Exploring Complexity of Deliberate Self-Poisoning through Network Analysis

Kalankesh, Leila R; Farahbakhsh, Mostafa; Fein, Rebecca; Moftian, Nazila; Nasiry, Zahra

doi:10.1155/2017/3619721

Cited by 3 publications

(3 citation statements)

References 55 publications

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“…Intentional self-poisoning occurs globally across all levels of income [5] , [6] . These self-harm episodes are not accidents; they are deliberate actions taken by patients to escape from complex and distressing life circumstances [7] . A population-based cohort study also indicated that intentional self-poisoning is a strong predictor of subsequent suicide (23%) and even premature death [8] .…”

Section: Introductionmentioning

confidence: 99%

The burden of intentional self-poisoning on a district-level public Hospital in Cape Town, South Africa

Hoving

Hunter

Gerber

et al. 2018

African Journal of Emergency Medicine

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IntroductionIntentional self-poisoning is a significant part of the toxicological burden experienced by emergency centres. The aim of this study was to describe all adults presenting with intentional self-poisoning over a six-month period to the resuscitation unit of Khayelitsha Hospital, Cape Town.MethodsAdult patients with a diagnosis of intentional self-poisoning between 1 November 2014 and 30 April 2015 were retrospectively analysed after eligible patients were obtained from the Khayelitsha Hospital Emergency Centre database. Missing data and variables not initially captured in the database were retrospectively collected by means of a chart review. Summary statistics were used to describe all variables.ResultsA total of 192 patients were included in the analysis. The mean age was 27.3 years with the majority being female (n = 132, 68.8%). HIV-infection was a comorbidity in 39 (20.3%) patients, while 13 (6.8%) previously attempted suicide. Presentations per day of the week were almost equally distributed while most patients presented after conventional office hours (n = 152, 79.2%), were transported from home (n = 124, 64.6%) and arrived by ambulance (n = 126, 65.6%). Patients spend a median time of 3h37m in the resuscitation unit (interquartile range 1 h 45 m–7 h 00 m; maximum 65 h 49 m). Patient acuity on admission was mostly low according to both the Triage Early Warning Score (non-urgent n = 100, 52.1%) and the Poison Severity Score (minor severity n = 107, 55.7%). Pharmaceuticals were the most common type of toxin ingested (261/343, 76.1%), with paracetamol the most frequently ingested toxin (n = 48, 25.0%). Eleven patients (5.7%) were intubated, 27 (14.1%) received N-acetylcysteine, and 18 (9.4%) received benzodiazepines. Fourteen (7.3%) patients were transferred to a higher level of care and four deaths (2%) were reported.DiscussionIntentional self-poisoning patients place a significant burden on emergency centres. The high percentage of low-grade acuity patients managed in a high-acuity area is of concern and should be investigated further.

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Section: Introductionmentioning

confidence: 99%

The burden of intentional self-poisoning on a district-level public Hospital in Cape Town, South Africa

Hoving

Hunter

Gerber

et al. 2018

African Journal of Emergency Medicine

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“…However, some of these barriers might be overcome by using network analysis but, to our knowledge, no independent study has employed this approach to studies of Li response. Network analysis describes a set of procedures based on the modelling of dynamic systems, and it has been employed recently in several high‐profile studies of inter‐relationships between symptoms . The technique provides a graphical representation of nodes (individual factors, objects, etc.)…”

Section: Introductionmentioning

confidence: 99%

“…The technique provides a graphical representation of nodes (individual factors, objects, etc.) and edges (associations, connections or links among those factors) and can be applied to many sets of items, including life events associated with suicide attempts and factors associated with treatment response (e.g. ).…”

Section: Introductionmentioning

confidence: 99%

Can network analysis shed light on predictors of lithium response in bipolar I disorder?

