Factors associated with choice of psychotropic drugs used for intentional drug overdose

Tournier, Marie; Grolleau, A.; Cougnard, Audrey; Molimard, Mathiéu; Verdoux, Hélène

doi:10.1007/s00406-008-0839-2

Cited by 27 publications

(29 citation statements)

References 28 publications

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“…Previous studies have highlighted the importance of considering risk of IDO among patients prescribed minor tranquillisers 7 11 13. A previous Irish study found that having a prescription for a minor tranquilliser increased the risk of using a psychotropic drug in an IDO, independent of any other studied factor.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics of hospital-treated intentional drug overdose in Ireland and Northern Ireland

et al. 2014

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ObjectivesThis study compared the profile of intentional drug overdoses (IDOs) presenting to emergency departments in Ireland and in the Western Trust Area of Northern Ireland between 2007 and 2012. Specifically the study aimed to compare characteristics of the patients involved, to explore the factors associated with repeated IDO and to report the prescription rates of common drug types in the population.MethodsWe utilised data from two comparable registries which monitor the incidence of hospital-treated self-harm, recording data from deliberate self-harm presentations involving an IDO to all hospital emergency departments for the period 1 January 2007 to 31 December 2012.ResultsBetween 2007 and 2012 the registries recorded 56 494 self-harm presentations involving an IDO. The study showed that hospital-treated IDO was almost twice as common in Northern Ireland than in Ireland (278 vs 156/100 000, respectively).ConclusionsDespite the overall difference in the rates of IDO, the profile of such presentations was remarkably similar in both countries. Minor tranquillisers were the drugs most commonly involved in IDOs. National campaigns are required to address the availability and misuse of minor tranquillisers, both prescribed and non-prescribed.

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Section: Discussionmentioning

confidence: 99%

“…Analgesics such as paracetamol are also common, particularly in England 12. It has been shown that the vast majority of IDO patients take their own medication whether prescribed or available over the counter 11 13 14. The prevalence of drugs taken in IDOs has been shown to reflect their prescription and availability in the population 6 15…”

Section: Introductionmentioning

confidence: 99%

Characteristics of hospital-treated intentional drug overdose in Ireland and Northern Ireland

et al. 2014

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“…Intentional drug overdose (IDO) is the most common form of hospital-treated deliberate self-harm [3,4]. In general, psychotropic drugs, such as minor and major tranquilizers, selective serotonin reuptake inhibitors (SSRIs) and barbiturates are over-represented in IDOs [5][6][7], accounting for up to 80% of IDOs involving prescription drugs [8]. In Ireland, approximately 68% of all hospital-treated episodes of deliberate self-harm involve an IDO [3], and, of these, minor tranquilizers (benzodiazepines) are present in approximately 43% of cases [9].…”

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confidence: 99%

“…Few studies, particularly in recent years, have focused on the source of medications taken in IDO acts. It has been consistently indicated that overdose patients primarily take their own medication in IDOs [5,10,11]. In addition, individuals who engage in IDOs are more likely to be depressed and to have previously engaged in selfharm compared with other self-harm patients who do not engage in IDOs [1,10,12].…”

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confidence: 99%

Psychotropic medication involved in intentional drug overdose: implications for treatment

Corcoran¹,

Heavey²,

Griffin³

et al. 2013

Neuropsychiatry

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Aims: Limited information is available on the source of medications taken in intentional drug overdoses (IDOs). The present study aimed to investigate the proportion of patients who engaged in IDOs with current prescriptions and the proportion of those that used their medicines in overdose acts, as well as the factors associated with patients who do so. Methods: The registration systems of three hospital emergency departments

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“…1 This reflects the facts that depression is the most frequent psychiatric disorder in people dying by suicide, 118 the method used for suicidal acts is often determined by availability 11 and self-poisoning in depressed individuals often involves antidepressants prescribed for them. 119 Relative toxicity is an important factor likely to determine the outcome of an antidepressant overdose. Studies using different approaches have shown wide variation in the relative toxicity of antidepressants, 120,121 with the older TCAs generally being more toxic than the newer SSRIs.…”

