Toxicological features of deliberate self-poisonings

Abstract

<jats:p> Background: Deliberate self-poisoning (DSP) is a major health problem with increasing incidence mainly among young people. Objective: To examine the clinical and toxicological characteristics of DSP, it is compared to unintentional (non-DSP) exposures and those characteristics which might be associated with increased toxicological risk are identified. Methods: Two-year retrospective poison centre chart review. Statistics: χ<jats:sup>2</jats:sup> analysis. Results: 3802 DSP cases were reported. Most calls (95%) were made by physicians compared to 51%) in non-DSP exposures, P &lt;0.0001. There were almost twice as many females as males, contrary to unintentional exposures (P &lt;0.001). Peak frequency involvement was at the age of 15-20 years for females and older for males. Only 19.8%) of DSP calls were made within the first hour of exposure compared to 46%) of the non-DSP calls (P &lt;0.001). Younger patients tended to present earlier. The vast majority of exposures occurred by ingestion and at home. Pharmaceuticals and chemicals were involved in 86% and 12% of DSP cases, respectively (compared to 29% and 44% in non-DSP exposures, respectively, P &lt;0.001). Psychiatric drugs were more commonly used in older age groups and analgesics among the younger. Insecticides, sodium hypochlorite and rodenticides were the most frequently used chemicals. Neurological involvement was observed in 48.2% of DSP patients compared to 16.9% in non-DSP exposures. DSP was associated with greater severity than non-DSP exposures (21% and 10% had moderate to severe toxicity, respectively, P &lt;0.001). Severity was greater among males, aged older than 45 years, with time from exposure to consultation 8 hours or longer and with exposure to chemicals, psychiatric drugs or combinations. Conclusions: Most DSP patients were females, aged 15-20 years, used pharmaceuticals and had neurological involvement. Males, aged over 45 years, with longer time to toxicology consult and the use of chemicals were associated with increased severity. These parameters should alert the treating physician to the possibility of a poor course and hence to a more aggressive therapeutic approach. </jats:p>

Newer antidepressants: evaluation of fatal toxicity index and interaction with alcohol based on Finnish postmortem data

“…This unanticipated finding was attributed to the increased proportion of newer, less toxic antidepressants [30]. All in all, our results confirm that the newer antidepressants are much safer than other common drugs involved in fatal intoxications, and the differences in toxicity between the newer antidepressants are small.…”

Intentional Self-Poisonings and Unintentional Poisonings of Adolescents With Nonfatal Outcomes

“…This often leads to poisoning. Therefore, the poisonings during the period of adolescence represent the major problem, and the frequency is the highest in childhood and adolescence and in the preschool age in Serbia (from 2 to 7 years) (Bronstein et al, 2008;Iancu et al, 1997;Ulmeanu & Niteskcu Girnia, 2005;Bentur et al, 2008;Lifshitz & Gavrilov, 2000;Mintegi et al, 2006;Martins, de Andrade, & de Paiva, 2006;Von Mach, Habermehl, Zepp, & Weilemann, 2006;Shotar, 2005;Matteucci, 2005;Szkolnicka, Mitrus, Morawska, Satora, & Targosz, 2005;Boyanova, Loukova, Stankova, & Hubenova, 2005;Hon et al, 2005;Bentur et al, 2004). Most of our patients reported that they used alcohol and=or drugs, mostly anxiolytics, before the actual poisoning (which was the cause of the admission to the Emergency Centre).…”

Perfil das tentativas de suicídio por sobredose intencional de medicamentos atendidas por um Centro de Controle de Intoxicações do Paraná, Brasil

“…Em um estudo sobre hospitalização nas tentativas de suicídio e suicídio, Iribarren et al 28 constataram uma maior incidência entre os que usaram, como método, a ingestão de medicamentos psicotrópicos e armas de fogo, respectivamente, destacando-se o sexo feminino no primeiro grupo. Analisando apenas as hospitalizações devido a tentativas de suicídio por auto-intoxicação, Bentur et al 29 verificaram que o uso de diferentes tipos de substâncias medicamentosas correspondia a 38% dos casos, sendo encontrada uma porcentagem de 42,2% nesse estudo.…”

“…Como neste estudo foi definida a faixa etária de 20-40 anos, por ser a faixa na qual ocorre mais freqüentemente intoxicação voluntária por medicamentos segundo dados do SINITOX, não foi possível constatar diferença entre os medicamentos utilizados por indiví-duos mais jovens e mais velhos. Vários estudos mostram que os mais jovens fazem maior uso de analgésicos e outros medicamentos de venda livre, e indivíduos mais velhos, de psicofárma-cos 8,22,29 .…”