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Andersen CU, Hansen S, Dalhoff KP, Nielsen LP, Møller JM, Olesen AE. Clinical characteristics of hospitalized patients with paracetamol poisoning before and after restrictions of over-the-counter sale of paracetamol. Clin Toxicol (Phila) 2023; 61:228-233. [PMID: 36919499 DOI: 10.1080/15563650.2023.2181104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/27/2023] [Accepted: 02/12/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Paracetamol poisoning is a frequent cause of hospitalization in Denmark. On 30 September 2013, the Danish authorities restricted packages available without a prescription in pharmacy outlets to contain a maximum of 10 g of paracetamol. We aimed to investigate the effects of this regulation. METHODS This was a cross-sectional study of two groups of patients admitted consecutively to a Danish University Hospital due to poisoning with paracetamol in 365 days in 2012-13 before 30 September 2013, and a corresponding 365-day period in 2017-18. Data were extracted from patient records. RESULTS In 2012-2013 and 2017-18, 156 and 92 admissions in 127 and 78 unique patients, respectively, were identified. Ingestion of more than 20 g paracetamol occurred in a significantly higher proportion of cases in 2012-13 compared to 2017-18 (29% vs 13%, P < 0.01). In accordance, there were no cases of international normalized ratio >1.5 or alanine aminotransferase activity >1000 U/L in the post-legislation period, and seven and five cases in the pre-legislation period, respectively. Females accounted for 80% and 78% of patients in the two periods, respectively, and were considerably younger than males (median [interquartile range]: 22 [17-40] vs. 47 [30-56], P < 0.01 in 2012-13, and 23 [18-46] vs. 43 [27-49] years, P = 0.02 in 2017-18). Furthermore, in 2012-13, intentional poisonings occurred in a higher proportion of females than males 2012-13 (97% vs 85%, P < 0.01). CONCLUSIONS The present study demonstrated a lower number of paracetamol poisonings, a decreased proportion of poisonings involving ingestion of more than 20 g of paracetamol, and a lower occurrence of hepatotoxicity after the regulation. However, circumstances other than pack size restrictions, such as increased public awareness of the danger of paracetamol poisonings, may affect these associations. Furthermore, the study showed that females and males constitute two distinct groups in terms of age and intentional poisoning.
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Affiliation(s)
- Charlotte Uggerhøj Andersen
- Department of Clinical Pharmacology, Aalborg University Hospital, Denmark
- Deartment of Clinical Medicine, Aalborg University, Denmark
- Department of Forensic Medicine, Aarhus University, Denmark
| | - Steffen Hansen
- Department of Clinical Pharmacology, Aalborg University Hospital, Denmark
| | - Kim Peder Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Denmark
- Acute and Trauma Center, Aalborg University Hospital, Denmark
| | - Lars Peter Nielsen
- Department of Clinical Pharmacology, Aalborg University Hospital, Denmark
| | | | - Anne Estrup Olesen
- Department of Clinical Pharmacology, Aalborg University Hospital, Denmark
- Deartment of Clinical Medicine, Aalborg University, Denmark
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Chidiac AS, Buckley NA, Noghrehchi F, Cairns R. Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease. Expert Opin Drug Metab Toxicol 2023; 19:297-317. [PMID: 37436926 DOI: 10.1080/17425255.2023.2223959] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/05/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Paracetamol is one of the most used medicines worldwide and is the most common important poisoning in high-income countries. In overdose, paracetamol causes dose-dependent hepatotoxicity. Acetylcysteine is an effective antidote, however despite its use hepatotoxicity and many deaths still occur. AREAS COVERED This review summarizes paracetamol overdose and toxicity (including mechanisms, risk factors, risk assessment, and treatment). In addition, we summarize the epidemiology of paracetamol overdose worldwide. A literature search on PubMed for poisoning epidemiology and mortality from 1 January 2017 to 26 October 2022 was performed to estimate rates of paracetamol overdose, liver injury, and deaths worldwide. EXPERT OPINION Paracetamol is widely available and yet is substantially more toxic than other analgesics available without prescription. Where data were available, we estimate that paracetamol is involved in 6% of poisonings, 56% of severe acute liver injury and acute liver failure, and 7% of drug-induced liver injury. These estimates are limited by lack of available data from many countries, particularly in Asia, South America, and Africa. Harm reduction from paracetamol is possible through better identification of high-risk overdoses, and better treatment regimens. Large overdoses and those involving modified-release paracetamol are high-risk and can be targeted through legislative change.
