Suicidal Drug Overdose Research Articles

COPD, Depression and COVID-19 Pandemic: A Harrowing, Demoralizing and Deleterious Triad

COPD is a highly incapacitating global public health problem, with pulmonary and extra-pulmonary manifestations and usually associated with significant concomitant chronic diseases. With enhanced understanding, it has extensively been reported as a complex, heterogeneous and dynamic disease affecting patients’ health beyond pulmones. Depression, with prevalence of 322 million people, is a major contributor to the overall global burden of disease. In various epidemiological and clinical studies, its prevalence among patients with COPD varies from 18% to 80%. This deadly duo leads to excessive health care utilization rates and costs including increased rates of exacerbation, sub-optimal adherence to prescribed medications, increased hospital admissions, longer hospital stays and increased hospital readmissions. Moreover, there is increased risk of suicidal ideation, suicidal attempts, and suicidal drug overdose. It is a pity that, in significant cases, the co-morbidity remains under-recognized and under-treated. The impact of prevailing COVID 19 pandemic, on the dual burden of COPD and depression, and possible remedial measures including “The 6 ways to boost one’s well-being-by Mental Heath UK, “The Living with the Times” toolkit--by WHO” and innovative add-ons like Dance Movement Therapy and Musical Engagement Therapy have been discussed.

Increasing Risks of Suicide Attempt and Suicidal Drug Overdose After Head Trauma in Patients With Sleep-Disordered Breathing: A Population-Based Study.

Objective: To determine the risks of suicide attempt (SA) and suicidal drug overdose (SDO) after head trauma in patients with sleep-disordered breathing (SDB) by using the National Health Insurance Research Database of Taiwan.Methods: We analyzed the data of patients aged ≥20 years who were diagnosed with SDB between 2000 and 2012. We further divided them into two cohorts [with admission for head injury (SBI) and without (SBN)], and we compared them against sex-, age-, comorbidity-, and index-date-matched healthy individuals. The adjusted hazard ratios (aHRs) and 95% confidence intervals of SA and SDO were calculated with adjustment of age, sex, and comorbidities.Results: Approximately 0.61% of patients among the overall 142,063 patients with SDB had SA, with 535 and 335 patients included in the SBN and SBI cohorts, respectively. Compared with patients with SBN, a significantly higher risk of SA was observed in patients with SBI (aHR = 2.22), especially in those aged under 50 years (aHR = 2.48). Notably, a SDO incidence of 1.20% was noted in patients with SDB, and the SBI cohort had a 1.81-fold higher risk for SDO when compared with the SBN cohort.Conclusion: The risks of subsequent SA and SDO are proportionally increased by the effects of head trauma with a moderating role of SDB, especially in those aged <50 years. SDB and head trauma can increase suicide behaviors individually and synergistically.

Suicide Attempt and Suicidal Drug Overdose in Chronic Obstructive Pulmonary Disease Patients With or Without Depression.

BackgroundTo determine differences in the incidence and risks of suicide attempt (SA) and suicidal drug overdose (SDO) between chronic obstructive pulmonary disease (COPD) patients with and without comorbid depression by using data from Taiwan’s National Health Insurance Research Database.MethodsWe analyzed the data of patients aged ≥20 years who had received a COPD diagnosis between 2000 and 2012. These COPD patients were divided into those with and without depression, and they were compared against a cohort from the general population. We calculated adjusted hazard ratios and the corresponding 95% confidence intervals for SA and SDO in the three cohorts after adjustment for age, sex, and comorbidities.ResultsUntil the end of 2012, 5.81% of patients with COPD developed depression. The incidence of SA and SDO in COPD patients with and without depression was 29.7 and 4.69 per 10,000 person-years and 71.2 and 20.9 per 10,000 person-years, respectively. COPD patients with depression had 13.6- and 10.0-fold higher risks of SA and SDO, respectively, than did controls. Particularly, an increased risk of SA caused by the enhancement effects of depression on COPD was noted in patients aged less than 50 years.ConclusionSA and SDO risks are extremely high in Taiwanese COPD patients with depression. Our findings suggest that clinicians should be aware that for COPD patients with comorbid depression, prescribing a large amount of medications may be associated with SA risk through SDO.

Differences in Incidence and Risks of Suicide Attempt and Suicidal Drug Overdose between Patients with Epilepsy with and without Comorbid Depression.

