Increased risk of fatal intoxication and polypharmacy among psychiatric patients at death

Mikkelsen, Christian Reuss; Hasselstrøm, Jørgen B.; Línnet, Kristían; Christoffersen, Dorte; Leth, Peter Mygind; Boel, Lene Warner Thorup; Banner, Jytte

doi:10.1111/1556-4029.14586

Cited by 7 publications

(12 citation statements)

References 33 publications

(58 reference statements)

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“…Thus, increased use of selective serotonin reuptake inhibitors (SSRIs) instead of TCAs may have decreased the occurrence of severe poisonings caused by antidepressants. Although we do not know the incidence of fatal TCA poisonings occurring outside the hospital, a report based on legal autopsies in psychiatric patients in Denmark in 2013–2015 7 found that SSRIs were detected considerably more frequently than TCAs in cases dying from poisoning. This supports that TCAs' role in poisonings is decreasing.…”

Section: Discussionmentioning

confidence: 95%

“…Furthermore, the illegal drug market in Denmark changes over time with, for example, methadone superseding heroin as the main cause of fatal poisoning in drug users 5 and new psychoactive substances (NPS) such as fentanyl analogues continuously entering the illegal drug market 6 . In addition, prescription patterns of psychotropic medications, which are often involved in poisonings, 7 may change over time. Altogether, epidemiology of poisonings is ever changing, and updated knowledge about current trends of involved drugs and demographics of patients is important to maintain quality in diagnostics and treatment, as well as to recognize potential areas for prophylactic efforts.…”

Section: Introductionmentioning

confidence: 99%

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Acute drug poisonings leading to hospitalization

Andersen

Nielsen

Møller

et al. 2021

Basic Clin Pharma Tox

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Knowledge about current trends and epidemiology in poisonings is important to maintain quality in diagnostics, treatment and prevention. We performed a cross-sectional study of all cases (n = 261) admitted with drug poisoning to Aalborg University Hospital during 1 year in 2017-2018. Median age was 30 (22-49) years, and 58% were female. Fifty percent were suicide attempts. In most cases, involved drugs were identified by history taking; blood analysis barely revealed any additional paracetamol and salicylicate poisonings. Drugs prescribed to the patient or available over the counter were involved in nearly two thirds of cases. Weak analgesics dominated by paracetamol (n = 91, 35%) was the most frequently involved group of drugs followed by opioids and benzodiazepines. Gender differences were observed with respect to involvement of weak analgesics and central stimulants. A higher prevalence of unidentified involved drugs was observed in 26 cases (10%) in which the length of admission exceeded 2 days and/or intensive care was needed. No deaths, cardiac arrhythmias or physical complications occurred. Thus, current handling of the acute poisoning seems effective in most cases. However, a more tailored use of blood analyses including a toxicological screen in selected cases may represent an opportunity for improvement.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Acute drug poisonings leading to hospitalization

Andersen

Nielsen

Møller

et al. 2021

Basic Clin Pharma Tox

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“…The results obtained in our series coincide with the figures cited above, as the simultaneous detection of MOs and BZDs was the most prevalent combination found. Nevertheless, as reported by Reuss et al [58], it is difficult to discern whether BZDs were a prescribed treatment or drug abuse. In this regard, our results confirm this situation, as the most frequently found pharmacological combination in our series was BZDs plus MOs (mainly tramadol, but also methadone and morphine).…”

Section: Discussionmentioning

confidence: 95%

Medical Psychotropics in Forensic Autopsies in European Countries: Results from a Three-Year Retrospective Study in Spain

Almeida-González

Boada

Hernández

et al. 2022

Toxics

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Medical psychotropics are widely used and prescribed in developed countries. These medications may have an impairing effect on mood or perception and may induce harmful behaviors. Nevertheless, in Europe, studies on their importance from a medico-legal perspective are scarce. To fill this gap, we evaluate the determinants of these drugs in a retrospective study based on data obtained from forensic autopsies. Toxicological analyses were performed on 394 blood samples from compulsory autopsies at the Institute of Legal Medicine of Las Palmas. Of the samples, 41% (159) were positive for at least one psychotropic, with benzodiazepines being the most frequently detected (24.1%), followed by opiates and antidepressants. Benzodiazepines, opiates, and antidepressants were detected more frequently in men who suffered a violent death. More than 30% of the positive samples showed two or more drugs, suggesting a prevalence of polypharmacy among forensic autopsy subjects, with the most frequently combination found being benzodiazepines plus opiates (28.3% of positive samples). A combination of opiates plus antidepressants was also found in subjects involved in violent deaths. Our results suggest that more than 40% of the adult European population involved in medico-legal issues may be under the influence of legal psychotropics. The link between violent deaths and the use of medical psychotropics is particularly worrisome and indicates that these drugs should be carefully monitored in developed countries, in all forensic autopsies, in a similar way to illegal psychotropics.

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“…This creates a number of issues as these are the patients that are seen increasingly in clinical practice; and who are most likely to be affected by adverse drug interactions. In particular, these issues affect a large proportion of individuals suffering from psychiatric disorders, who have an elevated risk of multimorbidity as well as a shorter life expectancy with an increased occurrence of fatal intoxication and polypharmacy ( Reuss et al., 2021 ; Kukreja et al., 2013 ; Dennis et al., 2020 ). This double burden of multimorbidity and prescription drugs is an increasing problem in the growing aging population ( Nobili et al., 2011 ; de Lima et al., 2020 ; Ersoy and Engin, 2018 ).…”

Section: Polypharmacy and Psychiatric Comorbiditiesmentioning

confidence: 99%

Targeting neurotransmitter-mediated inflammatory mechanisms of psychiatric drugs to mitigate the double burden of multimorbidity and polypharmacy

Matt

2021

Brain, Behavior, & Immunity - Health

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The increased incidence of multimorbidities and polypharmacy is a major concern, particularly in the growing aging population. While polypharmacy can be beneficial, in many cases it can be more harmful than no treatment, especially in individuals suffering from psychiatric disorders, who have elevated risks of multimorbidity and polypharmacy. Age-related chronic inflammation and immunopathologies might contribute to these increased risks in this population, but the optimal clinical management of drug-drug interactions and the neuro-immune mechanisms that are involved warrants further investigation. Given that neurotransmitter systems, which psychiatric medications predominantly act on, can influence the development of inflammation and the regulation of immune function, it is important to better understand these interactions to develop more successful strategies to manage these comorbidities and complicated polypharmacy. I propose that expanding upon research in translationally relevant human in vitro models, in tandem with other preclinical models, is critical to defining the neurotransmitter-mediated mechanisms by which psychiatric drugs alter immune function. This will define more precisely the interactions of psychiatric drugs and other immunomodulatory drugs, used in combination, enabling identification of novel targets to be translated into more efficacious diagnostic, preventive, and therapeutic interventions. This interdisciplinary approach will aid in better precision polypharmacy for combating adverse events associated with multimorbidity and polypharmacy in the future.

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Increased risk of fatal intoxication and polypharmacy among psychiatric patients at death

Cited by 7 publications

References 33 publications

Acute drug poisonings leading to hospitalization

Acute drug poisonings leading to hospitalization

Medical Psychotropics in Forensic Autopsies in European Countries: Results from a Three-Year Retrospective Study in Spain

Targeting neurotransmitter-mediated inflammatory mechanisms of psychiatric drugs to mitigate the double burden of multimorbidity and polypharmacy

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