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Affiliation(s)
- Annabelle S Chidiac
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, Australia
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
| | - Nicholas A Buckley
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
- Faculty of Medicine and Health, School of Medical Sciences, Discipline of Biomedical Informatics and Digital Health, The University of Sydney, Sydney, Australia
| | - Firouzeh Noghrehchi
- Faculty of Medicine and Health, School of Medical Sciences, Discipline of Biomedical Informatics and Digital Health, The University of Sydney, Sydney, Australia
| | - Rose Cairns
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, Australia
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
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Moss RE, Hertzberg EH, Person H, Stoffels G, Zackai S, Bucuvalas J, Gillen JK. Increase in Rate of Hospitalizations for Pediatric Intentional Acetaminophen Ingestion at a Single Center During the COVID-19 Pandemic. Clin Pediatr (Phila) 2022; 62:295-300. [PMID: 36171731 PMCID: PMC10102816 DOI: 10.1177/00099228221124680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Social disruption due to COVID-19 has detrimentally affected American adolescents' emotional well-being. Within our system, pediatric acetaminophen ingestions increased in 2020, compared with previous years. We sought to evaluate the rate of hospitalizations for acetaminophen self-harm ingestions and self-harm of adolescents during the COVID-19 pandemic. STUDY DESIGN We identified patients (aged 0-23) from billing data with diagnosis of acetaminophen ingestion with self-harm intent (ICD-10 code T391X2A), from a multicenter urban, quaternary health care system. We performed retrospective chart review from 2016 to 2020 and performed statistics using a generalized estimating equation (GEE) logistic regression model. RESULTS From 2016 to 2020, there were 25 790 discharges of adolescents with 65 acetaminophen self-harm ingestion and 148 self-harm discharges. Of the 65 acetaminophen patients, 75% identified as female and 54% identified as non-white; 71% with Medicaid insurance. The proportion of acetaminophen ingestion and self-harm admissions increased from 0.13% in 2016 to 0.46% by 2020 and 0.42% in 2016 to 0.73% by 2020, respectively. The odds of acetaminophen ingestion admission increased by 28% each additional year (odds ratio = 1.28; 95% confidence interval: 1.08, 1.53; P = .006). There was not enough evidence to conclude that the log-odds of a self-harm ingestion were linearly related to time (P = .06). CONCLUSIONS Acetaminophen ingestion for self-harm has significantly increased, while overall self-harm has increased to a lesser, nonsignificant degree. Primarily females of color and those with Medicaid insurance are affected. It is important to note this growing, disturbing trend, and to continue to screen for depression in our adolescent community and ensure access to mental health resources.
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Affiliation(s)
- Rachel E. Moss
- Division of Pediatric Critical Care,
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City,
NY, USA
| | - Emily H. Hertzberg
- Division of Pediatric Hospital
Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New
York City, NY, USA
| | - Hannibal Person
- Division of Pediatric Gastroenterology
and Hepatology, Department of Pediatrics, University of Washington School of
Medicine, Seattle, WA, USA
| | - Guillaume Stoffels
- Department of Biostatistical Support,
Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Sheemon Zackai
- Division of Pediatric Critical Care,
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City,
NY, USA
| | - John Bucuvalas
- Division of Pediatric Hepatology,
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City,
NY, USA
| | - Jennifer K. Gillen
- Division of Pediatric Critical Care,
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City,
NY, USA
- Jennifer K. Gillen, Division of Pediatric
Critical Care, Department of Pediatrics, Icahn School of Medicine at Mount
Sinai, 1184 5th Avenue, P6 3-25, New York City, NY 10029, USA.
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Kummer M, Müller T, Exadaktylos AK, Krähenbühl S, Liakoni E. Characteristics of Presentations to the Emergency Department Following Attempted Suicide with Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910232. [PMID: 34639533 PMCID: PMC8508216 DOI: 10.3390/ijerph181910232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/25/2021] [Accepted: 09/26/2021] [Indexed: 12/04/2022]
Abstract
A relatively high proportion of attempted suicides employ self-poisoning with medication. Data from emergency department presentations can help to identify possible risk drug classes and provide a basis for preventive measures. This retrospective analysis included cases presenting at the emergency department of the University Hospital of Bern, Switzerland, from May 2012 to August 2016, after attempted suicide with drugs. We excluded attempted suicides with only alcohol or other non-medical substances. During the study period, there were 488 cases (466 patients) of attempted suicide with medical substances. The median patient age was 33 years (range 16–93) and 354 (73%) cases were female. The most commonly involved substances/drug classes were benzo-diazepines (n = 167, 34%), neuroleptics (n = 114, 23%) and paracetamol (n = 111, 23%). A total of 231 (47%) cases employed only a single substance. Common symptoms included somnolence (n = 245, 50%), tachycardia (n = 119, 24%) and nausea/vomiting (n = 76, 16%). In most cases, the poisoning was of minor severity (n = 231, 47%) and the patients were admitted to a psychiatric hospital (n = 264, 54%). Important preventive measures may include careful monitoring for suicidal behaviour when prescribing psychotropic drugs, in addition to restrictions in pack size. Efforts should also be made to enhance the awareness of health professionals qualified to prescribe or supply paracetamol.
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Affiliation(s)
- Mirjam Kummer
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland; (M.K.); (S.K.)
| | - Thomas Müller
- Translational Research Centre, University Hospital of Psychiatry, 3000 Bern, Switzerland;
- Privatklinik Meiringen, 3860 Meiringen, Switzerland
| | - Aristomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland;
| | - Stephan Krähenbühl
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland; (M.K.); (S.K.)
- Division of Clinical Pharmacology & Toxicology, University Hospital Basel, 4031 Basel, Switzerland
| | - Evangelia Liakoni
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland; (M.K.); (S.K.)
