Budapest Registry of Self-poisoned patients

The majority of persons attempting suicide are young (peak in the 17–19 age group), female (68%), otherwise healthy, and use chemicals for this purpose (self-poisoning); 98% of these persons survive. Thus, survivors of self-poisoning present a unique model for the study of somatic and germinal mutagenic effects of large doses of chemicals in human beings. This recognition prompted the establishment of the Budapest Registry of Self-poisoned Patients in 1990. The recorded 11 847 cases used 20 324 drugs in 1990–1992. Benzodiazepines were the most popular drugs for self-poisoning. International collaboration by the use of molecular epidemiological methods seems to be promising in the self-poisoning model.     

Self-poisoning with drugs: the past 20 years in Sheffield.

In Sheffield there are now over 1000 admissions to hospital each year because of self-poisoning, an increase of twentyfold over the past two decades. The city is representative of the Trent Region, and it can be confidently estimated that there are at least 100 000 cases of self-poisoning in the United Kingdom each year. Most patients are in their late teens and early twenties, and in young women self-poisoning is the most common cause of emergency admission to a medical ward. Although the drugs are usually prescribed by a doctor, patients, especially the young, are showing an increasing tendency to misappropriate drugs prescribed for others. The choice of drug is a matter of simple availability, and national trends in prescribing are reflected in the overdose figures. Barbiturates and paracetamol are responsible for the most deaths. Residence in densely populated areas may be a predisposing factor.     

Self-poisoning with Drugs: A Worsening Situation

The incidence of self-poisoning with drugs has doubled in Sheffield in the past 10 years. It now causes almost 1 in 10 of all medical admissions and one in five of all medical emergencies; it is the second most common reason for emergency admission to medical beds.The average age of the patients has fallen; one in five has previously been admitted to hospital with self-poisoning. The drugs used are normally prescribed by a doctor and the types employed reflect national prescribing trends. It is estimated that over 70,000 self-poisoning cases may be admitted to hospitals in the United Kingdom each year.     

Admissions to Hospital due to Drugs

In a survey of adverse drug reactions in wards of two Belfast hospitals for 52 weeks in 1965–6, 2·9% of 1,268 patients seen were admitted to hospital because of adverse reactions to drugs taken for therapeutic reasons and 2·1% were admitted because of self-poisoning. Patients admitted because of adverse drug reactions were older than those admitted because of self-poisoning and stayed in hospital longer. Among the drugs which caused the adverse reactions were digitalis preparations, antibiotics, corticosteroids, anticoagulants, analgesics, and tranquillizers. Hypersensitivity and side-effect types of reactions were the most common. Barbiturates were the most frequently used drugs in suicidal attempts.     

The aftermath of Angie's overdose: is soap (opera) damaging to your health?

In a study designed to evaluate the behavioural impact of a fictional parasuicide--namely, Angie''s overdose on the popular television soap opera EastEnders--information about cases of deliberate overdose treated in accident and emergency departments in 63 hospitals throughout Britain was obtained for the week after the televised overdose (experimental period) and the week before the overdose (control period). After adjusting for trends in the equivalent weeks in a control year (1985) the increase in the cases of parasuicide treated by hospitals during the experimental week was not found to be significant. A significant increase (31%) was found among people aged greater than or less than 45, but this is not thought to be reliable. The increase among women alone (21%) was significant with a one tailed test. Contrary to expectations there was a positive association between trends in overdose and distance from London--that is, the further the distance of the region from London the greater the increase in cases of overdose during the experimental period--and a negative association between trends in overdose and viewing figures--that is, the higher the viewing figure the less the impact on the incidence of overdoses. These findings do not lend support to the claim that there was a strong imitation effect after this televised parasuicide.     

Effect of Psychiatric Intervention in Attempted Suicide: A Controlled Study

All patients presenting at the casualty department of King''s College Hospital during the first six months of 1968 with deliberate self-poisoning or self-injury were followed up. Of 211 patients 204 (97%) were traced after a mean interval of 18 months (range one to two years). Despite official hospital policy, 22% had not been seen by a psychiatrist before discharge; these 44 untreated patients were compared with the remaining 160 who had received either brief (one or two interviews) or more prolonged psychiatric and social help.Subsequent suicidal attempts occurred significantly more often among untreated than among treated patients, prolonged treatment being associated with the best prognosis. The same trend was observed in respect of actual suicide, though the numbers were small and differences did not reach statistical significance. These findings held good when the untreated and treated groups were controlled for other variables which were found to be correlated with outcome. These results indicate that psychiatric intervention is associated with a significant reduction in subsequent suicidal behaviour.     

