD attempt group (p <0.05). Of those who attempted suicide over the 12-month follow-up, nearly 60% of participants in the medication OD attempt group reported a subsequent SA via OD over follow-up. However, nearly half (46.5%) of participants with no medication OD at baseline also reported medication OD at follow-up. Among patients presenting to the ED, females, individuals with bipolar disorder, and patients with a college education, respectively, may be at highest risk for SAs via medication OD. Prospectively, medication OD appears to be a frequent method, even among individuals with no prior attempt via OD, as demonstrated by the high percentage of patients who did not have a medication OD at baseline, but reported a medication OD during follow-up.

Descriptive study of suicidal behavior in adult population attended in an emergency department during a one-year period and comparative study with the following annual period

IntroductionSuicide is the most frequent psychiatric emergency. About 1% of all deaths are due to suicide so around 700,000 people commit suicide each year. Suicide attempt is more frequent in women (3:1) while completed suicide is more frequent in men (4:1). Most suicides occur in the 35-64 age range. The severity of a suicide attempt is assessed in terms of method, potential lethality, rescuability and impulsivity. A previous suicide attempt is the main risk factor for suicide behavior. The majority (more than 90%) of suicide behavior are related to an underlying psychopathology, mainly depression and substance abuse, especially alcohol. However, there are also numerous cases of impulsive attempts in the context of life stressors.ObjectivesTo analyze sociodemographic and clinical characteristics of adult patients with suicidal behavior attended in the emergency department during a one-year period. To study the stability of the data obtained in the following annual periodMethodsA retrospective review of the population over 18 years attended in the emergency department during 2022 because of suicidal behavior, was carried out. Data collection for the year 2023 is in progress in order to be able to carry out a comparative study between both annual periods.Results562 patients over 18 years were attended in the emergency department of our hospital due to suicide behavior during 2022. 383 of these patients were women (68.1%) and 179 men (31.9%). with an average age of 38.6 and 42.2 years respectively. The age range between 18 and 25 years accounted for 28.5% of the total cases. The most frequent suicidal behavior was medication overdose with a total of 307 (54.6%), being more frequent in women than in men (2.6:1). The second most frequent reason for attention was suicidal ideation without suicide attempt, with a total of 212 patients (37.7%). 371 patients were discharged home from the emergency department (66%) and 191 required a longer observation in hospital environment. We are awaiting to complete data collection for 2023 to establish a comparison with those described above.ConclusionsAccording to our study, suicidal behavior in adult population is more frequent in women than in men. The most frequent age range in both genders was between 18 and 25 years old. The method most frequently used was medication overdose and suicidal ideation without a suicide attempt was the second most frequent reason of attention. Our patients mostly presented diagnoses of personality disorder, depression and substance use disorder.Disclosure of InterestNone Declared

Euthanasia and assisted suicide in people with mental disorders: a case report

IntroductionUntil 2020, only Belgium, Luxembourg, Switzerland, and the Netherlands legalized euthanasia and assisted suicide in Europe. Spain joined this list in March 2021 with the Euthanasia Regulation Law. However, the practice of euthanasia and assisted suicide in individuals with severe mental disorders is complex due to potential cognitive and decision-making challenges. Psychiatrists play a vital role in evaluating such requests.Objectiveshe case of a patient with recurrent depressive disorder requesting euthanasia is presented, followed by a theoretical review of the subject.MethodsA case is presented with a bibliographic review.Results An 89-year-old man with a history of one prior brief psychiatric hospitalization for depression three years ago was admitted after attempting suicide with an overdose of medication. He reports depressive symptoms of several years of evolution. Medical tests came back normal, but he had a urinary catheter due to voiding issues. He was initially on a medication regimen of amitriptyline, clomethiazole, and fluvoxamine. Despite his depressive state, he maintained his cognitive and decision-making abilities. Medication adjustments were made, including discontinuing amitriptyline and switching fluvoxamine to amitriptyline. His depressive symptoms worsened after three days, leading to the addition of trazodone to his treatment. He also developed urinary symptoms and was diagnosed with a urinary tract infection and metastatic prostate cancer during urological evaluation. Emotionally, he became more apathetic, anergic, and anhedonic, frequently expressing a desire for euthanasia, even with medication changes. Hyponatremia led to the discontinuation of duloxetine and the introduction of venlafaxine. To address anxiety and sleep problems, clomethiazole was replaced with mirtazapine. Upon learning of his cancer diagnosis, his mood deteriorated further, along with increased anxiety and continued mentions of euthanasia. Lorazepam was introduced, and he was informed of his right to request euthanasia after discussing therapeutic options with urology. Following this consultation, the patient became calmer, stopped expressing thoughts of death, and began making short-term plans, including the possibility of receiving palliative care at home upon discharge.Conclusions Euthanasia and assisted suicide in severe mental disorders are complex due to ethical and medical challenges. Patients must understand their condition, prognosis, and have decision-making capacity. Assessing their suffering is crucial. Coexisting mental and organic issues complicate the request’s origin. In SMD, determining irreversibility is tricky, as these are often chronic, non-terminal conditions. Exhausting treatment options is essential before considering euthanasia, despite patient treatment refusal. Limited research underscores the need for more studies.Disclosure of InterestNone Declared

