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Oya Y, Ishihara K, Shiko Y, Kawasaki Y, Iwase H. A Descriptive Study of the Characteristics of Homicide-Suicide in Forensic Autopsy Cases. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:1473-1495. [PMID: 37887432 DOI: 10.1177/08862605231207616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Homicide followed by suicide (HS) is a tragic event with varied characteristics across countries and regions. Compared to Western countries, there are limited studies on HS in Asian countries. Therefore, this study aimed to clarify the characteristics of recent HS cases by examining forensic autopsy records from 2008 to 2020 collected from the Department of Legal Medicine, Chiba University, in Japan. A total of 77 HS cases were identified, involving 77 perpetrators (52 completed suicides, 25 attempted suicides), with 28 perpetrator and 89 victim autopsies. Our findings showed that older adults accounted for nearly half of the victims; victims were mostly females, whereas most perpetrators were male. The most common HS relationship was that between a parent and a child. Autopsy findings showed that the most common cause of death was strangulation, and illegal drugs were detected only in a few cases; however, psychotropic drugs were detected in child victims. No obvious evidence of past child physical abuse by caregivers was found. In contrast, intimate partner violence (IPV) was present, with a history of IPV found in half of HS cases involving adult intimate partner relationships. Notably, gender differences in age and relationship to the victim were identified. Likewise, some perpetrators may have expressed their plans and intentions for HS before the event, which may represent an important sign for HS prevention. However, to accurately reveal the course of HS, nationwide integrated statistics, forensic autopsies, including toxicological analyses of the deceased; and forensic psychiatric perspectives, including psychological autopsy, are required.
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Affiliation(s)
| | | | | | - Yohei Kawasaki
- Japanese Red Cross College of Nursing, Shibuya-ku, Tokyo, Japan
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2
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Syed O, Jancic P, Fink AB, Knezevic NN. Drug Safety and Suicidality Risk of Chronic Pain Medications. Pharmaceuticals (Basel) 2023; 16:1497. [PMID: 37895968 PMCID: PMC10609967 DOI: 10.3390/ph16101497] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
Chronic pain is one of the main leading causes of disability in the world at present. A variety in the symptomatology, intensity and duration of this phenomenon has led to an ever-increasing demand of pharmacological treatment and relief. This demand for medication, ranging from well-known groups, such as antidepressants and benzodiazepines, to more novel drugs, was followed by a rise in safety concerns of such treatment options. The validity, frequency, and diversity of such concerns are discussed in this paper, as well as their possible effect on future prescription practices. A specific caution is provided towards the psychological safety and toll of these medications, regarding suicidality and suicidal ideation. Most significantly, this paper highlights the importance of pharmacovigilance and underscores the necessity of surveillance programs when considering chronic pain medication.
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Affiliation(s)
- Osman Syed
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA; (O.S.); (P.J.); (A.B.F.)
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL 60515, USA
| | - Predrag Jancic
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA; (O.S.); (P.J.); (A.B.F.)
| | - Adam B. Fink
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA; (O.S.); (P.J.); (A.B.F.)
- Harborview Medical Center, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA 98104, USA
| | - Nebojsa Nick Knezevic
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA; (O.S.); (P.J.); (A.B.F.)
- Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
- Department of Surgery, University of Illinois, Chicago, IL 60612, USA
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3
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Shoib S, Patel V, Khan S, Armiya'u AY, Saeed F, Swed S, Das S, Chandradasa M. Over-the-counter drug use in suicidal/self-harm behavior: Scoping review. Health Sci Rep 2022; 5:e662. [PMID: 35620537 PMCID: PMC9128395 DOI: 10.1002/hsr2.662] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 11/11/2022] Open
Abstract
Background and aims Minor physical ailments are treated with over-the-counter (OTC) medications. The availability of OTC drugs helps reduce waiting times and ease the suffering of many. Suicidal behavior includes suicidal ideation, attempts, and completed suicides and affects people of all ages, religions, and cultures. This study aims to review use of OTC drugs for self-harm and suicidal attempts. Methods We reviewed English language publications from the beginning of time to October 2021 on OTC drug use for suicidal behavior. Results Twenty-seven studies met the eligibility criteria, and 1,816,228 participants were reported in these publications. OTC analgesics and sedatives/hypnotics were frequently used for suicidal behavior. Females and young people mainly were reported to self-harm using OTC medications. An increase in OTC analgesic use for self-harm in adolescents during the school months was reported. Elderly persons use hypnotics more frequently for suicidal attempts. Persons with major psychiatric disorders were reported to use OTC for suicidal behavior. Conclusion The available information shows that the prevention strategies should focus on OTC analgesics and hypnotic use among women, the young, the elderly, and persons with mental health disorders.