Suboptimal health and memory performance of elderly

The influence of health-related incidents on memory test performance and subjective memory ratings was assessed in a) a group of healthy older adults recruited via the register of population (group 1: N = 117, mean age 62 years, range 46-89) and b) a group of healthy older subjects having memory complaints and applying for memory training (group 2: N = 111, mean age 63 years, range 45-85). The study tries to cross-validate a previous study, where the presence and frequency of health-related incidents were related to cognitive performance. The presence of 9 categories of health-related incidents (consultation of a neurologist, systemic diseases, repeated mild concussions, repeated anaesthesia, use of psychotropic medication, alcohol use, other neurotoxic factors, such as exposure to organic solvents, psychiatric disorders, birth complications or developmental problems) was assessed in a semi-structured interview. Memory performance was assessed with a battery covering different aspects of memory. Memory self-ratings were assessed with questionnaires asking for frequencies of memory failures and a general judgement of memory capacity. Health-related incidents occurred in about half of both subject groups and were not related to age or other demographic characteristics. In both subject groups, the presence, nor the number of health-related incidents was related to memory performance or memory complaints and there was no interaction with age. The results are not in agreement with the notion that health-related indices explain age differences in cognitive performance.     

Psychological and social evaluation in cases of deliberate self-poisoning admitted to a general hospital.

In a prospective clinical trial 312 cases of self-poisoning (276 patients) consecutively admitted to hospital were randomly allocated to medical teams or to psychiatrists for an initial psychiatric assessment and a decision as to "disposal." Junior doctors and nurses received some instruction in this work. Both groups of assessors asked for help from social workers when necessary. Once the medical teams had completed their assessments, psychiatrists provided most of the hospital treatment. Follow-up at one year showed no significant difference between the two groups of patients in the numbers who repeated their self-poisoning or self-injury (or both), or committed suicide. Provided junior doctors and nurses are taught to assess self-poisoned patients, we think medical teams can evaluate the suicidal risk and identify patients requiring psychiatric treatment or help from social workers, or both. Contrary to the Department of Health''s recommendation that all cases of deliberate self-poisoning should be seen by psychiatrists, we have reached the conclusion that physicians should decide for each of their patients if specialist psychiatric advice is necessary.     

Fatal self-poisoning with lithium carbonate.

In a fatal case of self-poisoning with lithium carbonate there was a progressive increase in serum lithium concentration for 48 hours after ingestion of the overdose. It is suggested that the continuous increase in serum lithium concentration reflects prolonged absorption of lithium from relatively insoluble aggregates of lithium carbonate in the gastrointestinal tract. In this case there was an interval of 45 hours between ingestion of the overdose and the onset of central nervous system depression. Simultaneous peritoneal dialysis and hemodialysis were effective in rapidly reducing the serum lithium concentration but there was little concomitant change in the patient''s level of consciousness. The terminal event was a respiratory complication of the comatose state.     

Substance-related health problems during rave parties in The Netherlands (1997-2008)

The objective of this study was to describe a 12-year (1997-2008) observation of substance-related incidents occurring at rave parties in the Netherlands, including length of visits to first-aid stations, substances used, and severity of the incidents. During rave parties, specifically trained medical and paramedical personnel staffed first aid stations. Visitors were diagnosed and treated, and their data were recorded using standardized methods. During the 12-year period with 249 rave parties involving about 3,800,000 visitors, 27,897 people visited a first aid station, of whom 10,100 reported having a substance-related problem. The mean age of these people was 22.3+/-5.4 years; 52.4% of them were male. Most (66.7%) substance-related problems were associated with ecstasy or alcohol use or both. Among 10,100 substance-related cases, 515 required professional medical care, and 16 of these cases were life threatening. People with a substance-related problem stayed 20 min at the first aid station, which was significantly longer than the 5 min that those without a substance-related health problem stayed. These unique data from the Netherlands identify a variety of acute health problems related to the use of alcohol, amphetamines, cannabis, cocaine, ecstasy, and GHB. Although most problems were minor, people using GHB more often required professional medical care those using the other substances. We recommended adherence to harm and risk reduction policy, and the use of first aid stations with specially trained staff for both minor and serious incidents.     

