Clinical characteristics of patients who overdose on multiple psychotropic drugs in Tokyo

Abstract

-OBJECTIVE: The purpose of this study was to identify the clinical aspects leading to overdose of multiple psychotropic drugs, in order to determine areas which need attention in the proper treatment of overdose patients. METHODS: Patients who were treated for overdose of psychotropic drugs at our emergency and critical center over two years were targeted. The clinical data was gathered from the medical records and database of all patients, including age, gender, vital signs, and laboratory data, drugs, and medical complications during hospital stay. In addition primary patient care at the emergency department was examined. RESULTS: Among the 277 patients treated during this study period, 255 (74.0%) used two or more types of psychotropic drugs. Risk factors associated with endotracheal intubation and aspiration pneumonitis included the use of antipsychotics and/or barbiturates as types of overdose drugs. The mean number of days in the ICU was 3.4 days. Seventy-four patients (26.7%) stayed 4 days or more in the ICU of which 16 patients (5.8%) still had suicidal thoughts. A significantly higher incidence of extended ICU stay or endotracheal intubation and aspiration pneumonitis was observed in the group who overdosed on more than 50 or 60 tablets of psychotropic drugs, respectively. CONCLUSIONS: Patients who ingested an overdose of more than 60 tablets of psychotropic drugs should be considered a high-risk group requiring intensive care with extended ICU stay. In case of including antipsychotics and/or barbiturates, the patient should be observed carefully due to a higher risk of medical complications.

Clinical features of children with drug poisoning in a single emergency department in Goyang, Korea

“…In a case of poisoning by the psychotropic drugs, a 15-year-old girl developed loss of consciousness and respiratory distress. Flumazenil was not tried in the study population because of its short half-life, adverse effects such as convulsions 18) , and the on-duty pediatricians' preference for conservative therapy.…”

Eleven-Year Trend of Drug and Chemical Substance Overdose at a Local Emergency Hospital in Japan

“…In Japan, psychiatrists play a crucial role in the treatment of overdoses; in EDs that accept overdose patients, physical symptoms are treated by all healthcare providers, but psychiatric symptoms are taken into account and followed up by psychiatrists from a long-term perspective [2]. Psychiatrists also identify suspected overdose medications and causes of overdoses such as abuse or suicide [2].…”

“…In Japan, psychiatrists play a crucial role in the treatment of overdoses; in EDs that accept overdose patients, physical symptoms are treated by all healthcare providers, but psychiatric symptoms are taken into account and followed up by psychiatrists from a long-term perspective [2]. Psychiatrists also identify suspected overdose medications and causes of overdoses such as abuse or suicide [2]. There have been studies that have examined the relationship between the dose of suspected overdose medications and the need for psychiatric hospitalization [3], and the relationship between dose and severity of overdose [4], all of which involved psychiatrists as members of the ED.…”

Memory impairment following intentional self-poisoning with benzodiazepines: Should we pay more attention to attention?

“…Intentional self-poisoning with drugs constitutes the majority of suicide attempts (Doshi et al, 2005;Hawton et al, 2007;Perry et al, 2012). However, most of the drugs ingested are benzodiazepines (BZD) (Canner et al, 2018;Exiara et al, 2009;Hori and Kinoshita, 2016;Shih et al, 2013;Staikowsky et al, 2004), which are known to lead to memory impairment, particularly anterograde amnesia (Curran et al, 1991). One idiosyncrasy of these drugs is that the amnesic effects can be dissociated from the sedative effects (Jatlow et al, 1979), whereas plasma level Memory impairment following intentional self-poisoning with benzodiazepines: Should we pay more attention to attention?…”