Objective: To determine the differences in the incidences and risks of suicide attempt (SA) and suicidal drug overdose (SDO) between patients with epilepsy with and without comorbid depression by using data from Taiwan’s National Health Insurance Research Database. Methods: We analyzed data of patients (≥20 years) who had received epilepsy diagnoses between 2000 and 2012; the diagnosis date of epilepsy was defined as the index date. The epilepsy patients were divided into the cohorts, with and without comorbid depression, and compared against a cohort from the non-affected population. We calculated adjusted hazard ratios and the corresponding 95% confidence intervals for SA and SDO in the three cohorts after adjustment for age, sex, and comorbidities. Results: The incidences of SA and SDO in the cohort with epilepsy and depression were 42.9 and 97.4 per 10,000 person-years, respectively. The epilepsy with depression cohort had 21.3 times of SA risk; and 22.9 times of SDO risk than did the comparison cohort had a 6.03-fold increased risk of SA and a 2.56-fold increased risk of SDO than did the epilepsy patients without depression. Moreover, patients’ age <65 years, and female sex would further increase the risk of SA in patients with epilepsy and comorbid depression. Conclusion: Risks of SA and SDO in patients with epilepsy are proportionally increased when depression is coexisted. Our findings provide crucial information for clinicians and the government for suicide prevention and to question whether prescribing a large number of medications to patients with epilepsy and depression is safe.

Increased Risks of Suicide Attempt and Suicidal Drug Overdose Following Admission for Head Injury in Patients with Depression.

Aims: To determine the risks of suicide attempt (SA) and suicidal drug overdose (SDO) following the admission for head injury of patients with depression. Design: We analyzed the NHIRD data of patients aged ≥20 years who had received depression diagnoses between 2000 and 2010. They were divided into cohorts of those with admission for head injury (DHI) and those without it (DWI) during the follow-up period and compared against a sex-, age-, comorbidity-, and index-date-matched cohort from the general population. Setting: The Taiwan National Health Insurance Research Database (NHIRD). Participants/Cases: We analyzed the NHIRD data of patients (≥20 years) who had received depression diagnoses between 2000 and 2010. Intervention(s): Regular interventions. Measurements: We calculated the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of SA and SDO in these cohorts after adjustment for age, sex, and comorbidities. Findings: Up to the end of 2011, our results revealed extremely high incidences of SA and SDO with 63.3 and 88.6 per 10,000 person-years, respectively, in the DHI cohort. The DHI cohort had a 37.4-times higher risk for SA and a 17.1-times higher risk for SDO compared with the comparison group and had aHRs of 14.4 and 16.3, respectively, for poisoning by medicinal substances and poisoning by tranquilizers compared with patients in the DWI cohort. Patients with DHI aged <50 years, of female sex, with high incomes, living in more urbanized areas, and without other comorbidities had extraordinarily higher risks for SA. Conclusions: The risks of SA and SDO were proportionally increased by head injury in patients with depression in Taiwan. Our findings provide crucial information to implement efficient suicide prevention strategies in the future.

Suicidal drug overdose following stroke in elderly patients: a retrospective population-based cohort study.

PurposeThe purpose of this study was to investigate the incidence and risk of suicidal drug overdose (SDO) after stroke in older patients.MethodsWe enrolled patients aged 60–99 years who were diagnosed with new-onset stroke between 2002 and 2013 and age-, sex-, and index-year-matched controls who did not have stroke. Patients with a history of SDO before enrollment were excluded. Both groups were observed until December 31, 2013. The primary end point was the occurrence of newly diagnosed SDO. The cumulative incidence rates of the study and control groups were estimated using the Kaplan–Meier method. Furthermore, we used the Cox proportional hazards model to identify risk factors for SDO.ResultsWe selected 22,770 individuals. Among them, 11,385 were older patients (aged 60–99 years) who had newly diagnosed stroke and 11,385 were controls. Of the 22,770 individuals, 275 (1.21%) had SDO during a mean follow-up period of 5.33±3.30 years, comprising 191 (1.68%) from the stroke group and 84 (0.74%) from the control group. Older patients with stroke had a significantly higher risk of SDO than the controls (adjusted hazard ratio: 2.288, 95% confidence interval [CI]: 1.746–2.999, p<0.001). Moreover, in older patients with stroke, the risk significantly increased with the number of stroke events. Patients with depressive disorder or coronary disease had an increased risk of SDO. Additionally, benzodiazepines and anticoagulants were the two most commonly prescribed medications for SDO.ConclusionClinicians should be aware of the risk of SDO and risk factors in older patients with stroke. Psychological assessment and medication monitoring should be incorporated into current clinical diagnoses in neurology and treatments following stroke.

Suicidal drug overdose in patients with systemic lupus erythematosus, a nationwide population-based case-control study.