Management of Type 2 Diabetes Mellitus in the Very Elderly: One Practice’s Experience

ObjectiveType 2 diabetes mellitus (T2DM) affects 25% of adults over age 65. Nevertheless, few clinical trials include patients over age 75.MethodsThis case series reports retrospective data on a cohort of 85 patients aged 80 and over (mean 88.1, range 80-104) with T2DM, managed by a single endocrinologist. The practice’s computerized data base was searched for all patients 80 years of age and older with a diagnosis of T2DM.ResultsThe major observations were the significant decrease in the use of agents associated with hypoglycemia (sulfonylureas and insulin), and the beneficial and well-tolerated use of glucagon like peptide-1 receptor analogues (GLP-1 RA). The mean A1c in the entire cohort dropped from 7.6% to 6.6% over a mean of 9 months. Nearly one-half of the cohort were treated with GLP1-RA, reflecting studies demonstrating the safety and efficacy of this class of drugs in less elderly patients. At presentation, 75% were on sulfonylurea and/or insulin; this number was reduced to 27%. Furthermore, none of the patients required short-acting (bolus) insulin to achieve the individualized A1c target.ConclusionPatients with T2DM aged 80 and over respond well to GLP1-RA drugs, drastically reducing the need for agents associated with hypoglycemia. The important question, which will require larger and prospective studies, is whether the lowering of A1c, as shown in this paper, and the use of GLP-1 RA specifically, are associated with improved morbidity and mortality in the very elderly.     

Children's multiple vitamins: overuse leads to overdose

A suburban Ontario community hospital encountered 21 ± 1 overdoses of children''s multiple vitamins yearly between 1978 and 1981. Of these, 35% involved one particular cartoon character preparation. Parents were surveyed to determine whether this particular preparation resulted in a disproportionate number of accidental overdoses. However, the use of vitamins with a cartoon character format did not lead to a greater risk of overdose than did conventional preparations. Of the 1051 families who had given multiple vitamins to their children 34 (3%) had experienced an overdose. The number of vitamin preparations used by each family was the most powerful determinant of overdose (p < 0.001). The risk of accidental overdose increased from 1.5% with one multiple-vitamin preparation to 8% with four or more preparations. Among all the variables examined, exposure was the most important element in the risk of multiple-vitamin overdose.     

Acute drug poisoning in the adult

In a prospective study of 349 patients with acute poisoning treated at The Montreal General Hospital in 1972 benzodiazepines and non-barbiturate hypnotics were found to be the most frequent putative drugs. Of the 108 patients admitted to hospital 37% had taken an overdose of a drug prescribed for them by their psychiatrist or other physician; 48% had formerly taken an overdose of drugs and 44% had had previous psychiatric treatment. Unconsciousness, respiratory depression, metabolic acidosis and acidemia, and hypokalemia were the most frequent clinical abnormalities observed. Treatment was supportive. There were six deaths. The average duration of coma was short; only five surviving patients remained unconscious for more than 24 hours. Respiratory complications were frequent.It is recommended that more attention be paid to recognizing patients whose behaviour pattern might include such an impulsive gesture, and that alternatives be found for barbiturate and non-barbiturate hypnotics.     

Gastric exocrine “failure” in critically ill patients: incidence and associated features

Following the observation that many critically ill patients cannot maintain their gastric juice pH below 4 without treatment a study was performed to measure the gastric juice pH in such patients and relate it to other clinical data. The case notes of 64 patients who had been admitted to the intensive care unit and taken part in two trials of ranitidine treatment were reviewed. During those trials gastric juice was aspirated hourly and the pH and volume measured. In this study the values recorded during a six hour untreated control phase were used. Data on age, diagnosis, treatment, outcome, episodes of hypoxia, episodes of hypotension, and use of inotropic drugs were also reviewed. Full data were available for 61 patients: 27 had a mean baseline pH of >5 during the control phase and 34 a mean baseline pH of <5. Significantly more of those with a high pH suffered hypotension (21/27 v 13/34) and received inotropic drugs (16/27 v 8/34).These findings suggest that hypotension in critically ill patients adversely affects gastric exocrine function; prophylaxis with drugs that can improve gastric mucosal blood flow may be more effective than with antacids.