- Correspondence:
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Martinez-De la Torre A, Weiler S, Bräm DS, Allemann SS, Kupferschmidt H, Burden AM. National Poison Center Calls Before vs After Availability of High-Dose Acetaminophen (Paracetamol) Tablets in Switzerland. JAMA Netw Open 2020; 3:e2022897. [PMID: 33112400 PMCID: PMC7593813 DOI: 10.1001/jamanetworkopen.2020.22897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Acetaminophen (paracetamol) is among the most widely used pain medications worldwide; while safe within the therapeutic range, intake exceeding 4000 mg/d can lead to hepatotoxicity. Prior evidence suggests that limiting the availability of large quantities of acetaminophen is associated with decreased acetaminophen-related poisonings and mortality; in Switzerland, 500-mg tablets are available over-the-counter (OTC) and, as of October 2003, 1000-mg tablets are available with prescription. OBJECTIVE To evaluate the association of adding 1000-mg acetaminophen tablets to the Swiss market with utilization and poisonings. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used a quasi-experimental interrupted time series analysis to evaluate 15 790 acetaminophen poison records from January 1, 2000, to December 31, 2018. All calls for acetaminophen-related poisonings identified from the National Swiss Poisons Centre and all sales for oral acetaminophen tablets (prescription and OTC) dispensed between January 2000 and December 2018 were included. EXPOSURE October 3, 2003 (Q4 2003), was defined as the intervention date, corresponding to the date of market entry for 1000-mg acetaminophen tablets in Switzerland. MAIN OUTCOMES AND MEASURES The primary outcome was the number of quarterly acetaminophen-related poison calls to the National Poison Centre. Additional outcomes included quarterly sales for acetaminophen and change in poisoning circumstances, stratified by preintervention and postintervention periods and by formulation (ie, 500-mg and 1000-mg tablets). RESULTS Between 2000 and 2018, 15 790 acetaminophen-related poisoning calls were identified, of which 10 628 (67.3%) were regarding women, and the mean (SD) age of patients was 25.2 (18.2) years. The interrupted time series analysis identified a significant increase in the slope for the number of reported poisonings following the intervention point, particularly for accidental circumstances (z score, -3.62; P < .001). In the preintervention period, 120 of 961 poisonings (15.3%) involved a dose greater than 10 000 mg, while for the postintervention period, 1140 of 5696 (30.6%) had a dose larger than 10 000 mg (P < .001). There was a rapid uptake in 1000-mg acetaminophen sales, while sales of the 500-mg tablet decreased slightly. Since 2012, a mean (SD) of 20.7 million (1.4 million) 1000-mg tablets were dispensed quarterly compared with 2.7 million (0.5 million) 500-mg tablets. CONCLUSIONS AND RELEVANCE This study found a significant increase in acetaminophen dispensing and acetaminophen-related poisonings in Switzerland following the approval of 1000-mg tablets in 2003. The availability of 1000-mg acetaminophen should be re-evaluated to minimize the potential for accidental poisonings.
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Affiliation(s)
- Adrian Martinez-De la Torre
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Stefan Weiler
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
- National Poisons Information Centre, Tox Info Suisse, Associated Institute of the University of Zurich, Zurich, Switzerland
| | - Dominic Stefan Bräm
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | | | - Hugo Kupferschmidt
- National Poisons Information Centre, Tox Info Suisse, Associated Institute of the University of Zurich, Zurich, Switzerland
| | - Andrea M. Burden
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
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Horst S, Kawati R, Rasmusson J, Pikwer A, Castegren M, Lipcsey M. Impact of resuscitation fluid bag size availability on volume of fluid administration in the intensive care unit. Acta Anaesthesiol Scand 2018; 62:1261-1266. [PMID: 29851027 DOI: 10.1111/aas.13161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/15/2018] [Accepted: 04/16/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Iatrogenic fluid overload is associated with increased mortality in the intensive care unit (ICU). Decisions on fluid therapy may, at times, be based on other factors than physiological endpoints. We hypothesized that because of psychological factors volume of available fluid bags would affect the amount of resuscitation fluid administered to ICU patients. METHODS We performed a prospective intervention cross-over study at 3 Swedish ICUs by replacing the standard resuscitation fluid bag of Ringer's Acetate 1000 mL with 500 mL bags (intervention group) for 5 separate months and then compared it with the standard bag size for 5 months (control group). Primary endpoint was the amount of Ringer's Acetate per patient during ICU stay. Secondary endpoints were differences between the groups in cumulative fluid balance and change in body weight, hemoglobin and creatinine levels, urine output, acute kidney failure (measured as the need for renal replacement therapy, RRT) and 90-day mortality. RESULTS Six hundred and thirty-five ICU patients were included (291 in the intervention group, 344 in the control group). There was no difference in the amount of resuscitation fluid per patient during the ICU stay (2200 mL [1000-4500 median IQR] vs 2245 mL [1000-5630 median IQR]), RRT rate (11 vs 9%), 90-day mortality (11 vs 10%) or total fluid balance between the groups. The daily amount of Ringer's acetate administered per day was lower in the intervention group (1040 (280-2000) vs 1520 (460-3000) mL; P = .03). CONCLUSIONS The amount of resuscitation fluid administered to ICU patients was not affected by the size of the available fluid bags. However, altering fluid bag size could have influenced fluid prescription behavior.