Trends in presumed drug overdose out-of-hospital cardiac arrests in San Francisco, 2015–2023

IntroductionEstimates of the prevalence of drug-related out of hospital cardiac arrest (OHCA) vary, ranging from 1.8% to 10.0% of medical OHCA. However, studies conducted prior to the recent wave of fentanyl deaths likely underestimate the current prevalence of drug-related OHCA. We evaluated recent trends in drug-related OHCA, hypothesizing that the proportion of presumed drug-related OHCA treated by emergency medical services (EMS) has increased since 2015. MethodsWe conducted a retrospective analysis of OHCA patients treated by EMS providers in San Francisco, California between 2015 and 2023. Participants included OHCA cases in which resuscitation was attempted by EMS. The study exposure was the year of arrest. Our primary outcome was the occurrence of drug-related OHCA, defined as the EMS impression of OHCA caused by a presumed or known overdose of medication(s) or drug(s). ResultsFrom 2015 to 2023, 5044 OHCA resuscitations attended by EMS (average 561 per year) met inclusion criteria. The median age was 65 (IQR 50–79); 3508 (69.6%) were male. The EMS impression of arrest etiology was drug-related in 446/5044 (8.8%) of OHCA. The prevalence of presumed drug-related OHCA increased significantly each year from 1% in 2015 to 17.6% in 2023 (p-value for trend = 0.0001). After adjustment, presumed drug-related OHCA increased by 30% each year from 2015-2023. ConclusionDrug-related OHCA is an increasingly common etiology of OHCA. In 2023, one in six OHCA was presumed to be drug related. Among participants less than 60 years old, one in three OHCA was presumed to be drug related.

Factors influencing overdose and misuse of gender-affirming medication in Chinese transgender and gender diverse individuals: a qualitative study of experience and perspectives

Background The overdose and misuse (ODM) of gender-affirming hormone treatment (GAHT) medications is common among the Chinese transgender and gender diverse (TGD) population due to a unique sociocultural and healthcare basis. However, there is no existing publication providing descriptions and interpretations of this situation among Chinese TGD people. Aims To investigate related factors, probable triggers, and causes of GAHT ODM among Chinese TGD people on a qualitative basis, and develop a corresponding framework for further studies. Methods We used an expert panel to draw up the criteria of ODM and semi-structured interviews to collect data. TGD people from mainland China were recruited online for interviews. An inductive thematic analysis was conducted using a framework method. A working analytical framework was developed based on the coding of nine randomly selected transcripts and the researchers’ discussion and experience. The framework was continuously refined and applied to code and chart all transcripts into the framework matrix. We examined all potential experiences and perspectives of participants on GAHT ODM. Results Twenty-one Chinese TGD youths (mean age 21.6, SD 3.65) with GAHT experience in the past 12 months completed eligible interviews, of whom eight were trans women, eight were trans men and five identified themselves as genderqueer or non-binary. Ten of them reported ODM according to the criteria derived from an expert panel. We extracted five domains consisting of 14 topics related to their GAHT medication behaviors, i.e. accessibility of healthcare resources, gender minority stress, online TGD communities and drug sellers, gender dysphoria and mental distress, and knowledge deficit. Conclusion This study firstly used qualitative methods to investigate GAHT ODM among Chinese TGD people, providing a framework to identify probable causes and triggers for further studies. Practitioners or psychologists can take this framework as a reference when evaluating TGD clients in order to better understand their behaviors.