Section: Introductionmentioning

confidence: 99%

A multicentre programme of clinical and public health research in support of the National Suicide Prevention Strategy for England

Gunnell

Hawton

Bennewith

et al. 2013

Programme Grants for Applied Research

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ObjectivesTo carry out a programme of linked research studies aimed at improving the management of self-harm, reducing the incidence of suicide and providing reliable data to evaluate the impact of theNational Suicide Prevention Strategy for England(2002).MethodsThere were four research streams: (1) we studied inquest records from 12 coroners and Ministry of Justice data to assess the accuracy of official suicide statistics; (2) we used Office for National Statistics mortality statistics, data from the Multicentre Study of Self-harm in England, national liver unit data, prescription data and patient interviews to assess (a) the impact of paracetamol (acetaminophen) pack size restrictions (1998), (b) the impact of withdrawal of co-proxamol in 2007 and (c) the relative toxicity in overdose of commonly used antidepressants; (3) we carried out 3-month audits of self-harm management in 32 hospitals to investigate variations between hospitals and the impact of management on repeat self-harm; and (4) we developed and piloted letter-based contact interventions aimed at reducing self-harm.Key findings(1) Between 1990 and 2005, the proportion of researcher-defined suicides given a verdict of suicide by the 12 coroners studied decreased by almost 7%, largely because of the increased use of misadventure/accident verdicts for deaths thought, on clinical review, to be suicides. Use of narrative verdicts increased markedly. Coroners who gave more narrative verdicts also gave fewer suicide verdicts, and geographical variations in the use of narrative verdicts appeared to distort reliable assessment of small-area differences in suicide rates. 2(a) UK legislation to reduce pack sizes of paracetamol was followed by a 43% reduction in number of deaths and a 61% reduction in registrations for liver transplantation over the next 11 years. Paracetamol overdoses were often impulsive and some were influenced by media (including the internet); sales outlets appeared mostly to be adhering to sales guidance. Smaller pack sizes of paracetamol for sale in Ireland compared with England did not result in a smaller number of tablets being taken in overdose. There was no clear evidence of an effect of the legislation on prescribing of non-steroidal anti-inflammatory drugs, nor on resulting gastrointestinal bleeds. 2(b) Withdrawal of co-proxamol from use in the UK resulted in approximately 600 fewer deaths than predicted between 2005 and 2010 based on previous trends, with no evidence of substitution by poisoning with other analgesics. 2(c) Of the tricyclic antidepressants, dosulepin and doxepin had the greatest toxicity. Citalopram was more toxic than other selective serotonin reuptake inhibitors. (3) There was marked variation between hospitals in the management of self-harm; effects of this variation on patient outcomes were unclear, although psychosocial assessment may have been associated with reduced repetition. Levels of specialist assessment remained static between 2001–2 and 2010–11, but service quality appeared to improve. (4) Findings of two pilot randomised controlled trials suggested that, although it would be feasible to scale up these interventions to full trials, these interventions might have low generalisability and be of limited benefit to patients.ConclusionWithin the context of the strengths and limitations of the individual studies, this research programme has made significant additions to the evidence base related to suicide and self-harm prevention in the UK.Study registrationA pilot study of a contact and information based intervention to reduce repeat self-harm; ISRCTN65171515.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Factors associated with choice of psychotropic drugs used for intentional drug overdose

Abstract: Prescription of the psychotropic drugs plays an important role in the choice of the drugs ingested for the IDO. It might make potentially "dangerous" drugs available for the patient. Physicians have always to balance the benefit of the treatment against the risk of drug overdose.

Cited by 27 publications

References 28 publications

Characteristics of hospital-treated intentional drug overdose in Ireland and Northern Ireland

Characteristics of hospital-treated intentional drug overdose in Ireland and Northern Ireland

Psychotropic medication involved in intentional drug overdose: implications for treatment

A multicentre programme of clinical and public health research in support of the National Suicide Prevention Strategy for England

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