Scott

Bellivier

Manchia

et al. 2020

Acta Psychiatr Scand

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investigators involved in the ConLiGen collaboration. Can network analysis shed light on predictors of lithium response in bipolar I disorder?.Objective: To undertake a large-scale clinical study of predictors of lithium (Li) response in bipolar I disorder (BD-I) and apply contemporary multivariate approaches to account for interrelationships between putative predictors. Methods: We used network analysis to estimate the number and strength of connections between potential predictors of good Li response (measured by a new scoring algorithm for the Retrospective Assessment of Response to Lithium Scale) in 900 individuals with BD-I recruited to the Consortium of Lithium Genetics. Results: After accounting for co-associations between potential predictors, the most important factors associated with the good Li response phenotype were panic disorder, manic predominant polarity, manic first episode, age at onset between 15-32 years and family history of BD. Factors most strongly linked to poor outcome were comorbid obsessive-compulsive disorder, alcohol and/or substance misuse, and/ or psychosis (symptoms or syndromes). Conclusions: Network analysis can offer important additional insights to prospective studies of predictors of Li treatment outcomes. It appears to especially help in further clarifying the role of family history of BD (i.e. its direct and indirect associations) and highlighting the positive and negative associations of different subtypes of anxiety disorders with Li response, particularly the little-known negative association between Li response and obsessive-compulsive disorder.• Using network modelling may help clarify predictors of lithium response and understand any differences associated with two commonly employed definitions of outcome: change in illness activity or change in illness activity after consideration of potential cofounders.• The network model highlighted that whilst family history of bipolar disorders has a weak direct connection with good lithium response, it is a highly influential node in the network and is linked to other predictors such as age at onset of illness.• This study identified that obsessive-compulsive disorder was one of the most robust predictors of poor lithium response, a finding that may have been obscured in previous studies due to lack of statistical power of other analytic approaches. Limitations• We focused only on bipolar I disorder, measured treatment outcome using only one rating scale and used a strict definition good response to lithium. Using these approaches, the overall rate of good outcome was about 14%.• The original data set available for this study lacks information on some factors previously identified as being associated with good response to lithium.• We created a binary network model, which may have over-or under-estimated some co-associations between putative predictors. As such, findings will need replicating in another large-scale, independent data set.

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The clinical profile, management, and outcomes of deliberate self-poisoning in a tertiary care hospital, Pretoria, South Africa

Chacko,

Kgole,

Mpe

2024

Wits Journal of Clinical Medicine

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Introduction: Deliberate self-poisoning is a major public health problem globally and constitutes a significant proportion of emergency department presentations. The purpose of the study was to determine the clinical profile, management, and outcomes of patients admitted with deliberate self-poisoning to a tertiary public academic center in South Africa. Methods: A review of the clinical records of medical admissions for deliberate self-poisoning over one year was conducted. Results: A total of 140 patient records were analysed. The mean age of the group was 25.7 ± 9.4 years of whom 75.6% were females. The majority (96.4%) of patients were unemployed. Pharmaceutical agents were the most common (75%) form of poisoning, taken orally by most (99%). Psycho-social stressors were responsible for deliberate self-poisoning in 49% of the patients. None of the patients had evidence of significant organ dysfunction at admission. Two patients were admitted to the intensive care unit. All patients survived. The median length of stay in the hospital was 5 days (IQR 4–7 days). Treatment consisted of supportive care and, where appropriate, gastric decontamination, administration of antidotes/reversal agents, and referral to psychosocial services. Conclusion: In this study, a high proportion of the patients were female, unemployed, and single. Psycho-social stressors were the predominant reasons for deliberate self-poisoning and pharmaceutical agents were the main form of poisoning in the majority of cases. Improving the mental health and coping skills of young females could potentially reduce episodes of deliberate self-poisoning among this vulnerable group.

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Exploring Complexity of Deliberate Self-Poisoning through Network Analysis

Cited by 3 publications

References 55 publications

The burden of intentional self-poisoning on a district-level public Hospital in Cape Town, South Africa

The burden of intentional self-poisoning on a district-level public Hospital in Cape Town, South Africa

Can network analysis shed light on predictors of lithium response in bipolar I disorder?

The clinical profile, management, and outcomes of deliberate self-poisoning in a tertiary care hospital, Pretoria, South Africa

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