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Affiliation(s)
- S. Horst
- Department of Surgical Sciences, Anesthesiology and Intensive Care; Uppsala University Hospital; Uppsala Sweden
| | - R. Kawati
- Department of Surgical Sciences, Anesthesiology and Intensive Care; Uppsala University Hospital; Uppsala Sweden
| | - J. Rasmusson
- Department of Anesthesiology and Intensive Care; Gävle County Hospital; Gävle Sweden
| | - A. Pikwer
- Centre for Clinical Research Sörmland; Uppsala University; Uppsala Sweden
| | - M. Castegren
- Perioperative Medicine and Intensive Care; Karolinska University Hospital and CLINTEC; Karolinska Institute; Stockholm Sweden
| | - M. Lipcsey
- Department of Surgical Sciences, Anesthesiology and Intensive Care; Uppsala University Hospital; Uppsala Sweden
- Hedenstierna Laboratory, CIRRUS; Department of Surgical Sciences, Anesthesiology and Intensive Care; Uppsala University Hospital; Uppsala Sweden
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Gedeborg R, Svennblad B, Holm L, Sjögren H, Bardage C, Personne M, Sjöberg G, Feltelius N, Zethelius B. Increased availability of paracetamol in Sweden and incidence of paracetamol poisoning: using laboratory data to increase validity of a population-based registry study. Pharmacoepidemiol Drug Saf 2017; 26:518-527. [PMID: 28083980 DOI: 10.1002/pds.4166] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/27/2016] [Accepted: 12/16/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE To estimate the incidence trend and outcome of paracetamol poisoning, in relation to increased availability of paracetamol from non-pharmacy outlets in 2009. METHOD Patients' serum paracetamol results over 14 years (2000-2013) from 20 (out of 21) regions in Sweden were linked to national registers of hospital care, cause of death, and prescriptions. Paracetamol poisonings were defined by serum paracetamol levels, hospital diagnoses, or cause of death. The change in incidence of poisonings following increased availability of paracetamol was analysed by using segmental regression of time series. RESULTS Of the 12 068 paracetamol poisonings, 85% were classified as intentional self-harm. Following increased availability from non-pharmacy outlets, there was a 40.5% increase in the incidence of paracetamol poisoning, from 11.5/100 000 in 2009 to 16.2/100 000 in 2013. Regression analyses indicated a change in the trend (p < 0.0001) but not an immediate jump in the incidence (p = 0.5991) following the increased availability. Adjusting for trends in hospital episodes for self-harm, suicides, and the sales volume of paracetamol did not influence the result. All-cause mortality at 30 days (3.2%) did not change over time. CONCLUSIONS The incidence of paracetamol poisoning in Sweden has increased since 2009, contrasting the decreased incidence in the period of 2007-2009. The change in trend was temporally associated with the introduction of availability of paracetamol from non-pharmacy outlets but did not appear to be related to sales volume of paracetamol or general trends in self-harm or suicides. © 2017 Commonwealth of Australia. Pharmacoepidemiology and Drug Safety © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Rolf Gedeborg
- Department of Scientific Expertise, Medical Products Agency, Uppsala, Sweden
| | - Bodil Svennblad
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Lennart Holm
- Department of Usage, Medical Products Agency, Uppsala, Sweden
| | - Hans Sjögren
- Department of Efficacy and Safety 1, Medical Products Agency, Uppsala, Sweden
| | - Carola Bardage
- Department of Usage, Medical Products Agency, Uppsala, Sweden
| | - Mark Personne
- Swedish Poisons Information Centre, Medical Products Agency, Uppsala, Sweden
| | - Gunilla Sjöberg
- Swedish Poisons Information Centre, Medical Products Agency, Uppsala, Sweden
| | - Nils Feltelius
- Department of Scientific Expertise, Medical Products Agency, Uppsala, Sweden
| | - Björn Zethelius
- Department of Scientific Expertise, Medical Products Agency, Uppsala, Sweden
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Windfuhr K, While D, Hunt IM, Shaw J, Appleby L, Kapur N. Suicide and accidental deaths in children and adolescents in England and Wales, 2001-2010. Arch Dis Child 2013; 98:945-50. [PMID: 24013808 DOI: 10.1136/archdischild-2012-302539] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the impact of narrative verdicts on suicide statistics among 10-19-year-olds; to identify the number and rate of suicide and accidental deaths, particularly in 10-14-year-olds. DESIGN National cohort study. SETTING England and Wales. METHODS Mid-year population estimates from the Office for National Statistics (ONS) were used to calculate rates per 100,000 population for suicide (undetermined and suicide verdicts) and accidental deaths (poisoning, hanging) for those aged 10-14 and 15-19. Trends in rates over time (2001-2010) were investigated using Poisson regression. Interaction tests were carried out to determine differences in trends between the two time periods (2001-2005 and 2006-2010). RESULTS There were 1523 suicides (2.25/100,000). Suicide rates were highest in those aged 15-19 years (4.04/100,000) and in males (3.14/100,000). Between 2001 and 2010, rates significantly decreased among those aged 15-19 years (incidence rate-ratio (IRR): 0.95; 95% CI 0.93 to 0.97), with no change in rates of accidental deaths (IRR: 1.01, 95% CI 0.95 to 1.07). However, there was a significant interaction between the two time periods for accidental poisonings (2001-2005: IRR: 0.79 (95% CI 0.69 to 0.91); 2006-2010: IRR: 1.01 (95% CI 0.89 to 1.15), interaction p=0.012) and accidental hangings (2001-2005: IRR: 0.93 (95% CI 0.76 to 1.14); 2006-2010: IRR: 1.25 (95% CI 1.04 to 1.49), interaction=0.01) Undetermined deaths significantly decreased among females aged 15-19 yeras (IRR: 0.93; 95% CI 0.88 to 0.98). There were no significant trends among 10-14-year-olds. CONCLUSIONS Rates of suicide are higher among older adolescents and males. There was a significant fall in suicide rates in males aged 15-19 years that was not accounted for by changes in rates of accidental death. The absence of a significant trend in suicide or accidental deaths in those aged 10-14 years may have been the result of small numbers. However, monitoring should continue to identify longitudinal trends in all young people.
