Antidepressant or Antipsychotic Overdose in the Intensive Care Unit – Identification of Patients at Risk

Abstract

It is often advised that patients who have ingested an overdose of antidepressants (AD) or antipsychotics (AP) are monitored with continuous ECG for minimum of 12-24 hr. These patients are often observed in an ICU. Our aim was to identify the number of patients with AD and/or AP overdose without adverse signs at hospital admission that turned out to need intensive care treatment. The effect of the antidepressants overdose risk assessment (ADORA) system was evaluated in patients with antidepressant as well as antipsychotic overdose. Our hypothesis was that patients with low ADORA do not need intensive care treatment. This retrospective study was conducted in adult patients admitted to the ICU at Odense University Hospital after an overdose with AP and/or AD between 1 January 2009 and 1 September 2014. Patients with predefined adverse signs in the emergency department were excluded due to obvious need of intensive care. Of the 157 patients included, 12 patients (8%) developed events during the ICU stay. Only 3 patients received intubation, vasoactive drugs and/or dialysis. None developed ventricular dysrhythmias. There were no fatalities. All the patients with low-risk assessment by ADORA within the first 6 hr did not develop events within the first 24 hr after hospital admission. The vast majority of patients with AD and/or AP overdose and no adverse signs at admission did not require intensive care treatment. Low-risk ADORA identified patients with antidepressant as well as antipsychotic overdose who would not require initial intensive care treatment. This is the first time the ADORA system has been evaluated in patients with antidepressant as well as antipsychotic overdose.The Danish Poison Information Centre (DPIC) provides overthe-phone counselling for the general public and healthcare professionals regarding all acute poisonings. DPIC registers the number of enquiries made and the number of substances included in each case. Antidepressants (AD) and antipsychotics (AP) account for 6.3% and 4.9% calls, respectively. According to DPIC, selective serotonin reuptake inhibitors (SSRI) were the most common AD and chlorprothixene the most common AP [1].Side effects of AD and AP overdose potentially include life-threatening complications like hypotension, ventricular dysrhythmias or seizures [2][3][4][5][6][7]. Both drugs pose a risk of QRS and QTc interval prolongation, tachycardia and hypotension [2][3][4]6]. AP more frequently causes QTc interval prolongation than AD, with ventricular fibrillation and torsades de pointes being two possibly fatal complications of QTc interval prolongation [8,9]. AD is shown to more commonly cause seizures than AP [5].The antidepressant overdose risk assessment (ADORA) criteria were first described in 1995 by Garrett E. Foulke [4]. The criteria describe the early complications of AD overdose and include QRS interval >0.1 sec., cardiac dysrhythmias, altered mental status (Glasgow Coma Scale <14), seizures, respiratory depression (<8 breaths/min. or assisted ventilation) and...

Assessment of Acute Antipsychotic Poisoned Cases Admitted to Tanta University Poison Control Unit

“…This reflects the increase in the use of atypical antipsychotics than typical ones due to less neurological side effects as extrapyramidal manifestations (Ucok and Gaebel, 2008). The worldwide increase of suicide may explain the increase of suicidal poisoning in our cases (71.7%) which coincided with other studies (Georgiev et al, 2015, Borg et al, 2016. Most of cases admitted to the hospital within 5 hours from ingestion (75%) which could be attributed to the location of Tanta Poison Control Unit in the center of Delta with easy availability of transportation for it.…”

“…The higher female ratio (65%) could be explained by the concept that females are socially and psychologically more vulnerable to drug poisoning than males in our culture (Boukatta et al, 2014, Shojaei et al, 2014, Georgiev et al, 2015, Borg et al, 2016, Toft et al, 2017. Most of our cases were unemployed (35%) followed by students (33.3%).…”

ECG Changes as a Predictive Tool of Outcomes in Antipsychotics Poisoned Patients

“…This study demonstrated that the majority of cases were females (65.1%). This was in accordance with other studies (Georgiev et al, 2015;Borg et al, 2016 andToft et al, 2017). The explanation of this result was the concept that females use self-poisoning as a mean of deliberate self-harm rather than males who adopt highly violent methods for suicidal attempt (Boukatta et al, 2014 andShojaei et al, 2014).…”

“…The most common ECG changes reported in the present study included sinus tachycardia and prolonged QTc. These results were similar to the findings observed by Minns & Clark, (2012) and Borg et al (2016). Sinus tachycardia is mediated by muscarinic (M1), antihistaminic (H1) and α1 adrenoceptor antagonism properties of antipsychotics (Rasimas &Liebelt, 2012 andNincevic et al, 2017).…”

B-Type Natriuretic Peptide and Troponin I as Possible Predictive Biomarkers for Cardiotoxicity Induced By Tricyclic Antidepressants and Antipsychotics Overdose

“…Although trends vary according to geographical region, psychiatric agents are among the most commonly encountered drugs in poisoning cases. Clinical effects of tricyclic antidepressants and antipsychotic drugs overdose can lead to potentially life-threatening neurological and cardiac complications (Borg et al, 2016).…”