A four-fold increase of suicide mortality has been demonstrated in systemic lupus erythematosus (SLE) patients. Prior studies showed that the most common method of suicide attempts in SLE patients involves drug overdose. Therefore, we conducted a nationwide population-based case-control study to elucidate factors associated with drug overdose as suicide attempt in SLE patients. This study was based on the National Health Insurance Research Database in Taiwan. We identified all SLE patients from January 1, 2000 to December 31, 2010. Patients who had suicidal drug overdose (SDO) were selected as cases while age- and gender-matched patients who did not have SDO were selected as controls. The incidence rate of SDO in SLE patients was 291 cases per 100,000 person-years, higher than that in the general population (160 cases per 100,000 person-years). In a multivariate logistic regression analysis, we observed that SDO was associated with psychiatric disorders such as depressive disorders (odds ratio: 8.36, 95% confidence interval (CI): 5.60-12.48) and insomnia (odds ratio: 2.71, 95% CI: 1.73-4.25), and lower monthly income (odds ratios: 2.74 to 3.50) in SLE patients. SDO is associated with psychiatric disorders such as depressive disorders and insomnia, and lower monthly income in SLE patients.

Characteristics of Suicides Caused by Drug Overdose in the State of Maryland

Suicidal drug overdose is a major public health issue. In the United States, every year more than 33,000 people commit suicides. Our study focused on the characteristics of suicide victims in the state of Maryland. Material and methods: This study was a retrospective review of autopsy cases of all suicide deaths caused by drug (s) or drug (s) with alcohol intoxication investigated by the OCME in Maryland over a 7-year period from January 2004 to December 2011. All deaths investigated by the OCME that require autopsy examination are subject to comprehensive toxicology testing for drugs and alcohol. The screen tests were performed using gas chromatography (GC) and radioimmunoassay techniques. All detected drugs and/or metabolites were confirmed using GC-mass spectrometry (GC-MS). Results: From 2004 to 2011, 434 deaths were certified as suicide. Of the 434 suicidal overdose deaths, 84% were white, 11% were African-American, and about 5% were either Hispanic or Asian. The male and female ratio was almost equal. Their ages ranged 15-82 years. Of the 434 suicidal drug overdose deaths, 277 victims (63.8%) consumed a single drug type and 157 (36.2%) consumed more than one type of drug. Of the 277 single-drug overdose cases, 71.1% suicides were due to prescription drugs, 23.5% due to over-the-counter drugs, and 5.4% due to street/recreational drugs. Among single-type prescription drugs, analgesic (N = 76), antidepressant (N = 45), and neuroleptic (N = 35) classes were the three leading type of drugs used in suicidal deaths. Oxycodone, morphine, quetiapine, and amitriptyline were the most common prescription drugs in suicidal overdose. Diphenhydramine was the leading over-the-counter drug. Of the 157 victims who consumed more than one drug, combined prescription drugs were present in 54.1%, mixed prescription and over-the-counter drugs in 29.3%, and prescription drugs/over-the-counter drugs and street drugs in 16.6% of cases. Of the multiple-drug overdose suicides, 66.2% cases involved antidepressants. Discussion: Suicide is found in every age, racial, and ethnic group. In the USA, poisoning is thethird-leading method of suicide, following firearm injuries and hanging/strangulation. Our study indicates that prescription drugs, such as those in the opioid analgesic, neuroleptic, and antidepressant class (e.g., oxycodone, morphine, quetiapine, amitriptyline, doxepin, and citalopram), are of special concern in the context of suicidal overdose deaths in the state of Maryland. Therefore, addressing the problems of intentional drug overdose in our society is worthy of public attention.

The toxicity of drugs used for suicide.

Death from suicidal drug overdose differs from other forms of suicide in that the drugs are often prescribed by the patient's physician. In 1987, 3 of the 12 most commonly taken drugs in completed suicide were antidepressants (dothiepin, amitriptyline and imipramine). Antidepressants account for approximately 15% of all drug overdoses. The differences in toxicity between antidepressants have been measured using fatal toxicity indices, which relate the number of deaths and the amount of drug prescribed. Results from the United Kingdom covering the years 1975 to 1986 have shown that older tricyclic antidepressants have a fatal toxicity index 5 to 8 times higher than that of new antidepressants such as mianserin. The limitation of barbiturate prescribing has been followed by a fall in deaths from these drugs. Hopefully in the future it might be possible either to prescribe less toxic antidepressants or to identify the patients at greatest risk of drug suicide and to prescribe for them the least toxic drugs.