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Affiliation(s)
- Kirsten Windfuhr
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Risk, Institute of Brain, Behaviour and Mental Health, University of Manchester, , Manchester, UK
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Bernal W, Hyyrylainen A, Gera A, Audimoolam VK, McPhail MJW, Auzinger G, Rela M, Heaton N, O'Grady JG, Wendon J, Williams R. Lessons from look-back in acute liver failure? A single centre experience of 3300 patients. J Hepatol 2013; 59:74-80. [PMID: 23439263 DOI: 10.1016/j.jhep.2013.02.010] [Citation(s) in RCA: 264] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/11/2013] [Accepted: 02/12/2013] [Indexed: 12/04/2022]
Abstract
BACKGROUND & AIMS Acute liver failure (ALF) is a rapidly progressive critical illness with high mortality. Complex intensive care unit (ICU) protocols and emergency liver transplantation (ELT) are now often available, but rarity and severity of illness have limited its study and evidence-base for care. We reviewed patients treated over a 35-year period at a specialist high-volume ICU, quantifying changes in disease aetiology, severity and evolution of ICU support and ELT use and outcome. METHODS Review of adult patients admitted during the period 1973-2008, with acute liver dysfunction and coagulopathy with overt hepatic encephalopathy (ALF) and those without (acute liver injury; ALI). RESULTS 3305 patients fulfilled inclusion criteria, 2095 with ALF. Overall hospital survival increased from 30% in 1973-78 to 76% in 2004-08; in ALF from 17% to 62% (both p<0.0001). In ALF patients treated without ELT, survival rose from 17% to 48% (p<0.0001); in those undergoing ELT (n=387) from 56% in 1984-88 to 86% in 2004-08 (p<0.01). Coincident with drug sales-restriction, paracetamol-related admissions fell significantly. Viral admissions fell from 56% to 17% of non-paracetamol cases (p<0.0001). Admission markers of liver injury severity fell significantly and the proportion of patients with intracranial hypertension (ICH) fell from 76% in 1984-88 to 20% in 2004-08 (p<0.0001). In those with ICH, mortality fell from 95% to 55% (p<0.0001). CONCLUSIONS The nature and outcome of ALF have transformed over 35 years, with major improvements in survival and a fall in prevalence of cerebral oedema and ICH, likely consequent upon earlier illness recognition, improved ICU care, and use of ELT.
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Affiliation(s)
- William Bernal
- Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London, United Kingdom.
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Kjartansdottir I, Bergmann OM, Arnadottir RS, Björnsson ES. Paracetamol intoxications: a retrospective population-based study in Iceland. Scand J Gastroenterol 2012; 47:1344-52. [PMID: 22827594 DOI: 10.3109/00365521.2012.703236] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Paracetamol is the most common cause of acute liver failure (ALF) in many countries. Much data on paracetamol toxicity originate from liver transplant centers and tertiary referral institutions. The authors analyzed the population-based annual incidence of paracetamol overdoses and ALF, and described the risk factors for hepatotoxicity. METHODS A search was undertaken for the diagnosis of paracetamol overdoses in the diagnoses registry of the National University Hospital of Iceland from 2004 to 2009 serving a population of 219,249 inhabitants. Relevant information was collected from medical records. RESULTS A total of 1913 drug-related poisoning episodes were identified and reviewed, 352 (18%) involved paracetamol overdoses. The annual incidence of paracetamol overdoses declined from 30.0 (2004) to 16.0/100,000 per year (2009) (p < 0.05). The female/male ratio was 3.0 and the largest age group was 16-25 years. After the initial examination, 26% were discharged home. Hospitalized index visits were 182 with accidental overdoses constituting 16 (9%) with no gender difference. Compared with intentional overdose the accidental group had higher aminotransferases (p < 0.005). ALF occurred in 3.8% (7/182) of the index visits and the incidence was 0.7/100,000 per year. In the intentional group, 1.2% (2/163) developed ALF versus 25% (4/16) of the accidental group (p = 0.001). Only one patient died from ALF and none underwent liver transplantation. CONCLUSION The annual incidence of paracetamol overdoses was high in this population-based study but declined. Young females with intentional overdose accounted for most of the cases, whereas accidental overdoses were more common in older patients. The occurrence of ALF was low and mostly associated with accidental overdose.
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Simkin S, Hawton K, Kapur N, Gunnell D. What can be done to reduce mortality from paracetamol overdoses? A patient interview study. QJM 2012; 105:41-51. [PMID: 21856743 DOI: 10.1093/qjmed/hcr135] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Paracetamol (acetaminophen) is the most common self-poisoning agent in the UK and a leading cause of fatal hepatotoxicity. Following legislation in 1998 to limit pack sizes, beneficial effects on paracetamol-related mortality and morbidity were reported in England. However, there are still over 100 deaths a year and evidence of breaches of sales guidelines. AIM To investigate characteristics of people taking larger paracetamol overdoses and compliance with sales guidelines, to inform possible further initiatives to reduce paracetamol fatalities. DESIGN AND METHODS Interview study of 60 general hospital patients who took overdoses of over 16 paracetamol tablets (8 g). RESULTS Half of all paracetamol overdoses involved over 16 tablets. Patients were predominantly young (three-quarters aged 16-40 years) and female (58.3%); over half (53.3%) had taken a previous paracetamol overdose. Three-quarters said they wanted to die. Half took the overdose within an hour of first thinking of it, half (53.3%) took tablets already in the home and 58.3% bought tablets specifically for the overdose. Ten people tried to buy more than 32 tablets in one transaction; four succeeded. Most knew that a paracetamol overdose could cause death or permanent damage (88.3%) and harm the liver (80.0%) but 70.0% thought they would lose consciousness. Warnings on packs had little deterrent effect. Media and internet influences were identified. Patients chose paracetamol because it was cheap and easily available. CONCLUSIONS Further measures to reduce breaches of sales guidelines and the dangers of paracetamol overdose are required. Media and internet site producers should follow guidelines on reporting suicide.