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Affiliation(s)
- Sheikh Shoib
- Department of Psychiatry Jawahar Lal Nehru Memorial Hospital Srinagar Kashmir India
| | - Viraj Patel
- Smt. NHL Municipal Medical College Ahmedabad Gujarat India
| | - Sonia Khan
- Frontier Medical and Dental College Abbottabad Pakistan
| | - Aishatu Yusha'u Armiya'u
- Department of Psychiatry, College of Medical Sciences Abubakar Tafawa Balewa University Bauchi Bauchi State Nigeria
| | - Fahimeh Saeed
- Department of Psychiatry, Psychosis Research Center University of Social Welfare and Rehabilitation Sciences Tehran Iran
| | - Sarya Swed
- Faculty of Medicine Aleppo University Aleppo Syria
| | - Soumitra Das
- Emergency Mental Health, Sunshine Hospital Melbourne Victoria Australia
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Sheridan DC, Lin A. Emergency Department Adolescent Suicidality: A Pilot Study to Determine How Common Actual Attempts Are. Pediatr Emerg Care 2022; 38:e458-e461. [PMID: 35100750 DOI: 10.1097/pec.0000000000002629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Adolescent mental health is a rapidly escalating presentation to emergency departments in the United States with depression and suicidal thoughts being the most prevalent condition. Much of the research and focus has been on preventing future attempts. However, one outcome that may be very important in addition to focus on is the impact of presentations for thoughts without self-injury. The aim was to evaluate outcomes of interest for a larger prospective observational adolescent suicidal trial including frequency of suicide attempts versus thoughts and factors associated with each outcome. METHODS This is a prospective pilot study of adolescents at a single pediatric emergency department between December 2016 and September 2017 with acute suicidality. We used descriptive statistics to compare chief complaint, medical history, Patient Health Questionnaire-9 (PHQ-9), and outcomes including final disposition and total emergency department length of stay (LOS). We used t tests for continuous outcomes, χ2 test for categorical data, and Fisher exact tests for categorical and sparse data (20% of cell sizes of <5). RESULTS Forty-one patients were enrolled, with 43.9% having an attempt; 72.2% of attempts were the result of an ingestion, and approximately 54% were over-the-counter medications. The average (SD) LOS was 30.8 (31.2) hours, and 63% were discharged home to outpatient services. There were no significant differences in age, chief complaint (except overdose), medical history, final disposition, total LOS in the ED, and the PHQ-9. Scores of the PHQ-9 were, on average (SD), 18.51 (4.7) across the entire cohort, 18.06 (5.75) in patients with an attempt, and 18.87 (3.77) in patients without an attempt (P = 0.59). CONCLUSIONS Adolescent mental health is a growing issue for pediatric emergency departments nationally. Prospective research to identify factors associated with worsening outcomes is important to identify and potentially modify if possible. This study did not find any specific factors associated with a suicide attempt, but found that less than half of patients presenting with suicidality actual made an attempt. Future research should focus on not only limiting suicide attempts but also using decreased emergency department visits for worsening thoughts as an outcome of interest.