Chlormezanone plasma and blood levels in patients after single and repeated oral doses and after suicidal drug overdose

Chlormezanone plasma concentrations were determined in 5 volunteers (group 1) after a single oral dose of 200 mg of chlormezanone with high performance liquid chromatography. A plasma elimination half-life of 23 +/- 2.3 h was calculated. The mean peak chlormezanone plasma level was 1.86 +/- 0.2 micrograms/ml, 1 h after ingestion. Additionally, chlormezanone plasma levels were determined after repeated oral doses of chlormezanone recommended for treatment of muscular spasms due to degenerative skeletal disease. After 5 days of repeated daily doses of 3 x 200 mg (group 2; 12 patients) or 3 x 400 mg (group 3; 10 patients) of chlormezanone, mean predose chlormezanone plasma levels were 12.0 +/- 2.0 micrograms/ml (group 2) and 22.7 +/- 4.0 micrograms/ml (group 3), respectively. Comparable plasma concentrations were determined after 10 days of repeated doses of 3 x 200 mg or 3 x 400 mg of chlormezanone in 3 patients from each of these 2 groups. In 7 patients of group 3, chlormezanone had to be discontinued on the 5th day due to increasing muscular weakness, ataxia and exercise-inducible tachycardia. After a loading dose of 800 mg and repeated doses of 3 x 200 mg chlormezanone to 5 patients (group 4), plasma levels of 6.5 +/- 2.1 micrograms/ml, 8.9 +/- 2.2 micrograms/ml, 12.7 +/- 2.0 micrograms/ml, and 10.4 +/- 2.4 micrograms/ml were determined after 2, 8, 16, and 36 h, respectively. Trace amounts of a degradation product of the acid-labile chlormezanone could be detected in plasma besides the unchanged drug after administration of repeated oral doses.(ABSTRACT TRUNCATED AT 250 WORDS)

Management of Suicidal Drug Overdose

INCIDENCE AND EPIDEMIOLOGY Suicide is the third leading cause of death among adolescents, and yet for each fatality it is estimated that between 50 to 200 adolescents survive a suicide attempt. Most of the survivors have taken overdoses of drugs commonly found at home. The rate of suicide attempts that do not result in death peaks in adolescence. The male to female ratio is 1/2 and self-poisoning is usually the method. In contrast, suicide fatality rates generally increase with age. Overall, suicide is the ninth leading cause of death in the United States; the male to female ratio is 3/1; and the method used most often is fire-arms. Clearly, suicidal behavior by adolescents is a major health problem in the United States today. The usual challenge for the pediatrician is first managing an acute drug overdose and then facilitating subsequent psychosocial evaluation of the troubled youth. The key challenge is identification of disturbed individuals and their families prior to any suicidal acts. DIAGNOSIS AND PHYSIOLOGIC MANAGEMENT Most young people who present with a suicidal drug overdose are not comatose; many are asymptomatic. In such situations a careful history may be obtained from the patient to determine: the events surrounding the ingestion, which drug or drugs were taken, how much, and when the ingestion occurred.

Management of Suicidal Drug Overdose

INCIDENCE AND EPIDEMIOLOGY Suicide is the third leading cause of death among adolescents, and yet for each fatality it is estimated that between 50 to 200 adolescents survive a suicide attempt. Most of the survivors have taken overdoses of drugs commonly found at home. The rate of suicide attempts that do not result in death peaks in adolescence. The male to female ratio is 1/2 and self-poisoning is usually the method. In contrast, suicide fatality rates generally increase with age. Overall, suicide is the ninth leading cause of death in the United States; the male to female ratio is 3/1; and the method used most often is fire-arms. Clearly, suicidal behavior by adolescents is a major health problem in the United States today. The usual challenge for the pediatrician is first managing an acute drug overdose and then facilitating subsequent psychosocial evaluation of the troubled youth. The key challenge is identification of disturbed individuals and their families prior to any suicidal acts. DIAGNOSIS AND PHYSIOLOGIC MANAGEMENT Most young people who present with a suicidal drug overdose are not comatose; many are asymptomatic. In such situations a careful history may be obtained from the patient to determine: the events surrounding the ingestion, which drug or drugs were taken, how much, and when the ingestion occurred.

Argument Against Hemoperfusion in Drug Overdose

<h3>To the Editor.—</h3> The editorial by Michael C. Gelfand, MD (240:2762, 1979), in a recent issue ofThe Journalpromotes the use of charcoal hemoperfusion in patients with drug overdose and stage IV coma. This more aggressive therapeutic approach was rationalized by a mortality of 34% in such patients, as reported by Arieff and Friedman¹in 1973. In our experience, patients with severe drug overdose in stage IV coma have had a much lower mortality than that reported by these latter-mentioned authors. This has been accomplished with conservative care, an approach that others^2,3have shown results in excellent survival. At the Montreal General Hospital, we have had an ongoing prospective study of adult suicidal drug overdose, conducted by the Division of Clinical Pharmacology, which supervises patient care from admission to discharge. Data for the four-year period from 1975 to 1979 show that 942 patients came to the emergency room