Adverse Safety Events in Emergency Medical Services Care of Children With Out-of-Hospital Cardiac Arrest

Survival for children with out-of-hospital cardiac arrest (OHCA) remains poor despite improvements in adult OHCA survival. To characterize the frequency of and factors associated with adverse safety events (ASEs) in pediatric OHCA. This population-based retrospective cohort study examined patient care reports from 51 emergency medical services (EMS) agencies in California, Georgia, Oregon, Pennsylvania, Texas, and Wisconsin for children younger than 18 years with an OHCA in which resuscitation was attempted by EMS personnel between 2013 and 2019. Medical record review was conducted from January 2019 to April 2022 and data analysis from October 2022 to February 2023. Severe ASEs during the patient encounter (eg, failure to give an indicated medication, 10-fold medication overdose). A total of 1019 encounters of EMS-treated pediatric OHCA were evaluated; 465 patients (46%) were younger than 12 months. At least 1 severe ASE occurred in 610 patients (60%), and 310 patients (30%) had 2 or more. Neonates had the highest frequency of ASEs. The most common severe ASEs involved epinephrine administration (332 [30%]), vascular access (212 [19%]), and ventilation (160 [14%]). In multivariable logistic regression, the only factor associated with severe ASEs was young age. Neonates with birth-related and non-birth-related OHCA had greater odds of a severe ASE compared with adolescents (birth-related: odds ratio [OR], 7.0; 95% CI, 3.1-16.1; non-birth-related: OR, 3.4; 95% CI, 1.2-9.6). In this large geographically diverse cohort of children with EMS-treated OHCA, 60% of all patients experienced at least 1 severe ASE. The odds of a severe ASE were higher for neonates than adolescents and even higher when the cardiac arrest was birth related. Given the national increase in out-of-hospital births and ongoing poor outcomes of OHCA in young children, these findings represent an urgent call to action to improve care delivery and training for this population.

Fentanyl-Induced Serotonin Syndrome 5 Days After Cessation of Serotonergic Agents: A Case Report.

A 21-year-old patient with intellectual disability was admitted for gastroenteritis due to serotonergic medication overdose, and subsequently developed serotonin syndrome. Her symptoms initially improved after the cessation of serotonergic medications, but worsened 5 days later after fentanyl administration during general anesthesia. On emergence, she had convulsions and was nonresponsive. Subsequent imaging and electroencephalography did not demonstrate intracranial pathology or seizure activity. We suspect she had an exacerbation of her serotonin syndrome. She recovered successfully after supportive care. This case demonstrates that common medications used during anesthesia such as fentanyl can provoke serotonin syndrome, even several days after serotonergic drug discontinuation.

Ophthalmic Atropine: A Typical Anticholinergic Toxidrome From an Atypical Old Culprit.

Included on the World Health Organization Model Lists of Essential Medicines, atropine remains a cornerstone medication that is used for a myriad of clinical indications. Systemically, atropine carries indications for the treatment of asymptomatic and symptomatic bradycardia, reduction of salivation and bronchial secretions prior to surgery, and as an antidote for a variety of poisoning agents (i.e., carbamate or organophosphate insecticides, nerve agents, muscarine-containing mushrooms). Topically, atropine is administered via the ophthalmic route for the treatment of cycloplegia, mydriasis, and amblyopia or may be administered sublingually to treat chronic sialorrhea. As an anticholinergic, supratherapeutic concentrations of atropine result in a toxidrome typical of other anticholinergic medication overdoses. However, it is easy to overlook atropine as the causative agent when being administered topically, potentially resulting in an unnecessarily extensive and complicated workup. This case report describes the systemic absorption of atropine administered through the ophthalmic route at normal doses, resulting in stroke-like symptoms in an adolescent male. Upon identifying that the patient was being treated with atropine ophthalmic drops prior to hospital arrival, a dose of intravenous physostigmine was administered, resulting in complete reversal of all toxidrome symptoms.