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Affiliation(s)
| | - Amber Lin
- From the Departments of Emergency Medicine
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An analysis of 1344 consecutive acute intoxication cases admitted to an academic emergency medicine department in Turkey. North Clin Istanb 2021; 8:377-384. [PMID: 34585073 PMCID: PMC8430352 DOI: 10.14744/nci.2020.98957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 12/25/2020] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE: One of the major causes of emergency department (ED) visits is acute poisoning. Acute intoxications occur soon after either single or multiple exposures to toxic substances, and they started to be a more serious problem in developing countries. The objective of this study was to investigate the local patterns of acute intoxications, as well as clinical and sociodemographic characteristics of patients with acute poisoning, admitted to our hospital’s ED. METHODS: This single-center, retrospective study was conducted using medical records of consecutive patients admitted to the ED between January 2016 and December 2017. RESULTS: A total of 1344 patients were included in the statistical analysis. Of these, 673 (50.1%) were female. Mean (±SD) age was 32.2 (±12.0), ranging between 17 and 84 years. The highest number of poisoning cases was observed in summer, especially in July (10.0%) and August (11.8%), whereas lowest number of admissions related to poisoning occurred during winter in November (5.1%) and December (5.2%). Among admitted cases, many were suicide attempts (55.7%) followed by non-intentional (accidental) ingestion of non-pharmaceutical (n=553, 41.2%) and pharmaceutical agents (n=42, 3.1%). Single agents were the most common cause of acute intoxications (63.2%) rather than multidrug intoxications. Most frequently observed causes of poisonings were recreational substances (30.0%) and agents exposed by inhalation (13.2%). INR, lactate, and pH levels at admission were significant predictors of 7-day mortality without a significant paired difference between each other. The AUCs for each were 0.89 (SE 0.04; p<0.0001), 0.84 (SE 0.10; p=0.0007), and 0.79 (SE 0.11; p=0.0102), respectively. CONCLUSION: We conclude that recreational substances and medicinal drug intoxications were the leading cause of acute poisonings in our region, occurring mostly during the summer.
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Oyekan PJ, Gorton HC, Copeland CS. Antihistamine-related deaths in England: Are the high safety profiles of antihistamines leading to their unsafe use? Br J Clin Pharmacol 2021; 87:3978-3987. [PMID: 33729599 DOI: 10.1111/bcp.14819] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/26/2021] [Accepted: 02/10/2021] [Indexed: 01/26/2023] Open
Abstract
AIMS Antihistamines are routinely taken to control allergic reactions or sedation to induce sleep. There are, however, growing concerns regarding sedating antihistamine misuse. This research aims to evaluate deaths related to antihistamines in England occurring during 2000-2019. METHODS Cases reported to the National Programme on Substance Abuse Deaths from England occurring in 2000-2019 with antihistamine detections at postmortem were extracted for analysis. RESULTS In total, 1666 antihistamine postmortem detections were identified from 1537 cases. Sedating antihistamines available for purchase under pharmacist supervision but without need for a prescription (pharmacy-only medications) were present in a significant majority of cases (85.2%, P < .01). Despite an increasing trend for antihistamine-related deaths over time, the proportion of deaths where an antihistamine was implicated declined over the same period. Specific concerns with regards to the misuse of these pharmacy-only sedating antihistamines are raised with regards to the significant proportion of cases that were concluded as suicide (20.9%, P < .01), and the high prevalence of their use in combination with other central nervous system depressants (94.8% of cases). CONCLUSION This is the first report in over 40 years regarding antihistamine-related mortality from England. The rising trend in sedating antihistamine-related deaths may be contributed to by their increasing availability and the perceived negligible dangers associated with antihistamines, both from the general public and learned professionals. Awareness of the dangerous sedative properties that some antihistamines possess is, however, heightened in individuals deliberately seeking these effects. Urgent review of sedating antihistamines currently assigned under the pharmacy-only classification is needed to achieve antihistamine harm reduction.