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Affiliation(s)
- S Simkin
- Centre for Suicide Research, University of Oxford, Department of Psychiatry, Warneford Hospital, Headington, Oxford, OX3 7JX, UK
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Iqbal M, Cash WJ, Sarwar S, McCormick PA. Paracetamol overdose: the liver unit perspective. Ir J Med Sci 2011; 181:439-43. [DOI: 10.1007/s11845-011-0783-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 11/01/2011] [Indexed: 01/01/2023]
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Ougrin D, Banarsee R, Dunn-Toroosian V, Majeed A. Suicide survey in a London borough: primary care and public health perspectives. J Public Health (Oxf) 2010; 33:385-91. [PMID: 21059687 DOI: 10.1093/pubmed/fdq094] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In order to achieve the national target of 20% reduction in suicide in the UK, many primary care trusts have developed local suicide prevention action plans. However, there is concern about a lack of a whole-system approach in some localities. Suicide surveys are a necessary component of any suicide reduction strategy. METHODS All deaths by suicides and open verdicts of a multi-ethnic, socio-economically diverse London Borough's residents between February 2005 and February 2008 were identified (n = 54). Health records of the identified subjects were analysed by two researchers. RESULTS The annual rate of suicide in the study period was 6.8 per 100 000 inhabitants. Of the 54 cases of suicide in the study period, 45% had a psychiatric diagnosis and 18% were in current contact with mental health services. Hanging was the most frequent mode of suicide. Twenty-four per cent were not registered with a GP, most of whom were immigrants. Twenty-five per cent had seen their GP within a month of suicide. The rate of suicide in those born in Ireland was 17.7 per 100 000. CONCLUSIONS Suicide survey is a feasible method of monitoring suicide, sharing data between key stakeholders and learning from the trends uncovered.
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Affiliation(s)
- Dennis Ougrin
- King's College London, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, PO 85, De Crespigny Park, London SE5 8AF, UK.
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Millson C. Update on liver transplantation. Br J Hosp Med (Lond) 2010; 70:692-7. [PMID: 20081614 DOI: 10.12968/hmed.2009.70.12.45505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Indications for liver transplant are expanding and most patients can expect a long-term successful outcome. Who should receive this life-saving gift and how should they be managed in an era of diminishing donors and increasing demand?
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Khan LR, Oniscu GC, Powell JJ. Long-term outcome following liver transplantation for paracetamol overdose. Transpl Int 2009; 23:524-9. [DOI: 10.1111/j.1432-2277.2009.01007.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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17
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Myers RP, Leung Y, Shaheen AAM, Li B. Validation of ICD-9-CM/ICD-10 coding algorithms for the identification of patients with acetaminophen overdose and hepatotoxicity using administrative data. BMC Health Serv Res 2007; 7:159. [PMID: 17910762 PMCID: PMC2174469 DOI: 10.1186/1472-6963-7-159] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 10/02/2007] [Indexed: 01/13/2023] Open
Abstract
Background Acetaminophen overdose is the most common cause of acute liver failure (ALF). Our objective was to develop coding algorithms using administrative data for identifying patients with acetaminophen overdose and hepatic complications. Methods Patients hospitalized for acetaminophen overdose were identified using population-based administrative data (1995–2004). Coding algorithms for acetaminophen overdose, hepatotoxicity (alanine aminotransferase >1,000 U/L) and ALF (encephalopathy and international normalized ratio >1.5) were derived using chart abstraction data as the reference and logistic regression analyses. Results Of 1,776 potential acetaminophen overdose cases, the charts of 181 patients were reviewed; 139 (77%) had confirmed acetaminophen overdose. An algorithm including codes 965.4 (ICD-9-CM) and T39.1 (ICD-10) was highly accurate (sensitivity 90% [95% confidence interval 84–94%], specificity 83% [69–93%], positive predictive value 95% [89–98%], negative predictive value 71% [57–83%], c-statistic 0.87 [0.80–0.93]). Algorithms for hepatotoxicity (including codes for hepatic necrosis, toxic hepatitis and encephalopathy) and ALF (hepatic necrosis and encephalopathy) were also highly predictive (c-statistics = 0.88). The accuracy of the algorithms was not affected by age, gender, or ICD coding system, but the acetaminophen overdose algorithm varied between hospitals (c-statistics 0.84–0.98; P = 0.003). Conclusion Administrative databases can be used to identify patients with acetaminophen overdose and hepatic complications. If externally validated, these algorithms will facilitate investigations of the epidemiology and outcomes of acetaminophen overdose.