Drugs involved in Kentucky drug poisoning deaths and relation with antecedent controlled substance prescription dispensing

BackgroundThe shift from prescription to illicit drugs involved in drug poisoning deaths raises questions about the current utility of prescription drug monitoring program (PDMP) data to inform drug poisoning (overdose) prevention efforts. In this study, we describe relations between specific drugs involved in Kentucky drug poisoning deaths and antecedent controlled substance (CS) dispensing.MethodsThe study used linked death certificates and PDMP data for 2,248 Kentucky resident drug poisoning deaths in 2021. Death certificate literal text analysis identified drugs mentioned with involvement (DMI) in drug poisoning deaths. We characterized the concordance between each DMI and the CS dispensing history for this drug at varying timepoints since 2008.ResultsOverall, 25.5% of all decedents had dispensed CS in the month before fatal drug poisoning. Over 80% of decedents were dispensed opioid(s) since 2008; the percentage was similar regardless of opioid involvement in the poisoning death. One-third of decedents had dispensed buprenorphine for treatment of opioid use disorder since 2008, but only 6.1% had dispensed buprenorphine in the month preceding death. Fentanyl/fentanyl analogs were DMI in 1,568 (69.8%) deaths, yet only 3% had received a fentanyl prescription since 2008. The highest concordance in the month preceding death was observed for clonazepam (43.6%).ConclusionOverall, concordance between CS dispensing history and the drugs involved in poisoning deaths was low, suggesting a need to reevaluate the complex relationships between prescription medication exposure and overdose death and to expand harm reduction interventions both within and outside the healthcare system to reduce drug poisoning mortality.

Types and outcome of patients with acute poisoning presenting to emergency department of Patan Hospital, Nepal

Introduction: Poisoning poses major health and health related issues with the burden of mortality and morbidity in people. Pesticides ingestion poses major burden in our part of world whereas carbon monoxide, prescribed medication overdose is more common in developed regions. This study aimed at finding the type and outcome of patients with poisoning landing in emergency room of Patan Hospital. Method: This is a retrospective observational study conducted at Patan Hospital. This study included data of patients with acute poisoning over a period of 3 years from Apr 2020 to Apr 2023, which was obtained from the nursing register books and record section. The data included information regarding demographic profile of the patient (age and sex), type of poison and outcome of the patient namely admission, referral and mortality. Result: A total of 189 cases of acute poisoning were included in the study over a period of 3 y. Female outnumbered the male with female: male ratio of 1.14:1; 90(47.61%) were seen in age group between 18-29 y. Out of them 112(59.26%) were admitted whereas 70(37.04%) were referred and 7(3%) had mortality. Organophosphate poisoning was the most common form of poison used by the patients 116(61.38%). Conclusion: Pesticides are the most common cause of acute poisoning. Most of the cases were admitted and managed in hospital, however it still poses risk of death. Early identification of the type of poisoning will help in prompt diagnosis, standard management and patient safety.

Medication overdose data analysis: a review of medication error reports in the FDA adverse event reporting system (FAERS)

Backgrounddrug overdose is a common type of medication error, which caused significant patient injuries and economic losses. To determine which drugs are reported most frequently in association with drug overdose, a comprehensive search was conducted in the FDA Adverse Event Reporting System (FAERS) database. The study also sought to determine the top 10 drugs reported with drug overdose.MethodsFAERS database was searched for drug overdose records submitted from the first quarter of 2017 to the fourth quarter of 2021. Descriptive analyses were conducted based on the total counts and percentages of reports associated with the drug. Subgroup analyses were performed on drugs of different pharmacological classifications.ResultsA total of 170,424 drug overdose reports were retrieved. The results revealed that antipyretics and analgesics took the highest risk for overdose, with 63,143 (37.05%) cases reported. Among them, opioids were associated with the most drug overdose events. The top 10 drug classes relating to drug overdose in FAERS were opioid analgesic, anilide antipyretic analgesic, 5-HT reuptake inhibitors, bronchodilators, monoclonal antibodies and antibody-drug conjugates, benzodiazepines, antipsychotics, GABA derivatives, antimanic agents, and propionic acid derivatives.Conclusionto reduce the occurrence of drug overdose events, some methods could be considered including applying a pre-prescription review system, drug safety education, developing warning lists, etc.