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Affiliation(s)
- Princess J Oyekan
- Institute of Pharmaceutical Sciences, King's College London, London, UK
| | - Hayley C Gorton
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Caroline S Copeland
- Institute of Pharmaceutical Sciences, King's College London, London, UK.,Population Health Research Institute, St George's, University of London, London, UK
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Hughes AR, Lin A, Hendrickson RG. Clinical and patient characteristics associated with severe outcome in diphenhydramine toxicity. Clin Toxicol (Phila) 2021; 59:918-925. [PMID: 33666139 DOI: 10.1080/15563650.2021.1891244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Diphenhydramine is frequently misused and ingested recreationally for its antihistaminergic and antimuscarinic effects and is often involved in both serious and fatal poisonings, either in isolation or in combination with other xenobiotics. OBJECTIVE This analysis sought to determine which patient and encounter characteristics were associated with severe outcome after diphenhydramine overdose. METHODS This is an analysis of the multi-center ToxIC registry (2010-2016). Descriptive analysis of all cases with diphenhydramine listed as the "primary agent" contributing to toxicity were included. Analysis sought to determine which patient and encounter characteristics were associated with severe outcome, defined as occurrence of seizure, ventricular dysrhythmia, or intubation. To determine which patient and encounter characteristics were individually associated with severe outcome, we performed chi-square tests. Fisher's exact tests were used in the case of sparse data. We also performed multivariable logistic regression to further determine independent risk factors for severe outcome in diphenhydramine overdose. RESULTS Eight hundred and sixty-three cases remained after exclusion with 15.6% (n = 135) of all patients having one or more severe outcome. The most common severe outcome was seizures which occurred in 98 (11.6%) of all ingestions. Females comprised 59.1% (n = 510) of all ingestions. Most ingestions were intentional (86.0%, n = 742) with the most common known reason for an intentional ingestion being self-harm, accounting for 37.5% (n = 324) of all ingestions. Self-harm ingestions and ingestions in males were more commonly associated with intubation. When examining outcomes by age, there were no significant differences overall or in any individual outcome except intubation in which children 0-12 were less likely to be intubated as compared to teens and adults. Signs and symptoms most strongly associated with a severe outcome included acidemia (pH < 7.2), QRS prolongation (QRS > 120 ms), and elevated anion gap (AG > 20). DISCUSSION Acidemia, QRS prolongation, and elevated anion gap are associated with severe outcomes in diphenhydramine toxicity. Further research is warranted to determine their predictive characteristics.
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Affiliation(s)
- Adrienne R Hughes
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA.,Oregon Poison Center, Portland, OR, USA
| | - Amber Lin
- Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Robert G Hendrickson
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA.,Oregon Poison Center, Portland, OR, USA
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Beauchamp GA, Carey JL, Cook MD, Cannon RD, Katz KD, Yoon J, Kincaid H, Ely BJ, Pollack E, Mazzaccaro RJ, Greenberg MR. Sex Differences in Pediatric Poisonings by Age Group: a Toxicology Investigators' Consortium (ToxIC) Analysis (2010-2016). J Med Toxicol 2020; 16:423-443. [PMID: 32488629 DOI: 10.1007/s13181-020-00781-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/13/2020] [Accepted: 04/28/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To review pediatric poisonings evaluated at the bedside by medical toxicologists and reported in the ToxIC registry, by sex and age group. METHODS Pediatric poisoning cases age ≤18 years, reported between January 2010 and December 2016, were reviewed. Descriptive statistics were used to describe study variables by age group and sex. RESULTS A total of 12,699 cases were analyzed. There were 7517 females and 5182 males. Those < 2 years old represented 12.5% of the study group (n = 1584), 17.2% were 2-6 years old (n = 2178), 8.6% were 7-12 years old (n = 1097), and 61.7% were 13-18 years old (n = 7840). The most common primary reasons for encounter were intentional pharmaceutical with 4900 females and 1836 males; intentional non-pharmaceutical with 952 females and 1213 males; unintentional pharmaceutical with 539 females and 644 males; and unintentional non-pharmaceutical with 435 females and 593 males. Overall, pharmaceuticals were the most commonly involved agents, including analgesics (20.9% of cases) and antidepressants (11% of cases): 27.8% of females and 10.7% of males were reportedly exposed to an analgesic.13.7% of females and 7.0% of males were reportedly exposed to an antidepressant. Among 1584 cases under 2 years, there were 747 females and 837 males; among 2178 cases aged 2-6 years, there were 954 females and 1224 males; among 1097 cases aged 7-12 years, there were 555 females and 542 males; and among 7840 cases aged 13-18 years, there were 5261 females and 2579 males. Death was reported in 0.7% of the cases: 20 females and 18 males. 6.1% of cases were managed with intubation: 421 females and 351 males. CONCLUSIONS Sex-based characteristics of poisonings varied by age group among pediatric poisoning presentations reported to the ToxIC registry and further research is needed to determine implications for education and prevention efforts.
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Affiliation(s)
- Gillian A Beauchamp
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA.
