Outcome Of Overdose Research Articles

Acute Calcineurin Inhibitor Overdose: Analysis of Cases Reported to a National Poison Center Between 1995 and 2011

Transplant recipients and other patients requiring immunosuppression with calcineurin inhibitors or their household contacts may be exposed to overdose. This study investigated the circumstances, pharmacokinetics and outcomes of overdose with cyclosporine and tacrolimus reported to the Swiss Toxicological Information Centre between 1995 and 2011. Of 145,396 reports by healthcare professionals, 28 (0.02%) concerned enteral or parenteral overdose with these calcineurin inhibitors. Thirteen (46%) were iatrogenic errors, 12 (43%) were with suicidal intent and 3 (11%) were accidental. Iatrogenic overdoses usually involved noncapsule drug formulations. Acute enteral overdoses caused symptoms in a dose-dependent fashion but were generally well tolerated; the mean multiple of patient's usual dose was 20.8 ± 28.8 for symptomatic versus 4.4 ± 3.4 for asymptomatic cases (p = 0.037). The most common symptoms were nausea, headache, somnolence, confusion, hypertension and renal impairment. In contrast, acute intravenous overdoses were often poorly tolerated and resulted in one fatality due to cerebral edema after a cyclosporine overdose. Enteral decontamination measures were performed in six cases involving oral ingestion and appeared to reduce drug absorption, as shown by pharmacokinetic calculations. In the one case where it was used, pharmacoenhancement appeared to accelerate tacrolimus clearance after intravenous overdose.

Patients Who Attend the Emergency Department Following Medication Overdose: Self-reported Mental Health History and Intended Outcomes of Overdose

Medication overdose is a common method of non-fatal self-harm. Previous studies have established which mental health disorders are commonly associated with the behaviour (affective, substance use, anxiety and personality disorders) and which medications are most frequently implicated (benzodiazepines, antidepressants, antipsychotics and non-opioid analgesics). However, few studies have explored patient experiences of medication overdose. We address this gap by examining patient stories of a recent medication overdose event, including severity of depression, intended outcomes and patient experiences of emergency medical care, in part to determine the unmet needs of this group of patients. Semi-structured interviews were conducted with 31 patients attending an urban Emergency Department (ED) in Melbourne, Australia, following a medication overdose regarding their mental health history, state of mind at the time of the overdose, circumstances of the overdose, and experiences of emergency medical care. Participants were heterogeneous regarding the severity of depressive symptomatology at the time of overdose. Participant ratings of how accidental or deliberate the overdose was and how strongly they intended to die were also diverse. Stories relating to the overdose usually covered the themes of precipitating events, negative feeling states, and intended outcomes (ambivalent or contradictory). Few problems were identified in relation to the care received in relation to the current overdose. However, histories of extensive mental health problems were commonly reported, along with unsuccessful treatment for these. While mental health problems are common among patients attending the ED following a medication overdose, there is considerable diversity in current levels of distress and intended outcomes, indicating a thorough suicide risk assessment is always warranted. Presentation to the ED for medication overdose should also trigger a mental health treatment review.

Is there evidence for negative effects of antidepressants on suicidality in depressive patients?

The role of antidepressants in suicide prevention is a major public health question given the high prevalence of both depression and depression-related suicidality. Therefore all available means should be utilised to clarify the influence of antidepressants on suicidality, especially in view of the ongoing intensive debate about possible suicidality-inducing effects of antidepressants that may outweigh their traditionally hypothesised beneficial effects. This paper gives a systematic and comprehensive review of the empirical data which might indicate that antidepressants have negative effects on suicidality. First, principal methodological issues related to this research question are discussed. Thereafter, the results of controlled trials and epidemiological and cohort studies are presented. Altogether, there seems to be only a small amount of evidence from different research approaches that antidepressants, not only serotonin reuptake inhibitors (SSRIs), might induce, aggravate or increase the risk of suicidal ideation and suicide attempts. As to suicide, there are no hints in this direction. TCAs have a higher risk of fatal outcome in overdose compared to SSRIs, which, in case of mono-intoxication, carry almost no risk of lethal consequences. The ongoing discussion about suicidality-inducing effects should not prevent physicians from prescribing SSRIs and other antidepressants to their patients if they are clinically indicated. However, they should take into account potential risks and manage them by good clinical practice.

Drug overdose: new insights, innovative surveillance, and promising interventions.

2 Unlike other localities, cocaine accounts for a substantial portion of overdose mortality in New York City. 3 Cocaine admissions in the city declined steadily, from 264 per 100,000 in 1996 to 166 per 100,000 in 2000 and 2001. Thus, while estimates of overdose prevalence evidence waxing and waning over the past decade, drug overdose persists as a significant cause of morbidity and mortality in our city and in many others worldwide. This issue of the Journal brings together 11 original research articles that focus attention on the persistent problem of drug overdose. These articles summarize the burden of overdose that persists worldwide, as well as promising research and interventions that may contribute to a reduction in both the incidence of overdose and its consequences. In a review, Darke and Hall, who have made seminal contributions to overdose research, summarize the known determinants of heroin overdose and suggest prin- cipal areas for urgent research—the role of polydrug use in overdose, demographics and circumstances of overdose, and interventions that can affect the incidence and outcome of overdose. Additions to this list by other contributors include the intro- duction of innovative surveillance and monitoring methods and the role of mental health conditions in the etiology of overdose. The articles that follow elaborate on these points, suggest answers, and raise more questions. Two articles in this issue highlight areas in the study of overdose demographics and their correlates that have thus far received inadequate attention. Galea et al. discuss the racial/ethnic disparities in overdose mortality in New York City during the past decade. The authors show that, although rates of overdose death were con- sistently higher among blacks and Latinos compared to whites throughout the