Evaluation of factors related to overdose in patients with impaired consciousness who are transported by emergency medical services: an age-specific research

Abstract

Background Drug overdose accounts for most of the admissions to the emergency department. Prescription drugs, most of which are psychotropic medications, are often misused for drug overdose. The purpose of this study was to investigate the association between overdose in patients transported with disorders of consciousness and psychotropic medications administered prior to transport, so as to enable quick differentiation of drug overdose patients from patients with disorders of consciousness. Methods We evaluated 222 patients transported to the Advanced Critical Care Center of Teikyo University Hospital due to disorders of consciousness. The patients were categorized into two groups: overdose group (n = 128) and control group with other disorders of consciousness (n = 94). Logistic regression models were used to assess the association between disorders of consciousness due to drug overdose and psychotropic drugs prescribed before emergency transportation based on sex and age. Results According to multivariate logistic regression analysis, only female sex (odds ratio [OR] 4.54, 95% confidence interval [CI] 2.43–8.05, P < 0.0001) was associated with overall overdose. Results from the univariate logistic regression analysis showed that in the group of patients aged 40–50 years, female sex (OR 4.36, 95% CI; 1.54–12.4, P = 0.006) and the use of psychotropic drugs (OR 5.05, 95% CI; 1.75–14.6, P = 0.003), benzodiazepines (OR 4.64, 95% CI; 1.61–13.4, P < 0.05), antidepressants (OR 11.4, 95% CI; 2.35–55.8, P = 0.003), and anticonvulsants (OR 4.46, 95% CI; 1.11–17.9, P = 0.035) were associated with overdose. According to multivariate logistic regression analysis, female sex (OR 4.44, 95% CI; 1.37–14.3, P = 0.013) and antidepressants (OR 7.95, 95% CI; 1.21–52.1, P = 0.031) were associated with overdose patients aged 40–50 years. Conclusions As a reference in distinguishing overdose in women in their 40s and 50s who present with impaired consciousness, attention may need to be paid to the type of psychotropic drug used, especially antidepressants.

Suicidal attempts and self‐poisoning: 1‐year retrospective cohort study from the quaternary hospital in Thai metropolitan area

“…Several overdoses involved OTC and prescribed controlled substances such as benzodiazepines and psychotropic agents, similar to previous studies. 25 , 26 , 27 Because self‐harm is often impulsive, it was not surprising that the most common overdose was readily available medications.…”

Creating and evaluating the score to assess overdose: the OD score

“…The assessment items were based on the reported evidence related to suicide and overdose. The OD score was calculated based on age [ 3 , 8 ], regular use of psychotropic drugs (antipsychotics, antidepressants, mood stabilizers, and benzodiazepines) [ 5 – 7 ], history of self-harm [ 2 , 11 , 12 ] (overdose, wrist cuts, etc. ), sex [ 3 , 8 ], alcohol consumption [ 9 , 10 ], recent experience of mental anxiety [ 13 ], and a history of psychiatric consultations [ 21 ].…”

“…The OD score was calculated based on age [ 3 , 8 ], regular use of psychotropic drugs (antipsychotics, antidepressants, mood stabilizers, and benzodiazepines) [ 5 – 7 ], history of self-harm [ 2 , 11 , 12 ] (overdose, wrist cuts, etc. ), sex [ 3 , 8 ], alcohol consumption [ 9 , 10 ], recent experience of mental anxiety [ 13 ], and a history of psychiatric consultations [ 21 ]. Age was classified based on previous reports [ 3 , 8 ] and assessed considering the recent increase in overdose episodes among young people.…”

“…), sex [ 3 , 8 ], alcohol consumption [ 9 , 10 ], recent experience of mental anxiety [ 13 ], and a history of psychiatric consultations [ 21 ]. Age was classified based on previous reports [ 3 , 8 ] and assessed considering the recent increase in overdose episodes among young people. Notably, the cases of overdose are more common in women [ 3 , 8 ], self-harm has been reported tend to repeat [ 2 , 11 , 12 ], and excessive alcohol consumption has been reported to be associated with suicide [ 9 , 10 ].…”

“…In addition, there are numerous reports on the regular use of psychotropic medications (e.g., antipsychotics, antidepressants, benzodiazepines, mood stabilizers, etc.) [ 5 – 7 ], and overdose victims are typically young [ 3 , 8 ]. Moreover, there have been reports of a link between alcohol consumption and suicide [ 9 , 10 ].…”