- Division of Medical Toxicology, Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/USF Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA.
| | - Jennifer L Carey
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA, 01655, USA
| | - Matthew D Cook
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
- Division of Medical Toxicology, Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/USF Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
| | - Robert D Cannon
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
- Division of Medical Toxicology, Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/USF Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
| | - Kenneth D Katz
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
- Division of Medical Toxicology, Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/USF Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
| | - Jennifer Yoon
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
| | - Hope Kincaid
- Network Office of Research Innovation, Lehigh Valley Health Network/USF Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
| | - Brittany J Ely
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
| | - Emily Pollack
- Department of Pediatrics, Lehigh Valley Health Network/USF Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
| | - Richard J Mazzaccaro
- Department of Pediatrics, Lehigh Valley Health Network/USF Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
| | - Marna Rayl Greenberg
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
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Spiller HA, Ackerman JP, Smith GA, Kistamgari S, Funk AR, McDermott MR, Casavant MJ. Suicide attempts by self-poisoning in the United States among 10-25 year olds from 2000 to 2018: substances used, temporal changes and demographics. Clin Toxicol (Phila) 2019; 58:676-687. [PMID: 31587583 DOI: 10.1080/15563650.2019.1665182] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To evaluate the substances used, outcomes, temporal and demographics associated with suicide attempts by self-poisoning in children and young adults aged 10-25 years old from 2000 to 2018.Methods: This is a retrospective review of suspected-suicide self-poisoning cases reported to the National Poison Data System (NPDS) from US Poison Centers from 2000 to 2018 for patients 10-25 years old. For comparison of annual rates, we obtained population data by year of age from the US Census Bureau. We evaluated changes in: monthly and annual incidence/rate per 100,000 population, substances used and outcome by patient age and demographics.Results: There were 1,677,435 cases of suicide attempt by self-poisoning among individuals 10-25 years old reported to US PCCs from 2000 to 2018. There were 410,940 self-poisoning cases (24.5%) with a serious medical outcome, and the proportion of exposures that resulted in a serious medical outcome increased with increasing age group. For the age groups of 10-12, 13-15 and 16-18 years of age, there was a significant increase after 2011, which was influenced primarily by females. The substance groups with the greatest number of serious medical outcomes were OTC analgesics, antidepressants, antihistamines and antipsychotics. ADHD medications were common in the younger age groups of 10-15 years, while the sedative/hypnotics occurred more commonly in the older age groups. The groups with the greatest increase in serious medical outcomes after 2011 were antidepressants, OTC analgesics, antihistamines and ADHD medications. Opiates were less commonly involved (7.4%) in cases with serious medical outcomes and decreased significantly in the 19-25 year-old age groups after 2012. States with a lower population per square mile had a greater number of reported cases with serious medical outcomes. There was a significant decrease in the number of cases in the age groups of 10-18 years during the traditional non-school months of June-August compared with September-May. This seasonal trend occurred among cases with all outcomes and among cases with serious medical outcomes. This decrease did not occur in the age group of 19-21 years, and there was an increase during summer months in the age group 22-25 years.Conclusions: The substances used during self-poisoning varies by age group but appears to include substances available to that age group, with a significant increase after 2011, increased rates in more rural states, and a seasonal variation of increased rates during school months among adolescents but not among young adults. Two of the top substances, OTC analgesics and antihistamines, in all age groups, comprising more than a third of all substances used, are widely available over-the-counter with no restrictions regarding access. Of additional concern, ADHD medications had the highest risk of a serious medical outcome.