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Affiliation(s)
- Robert P Myers
- Liver Unit, Division of Gastroenterology, Department of Medicine; University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences; University of Calgary, Calgary, Alberta, Canada
| | - Yvette Leung
- Liver Unit, Division of Gastroenterology, Department of Medicine; University of Calgary, Calgary, Alberta, Canada
| | - Abdel Aziz M Shaheen
- Liver Unit, Division of Gastroenterology, Department of Medicine; University of Calgary, Calgary, Alberta, Canada
| | - Bing Li
- Department of Community Health Sciences; University of Calgary, Calgary, Alberta, Canada
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Myers RP, Li B, Fong A, Shaheen AAM, Quan H. Hospitalizations for acetaminophen overdose: a Canadian population-based study from 1995 to 2004. BMC Public Health 2007; 7:143. [PMID: 17615056 PMCID: PMC1931590 DOI: 10.1186/1471-2458-7-143] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Accepted: 07/05/2007] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acetaminophen overdose (AO) is the most common cause of acute liver failure. We examined temporal trends and sociodemographic risk factors for AO in a large Canadian health region. METHODS 1,543 patients hospitalized for AO in the Calgary Health Region (population ~1.1 million) between 1995 and 2004 were identified using administrative data. RESULTS The age/sex-adjusted hospitalization rate decreased by 41% from 19.6 per 100,000 population in 1995 to 12.1 per 100,000 in 2004 (P < 0.0005). This decline was greater in females than males (46% vs. 29%). Whereas rates fell 46% in individuals under 50 years, a 50% increase was seen in those >/= 50 years. Hospitalization rates for intentional overdoses fell from 16.6 per 100,000 in 1995 to 8.6 per 100,000 in 2004 (2004 vs. 1995: rate ratio [RR] 0.49; P < 0.0005). Accidental overdoses decreased between 1995 and 2002, but increased to above baseline levels by 2004 (2004 vs. 1995: RR 1.24;P < 0.0005). Risk factors for AO included female sex (RR 2.19; P < 0.0005), Aboriginal status (RR 4.04; P < 0.0005), and receipt of social assistance (RR 5.15; P < 0.0005). CONCLUSION Hospitalization rates for AO, particularly intentional ingestions, have fallen in our Canadian health region between 1995 and 2004. Young patients, especially females, Aboriginals, and recipients of social assistance, are at highest risk.
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Affiliation(s)
- Robert P Myers
- Liver Unit, Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences; University of Calgary, Calgary, Alberta, Canada
| | - Bing Li
- Department of Community Health Sciences; University of Calgary, Calgary, Alberta, Canada
| | - Andrew Fong
- Department of Community Health Sciences; University of Calgary, Calgary, Alberta, Canada
| | - Abdel Aziz M Shaheen
- Liver Unit, Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Hude Quan
- Department of Community Health Sciences; University of Calgary, Calgary, Alberta, Canada
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Morgan OW, Griffiths C, Majeed A. Interrupted time-series analysis of regulations to reduce paracetamol (acetaminophen) poisoning. PLoS Med 2007; 4:e105. [PMID: 17407385 PMCID: PMC1845154 DOI: 10.1371/journal.pmed.0040105] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Accepted: 01/30/2007] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Paracetamol (acetaminophen) poisoning is the leading cause of acute liver failure in Great Britain and the United States. Successful interventions to reduced harm from paracetamol poisoning are needed. To achieve this, the government of the United Kingdom introduced legislation in 1998 limiting the pack size of paracetamol sold in shops. Several studies have reported recent decreases in fatal poisonings involving paracetamol. We use interrupted time-series analysis to evaluate whether the recent fall in the number of paracetamol deaths is different to trends in fatal poisoning involving aspirin, paracetamol compounds, antidepressants, or nondrug poisoning suicide. METHODS AND FINDINGS We calculated directly age-standardised mortality rates for paracetamol poisoning in England and Wales from 1993 to 2004. We used an ordinary least-squares regression model divided into pre- and postintervention segments at 1999. The model included a term for autocorrelation within the time series. We tested for changes in the level and slope between the pre- and postintervention segments. To assess whether observed changes in the time series were unique to paracetamol, we compared against poisoning deaths involving compound paracetamol (not covered by the regulations), aspirin, antidepressants, and nonpoisoning suicide deaths. We did this comparison by calculating a ratio of each comparison series with paracetamol and applying a segmented regression model to the ratios. No change in the ratio level or slope indicated no difference compared to the control series. There were about 2,200 deaths involving paracetamol. The age-standardised mortality rate rose from 8.1 per million in 1993 to 8.8 per million in 1997, subsequently falling to about 5.3 per million in 2004. After the regulations were introduced, deaths dropped by 2.69 per million (p = 0.003). Trends in the age-standardised mortality rate for paracetamol compounds, aspirin, and antidepressants were broadly similar to paracetamol, increasing until 1997 and then declining. Nondrug poisoning suicide also declined during the study period, but was highest in 1993. The segmented regression models showed that the age-standardised mortality rate for compound paracetamol dropped less after the regulations (p = 0.012) but declined more rapidly afterward (p = 0.031). However, age-standardised rates for aspirin and antidepressants fell in a similar way to paracetamol after the regulations. Nondrug poisoning suicide declined at a similar rate to paracetamol after the regulations were introduced. CONCLUSIONS Introduction of regulations to limit availability of paracetamol coincided with a decrease in paracetamol-poisoning mortality. However, fatal poisoning involving aspirin, antidepressants, and to a lesser degree, paracetamol compounds, also showed similar trends. This raises the question whether the decline in paracetamol deaths was due to the regulations or was part of a wider trend in decreasing drug-poisoning mortality. We found little evidence to support the hypothesis that the 1998 regulations limiting pack size resulted in a greater reduction in poisoning deaths involving paracetamol than occurred for other drugs or nondrug poisoning suicide.