ID: 217168 Intrathecal Pump Refill Leading to Altered Mental Status: Diagnosis and Management of a Pocket Fill

An 83 year-old male was admitted to the ICU from an outside hospital secondary to altered mental status in the setting of an intrathecal pump. The family reported the patient was in his usual state of health until four days prior when a home health nurse refilled his intrathecal pump with hydromorphone. At the time of pump refill, there was concern for drainage from the pump site and the usual difficulty of fill due to scar anterior to the device. The patient presented that evening to a local hospital due to being sluggish but was sent home with no clear etiology identified or trigger for admission. Three days later, he returned to the local hospital due to altered mental status felt to be medication overdose. Narcan was given causing severe agitation necessitating treatment with ketamine, morphine, and lorazepam. He was then transferred to Emory University for further critical care management and evaluation for possible intrathecal pump infection versus system failure.

P4: Successful VA-Extracorporeal Membrane Oxygenation course in a patient with intentional Calcium Channel Blocker overdose without the need for mechanical ventilation

Background: Cardiovascular medication overdose constitutes about 3.5% of all drug overdoses, and carries a mortality of 16%. Calcium channel blockers (CCBs) and beta blockers account for more than 65% of these deaths. Overdose of cardiovascular medications cause impaired cardiac contractility, vasoplegia, and/or rhythm disturbances. We review the current literature and case reports of VA ECMO being utilized to support patients with cardiovascular medication overdose. Methods: We present a case of a 20-year-old female with no medical history presenting with bradycardia and hypotension after ingesting ninety ezetimibe 10mg, seventy-five nebivolol 10mg, and one hundred and eighty amlodipine 5mg, from her mother’s medication, with the intent of self harm. Patient received glucagon, calcium, lipid emulsion, and was being supported on vasopressin, norepinephrine, epienephrine, phenylephrine and dopamine. The patients HR 78 and SBP 68mmHg. Laboratory significant for leukocytosis and elevated lactic acid. On exam, patient was lethargic, without respiratory distress. Echocardiogram revealed EF 55-65% and a large right ventricular mass suspicious for atrial myxoma. Patient was initiated on peripheral Veno-Arterial ECMO using Femoral-Femoral configuration to provide circulatory support as a bridge to allow drug metabolism and clearance. Results: Following 72 hours of VA-ECMO, vasopressors were weaned, with ECMO successfully being discontinued. Throughout the ECMO course, the patient had no respiratory compromise and did not require intubation or mechanical ventilation. Following decannulation, the patient was discharged to follow for an elective resection of the atrial myxoma. Conclusion: ECMO has been reported as a rescue therapy in CCB and Beta blocker overdose when refractory to medical therapy. Conventional medical therapy includes limiting absorption, increasing elimination and hemodynamic support using vasopressor agents, intravenous (IV) calcium infusion, hyperinsulinemia therapy, glucagon infusion, and IV lipid emulsion. This unique case demonstrates the successful utilization of VA ECMO to support patients with cardiovascular medication overdose and illustrates the potential for hemodynamic support without the need for ventilator support. This is the only known report of VA ECMO being utilized for calcium channel overdose while the patient is awake and unventilated throughout their ECMO course.

ID: 215295 Targeted Drug Delivery Pump Failure Post MRI - A Sentinel Event

Intrathecal drug delivery systems (IDDS) are commonly utilized for many refractory chronic pain conditions and cancer associated pain. Manufacturer recommendations are available for physicians and MRI facilities to review prior to obtaining a scan1. We discuss a case in which IDDS malfunction occurred following MRI, despite following manufacturer instructions prior to and after MRI, resulting in profound medication overdose.