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Affiliation(s)
- Henry A Spiller
- Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA.,College of Medicine, The Ohio State University, Columbus, OH, USA
| | - John P Ackerman
- College of Medicine, The Ohio State University, Columbus, OH, USA.,Center for Suicide Prevention and Research, Behavioral Health Services, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Gary A Smith
- College of Medicine, The Ohio State University, Columbus, OH, USA.,Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Child Injury Prevention Alliance, Columbus, OH, USA
| | - Sandhya Kistamgari
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Alexandra R Funk
- Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Michael R McDermott
- Heritage College of Osteopathic Medicine, Ohio University, Columbus, OH, USA
| | - Marcel J Casavant
- Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA.,College of Medicine, The Ohio State University, Columbus, OH, USA
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10
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Spyres MB, Farrugia LA, Kang AM, Calello DP, Campleman SL, Pizon A, Wiegand T, Kao L, Riley BD, Li S, Wax PM, Brent J. The Toxicology Investigators Consortium Case Registry-the 2018 Annual Report. J Med Toxicol 2019; 15:228-254. [PMID: 31642014 PMCID: PMC6825068 DOI: 10.1007/s13181-019-00736-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 08/23/2019] [Accepted: 08/23/2019] [Indexed: 10/25/2022] Open
Abstract
The Toxicology Investigators Consortium (ToxIC) Registry was established by the American College of Medical Toxicology (ACMT) in 2010. The Registry collects data from participating sites with the agreement that all bedside medical toxicology consultation will be entered. The objective of this ninth annual report is to summarize the Registry's 2018 data and activity with its additional 7043 cases. Cases were identified for inclusion in this report by a query of the ToxIC database for any case entered from 1 January to 31 December 2018. Detailed data was collected from these cases and aggregated to provide information which included demographics, reason for medical toxicology evaluation, agent and agent class, clinical signs and symptoms, treatments and antidotes administered, mortality, and whether life support was withdrawn. A total of 51.5% of cases were female, 48% were male, and 0.6% transgender. Non-opioid analgesics were the most commonly reported agent class, followed by antidepressants and opioids. Acetaminophen was once again the most common agent reported. There were 106 fatalities, comprising 1.5% of all registry cases. Major trends in demographics and exposure characteristics remained similar to past years' reports. Sub-analyses were conducted to describe exposures in elderly patients, addiction consultation practices, and risk factors for bupropion-induced seizures. The launch of the ToxIC Qualified Clinical Data Registry (TQCDR) is also described.
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Affiliation(s)
- Meghan B Spyres
- Department of Emergency Medicine, Division of Medical Toxicology, University of Southern California, 1200 N State St. Rm 1011, Los Angeles, CA, 90033, USA.
| | - Lynn A Farrugia
- Hartford Hospital and University of Connecticut School of Medicine, 80 Seymour Street, Hartford, CT, 06102, USA
| | - A Min Kang
- Departments of Medicine and Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
- Department of Medical Toxicology, Banner-University Medical Center, 1012 E Willetta Street, Fl 2, Phoenix, AZ, 85006, USA
| | - Diane P Calello
- New Jersey Medical School, Rutgers, The State University of New Jersey, 140 Bergen Street, Suite G1600, Newark, NJ, 07101-1709, USA
| | - Sharan L Campleman
- American College of Medical Toxicology, 10645 N Tatum Blvd., Suite 200-111, Phoenix, AZ, 85028, USA
| | - Anthony Pizon
- University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Timothy Wiegand
- University of Rochester Medical Center and Strong Memorial Hospital, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Louise Kao
- Indiana university school of medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, 46202, USA
| | - Brad D Riley
- Michigan State University College of Human Medicine, 100 Michigan NE MC49, Grand Rapids, MI, 49503, USA
| | - Shao Li
- American College of Medical Toxicology, 10645 N Tatum Blvd., Suite 200-111, Phoenix, AZ, 85028, USA
| | - Paul M Wax
- University of Texas Southwestern Medical School, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Jeffery Brent
- University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA
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Abstract
Aspirin-use disorder is an underreported condition. Identification of the signs and symptoms of aspirin misuse are important in light of prevalent non-prescribed medicine/over-the-counter medication (NPM/OTC) misuse. We discuss here the case of a patient with a history of chronic aspirin misuse who presented to the emergency department with salicylate intoxication and described elation secondary to deliberate aspirin consumption. This case highlights the importance of screening for NPM/OTC medication misuse in at-risk populations.
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Affiliation(s)
- David Goldrich
- Fourth-Year Medical Student, Rutgers Robert Wood Johnson Medical School, USA
| | - Anita Sreedhar
- Fourth-Year Medical Student, Rutgers Robert Wood Johnson Medical School, USA
| | - Rehan Aziz
- Associate Professor of Psychiatry and Neurology, Rutgers Robert Wood Johnson Medical School, USA
| | - Kenneth R Kaufman
- Professor of Psychiatry, Neurology, and Anaesthesiology, Rutgers Robert Wood Johnson Medical School, USA; and Visiting Professor of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Anthony Tobia
- Professor of Psychiatry, Rutgers Robert Wood Johnson Medical School, USA
| | - Adam Trenton
- Associate Professor of Psychiatry, Rutgers Robert Wood Johnson Medical School, USA
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