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Affiliation(s)
- Oliver W Morgan
- Department of Primary Care and Social Medicine, Imperial College London, United Kingdom.
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Abstract
The authors discuss a new study that examined the change in deaths attributed to paracetamol poisoning in England and Wales in the six years before and after a legislated reduction in the maximum pack size.
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Affiliation(s)
- Nicholas A Buckley
- Department of Clinical Pharmacology and Toxicology, Australian National University Medical School, Canberra, Australian Capital Territory, Australia.
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Bateman DN, Gorman DR, Bain M, Inglis JHC, House FR, Murphy D. Legislation restricting paracetamol sales and patterns of self-harm and death from paracetamol-containing preparations in Scotland. Br J Clin Pharmacol 2007; 62:573-81. [PMID: 17061964 PMCID: PMC1885177 DOI: 10.1111/j.1365-2125.2006.02668.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS To describe how changes in legislation to restrict paracetamol sales have affected overdose discharges and death associated with the drug in Scotland. METHODS A descriptive analysis of routine death and hospital discharge data for the entire Scottish population between 1995 and 2004. Patients in Scotland participated who were discharged from hospital with a diagnosis of poisoning; deaths in Scotland from diagnosis of poisoning 1995-2003 were also analysed. Outcome measures were changes in mortality and overdose due to poisoning involving paracetamol. A comparison was made of in-hospital and out-of-hospital mortality in fatalities involving paracetamol. RESULTS The majority of paracetamol-associated deaths were due to co-proxamol. Deaths associated with paracetamol alone or with ethanol occurred principally in hospital and were a minority of deaths overall. The proportion of in-hospital deaths attributed to paracetamol increased (post/pre ratio 1.347; 95% confidence interval 1.076, 1.639; P = 0.013). Overall numbers of cases discharged with poisoning fell. The proportion of these involving paracetamol in any form increased significantly in all groups except young men aged 10 to <20 years. CONCLUSIONS Legislation has not reduced mortality or proportional use of paracetamol in overdose, both of which appear to have increased in Scotland since pack-size limitations. Other approaches are necessary to reduce the death rate from overdoses involving paracetamol.
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Affiliation(s)
- D N Bateman
- NPIS Edinburgh (Scottish Poisons Information Bureau), Royal Infirmary of Edinburgh, Edinburgh, UK.
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Greene SL, Dargan PI, Leman P, Jones AL. Paracetamol availability and recent changes in paracetamol poisoning: is the 1998 legislation limiting availability of paracetamol being followed? Postgrad Med J 2006; 82:520-3. [PMID: 16891443 PMCID: PMC2585716 DOI: 10.1136/pgmj.2005.042036] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the degree of adherence to legislation introduced in 1998 restricting the availability of over the counter paracetamol. DESIGN A prospective observational study. SETTING An emergency department in an inner city London teaching hospital. Pharmacy and non-pharmacy outlets in south London. MAIN OUTCOME MEASURES (1) The source of paracetamol ingested by 107 patients presenting with an acute paracetamol overdose (2001-2003) and (2) the ability to purchase paracetamol from pharmacy and non-pharmacy outlets in a manner contravening paracetamol pack size legislation (2004). RESULTS Potentially toxic amounts of paracetamol in excess of pack size restrictions were purchased in 70% (17 of 24) of outlets. Forty six per cent of patients who had ingested a potentially toxic dose of paracetamol obtained the tablets in a manner contravening the 1998 legislation. CONCLUSION Legislation limiting the availability of over the counter paracetamol is not being adhered to in south London. A significant number of patients ingesting a potentially toxic dose of paracetamol report purchasing the tablets in a manner contravening the legislation. Studies that attempt to assess the impact of the legislation need to be interpreted in the context of these results. Measures to enforce current legislation may help to reduce the severity of paracetamol poisoning in the UK.
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Affiliation(s)
- S L Greene
- Guy's and St Thomas's Poisons Unit, Avonley Road, New Cross, London SE14 5ER UK.
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Abstract
PURPOSE OF REVIEW Consultation-liaison psychiatry deals with patients who manifest both psychological and somatic symptoms and involves a close and collaborative interaction with other medical specialities. While it is a clinically rich area, resource constraints and service requirements have meant that it has perhaps contributed a little below its weight in academic terms. This review, although far from exhaustive, seeks to present some themes of recent research in this fascinating discipline. RECENT FINDINGS The need to demonstrate the utility, and ensure the funding, of a service that is all too often regarded as 'non-core' by both mental health services and general hospitals remains constant. Useful work is being done in streamlining data collection, accurately measuring disability and improving outcomes for these complex and resource-intensive patients. Recent reviews have helped to clarify our understanding of medication-induced depression, the treatment options in self-harm, the place of psychosocial interventions in oncology, and the relationship between depression and heart disease among other areas. SUMMARY Consultation-liaison psychiatry is a fascinating and underresearched field. Important work remains to be done in service delivery, diagnosis, treatment and outcome, as well as medical ethics and systems research. Although our knowledge is progressing, many existing studies are underpowered and multisite collaborations are necessary. Our patients carry an enormous burden of ill health and require the services of skilled clinicians, advocates and treatment brokers.
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Affiliation(s)
- Ralf Ilchef
- Department of Psychological Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2005. [DOI: 10.1002/pds.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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