Emotional Intelligence and Quality of Life Among Substance Abuse Adults

bstract: Substance use among young people goes from experimentation to extreme substance use problems. All substance use, even test use, puts teenagers in danger of momentary issues, for example, mishaps, battles, undesirable sexual movement, and overdose. Substance use likewise meddles with young adult mental health. Teenagers are helpless against the impacts of substance use and are at expanded danger of growing long-haul outcomes, for example, emotional well-being messes, underachievement in school, a substance use issue, and higher paces of enslavement, if they routinely use liquor, cannabis, nicotine, or different medications during puberty. In present day Western culture, substance use is a simple path for young people to full-fill the typical formative need to face challenges and look for thrills. As anyone might expect, substance use is regular as young people get more seasoned, and about 70% of teenagers will attempt liquor before secondary school graduation. In any case, repeating or continuous substance utilize is considerably less normal. Indeed, even incidental substance use is dangerous and ought not be downplayed, overlooked, or permitted by grown-ups. Parental perspectives and the models that guardians set with respect to their own utilization of liquor, tobacco, professionally prescribed medications, and different substances are an incredible impact. As per public reviews, the extent of twelfth graders who report they have not utilized any substances during their life has been consistently expanding in the course of recent years. Be that as it may, simultaneously, an expansive scope of more strong and perilous items, (for example, solution narcotics, high-strength pot items, and fentanyl) has opened up. These items put youths who do begin utilizing substances at higher danger of creating both short-and long-haul results. The substances that are utilized most by youths are liquor, nicotine (in tobacco or vaping items), and pot. The aim was to study the effect substance abuse on the well- being of adolescence. Boles and miotto (2003) conducted a study on substance abuse and violence, studied that illegal medications are available in the two wrongdoers and casualties in numerous vicious occasions. The connections between psychoactive substances and savagery include expansive social and financial powers, the settings wherein individuals acquire and burn-through the substance, and the organic cycles that underlie all human conduct. On account of liquor, proof from lab and exact examinations uphold the chance of a causal part in fierce conduct. Additionally, the psychopharma-codynamics of energizers, for example, amphetamines and cocaine, likewise propose that these substances could assume a contributing part in vicious conduct. Overdose of liquor and different medications lead to extreme medical conditions and mental issues. Liquor utilizations are more pervasive in the present youth either to flaunt or to keep themselves standoffish from rest of the world. Individuals have issues identified with their work and expert life and even now and again face divisions from their friends and family. Substance misuse and substance reliance mess up mental, physical, mental, and enthusiastic prosperity of a person. The un-favourable impact of substance reliance drives Individual to carries out grievous wrongdoing, for example, assaults, murder, lewd behaviour, physical and aggressive behaviour at home, mishaps, battles and so on. Based on our findings, Emotional Intelligence was significantly correlated with Quality of Life in substance abusers. There was no major difference in the mean of the groups of Males and Females

Factitious Disorder Presenting as the Intentional Swallowing of Foreign Objects

Background: Factitious disorder (FD) imposed on self is a psychiatric disorder characterized by the intentional feigning of symptoms or the self-inflicted production of symptoms in the absence of an obvious external reward. Case: This report describes a severe case of FD imposed on self in a 31-year-old male who frequently presented to several regional Emergency Departments with intentional ingestion of foreign objects, ultimately requiring 32 esophagogastroduodenoscopy (EGD) and 28 gastroscopy procedures over two years. Significant history of frequent suicide attempts via medication overdose and clinical suspicion of drug-seeking behavior complicated the case. Motivating factors for the patient’s behavior, suicidality in FD, and thepatient’s treatment and outcome to date will be discussed. Conclusion: There is no well-established treatment for FD documented in the literature. High-quality studies and additional reports of FD could help clinicians when managing such a challenging diagnosis.

İntihar Girişimi ile Acil Servise Başvuran Hastaların Analizi

Aim: Suicide is an important public health problem worldwide. This study aims to investigate the general characteristics of patients presenting to the emergency department with a suicide attempt. Material and Methods: Patients who presented to the emergency department with a suicide attempt between 01.12.2019 and 31.05.2020 were investigated prospectively. Age, gender, vital signs, method of suicide attempt, past medical history, additional diseases, and regularly used medications were recorded. Results: The study included 247 patients. The median age of the patients was 32 (IQR 25-75: 25-41). 157 (63.6%) of the patients were female. While 222 (89.9%) of the patients attempted suicide by medication overdose, 78 (31.6%) of the patients were receiving psychiatric treatment. There was no statistically significant correlation between the suicide attempt method and the psychiatric treatment status of the patients (p&amp;gt;0.05). Similarly, no statistically significant correlation was found between the outcome of the patients and patients’ psychiatric treatment receiving status. (p&amp;gt;0.05). Conclusion: The most frequent method used for suicide in patients who presented to the emergency services with a suicide attempt is medication overuse. There is no relationship between the method of suicide attempt and the psychiatric treatment status of the patients.