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

Abstract

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

Evaluation of the Effectiveness of Suicide Prevention Programs: A Methodological Perspective

“…However, despite these difficulties, a number of studies have shown that acceptable rates are possible with attempted suicides. As mentioned above, Greer and Bagley (1971) followed up 97% of their 211 patients; Gardner et al . (1977) traced 85% of the patients in their study at 12 months; Hawton et al .…”

“…However, randomization is feasible, and has been successfully carried out in a number of studies (e.g., Chowdhury et al ., 1973; Gardner, Hanka, O'Brien, Page, & Rees, 1977; Gibbons, Butler, Urwin, & Gibbons, 1978; Hawton, Bancroft, Catalan, Kingston, Stedeford, & Welch, 1981; Liberman & Eckman, 1981; Termansen & Bywater, 1975; Welu, 1977). Indeed, it is felt within the research community that the increased difficulty and cost of the RCT are outweighed by the confidence that clinicians can put in their findings, in comparison to results from other types of trials.…”

Dextropropoxyphene Overdose

“…Finkle (1984) claimed that the overall reduction in prescriptions for dextropropoxyphene in the US could not account for the relatively larger fall in fatal overdoses, and he suggested that doctors had become particularly wary of prescribing dextropropoxy-phene to patients considered to be 'at risk' of selfpoisoning, but had continued to prescribe the drug for other patients. This 'at risk' group are typically female, experience relative social isolation, have known marital problems or difficulty with interpersonal relationships, drug or alcohol dependency and a past history of deliberate self-poisoning or other previous psychiatric history (Gardener et al 1977).…”

III. Rückfälligkeit

“…Von jenen, denen ambulante psychiatrische Behand lung vorgeschlagen wurde, ergriffen 43% diese Möglichkeit nicht. Gardner et al [1977] wiesen nach, dass die Übernahmeder Betreuung durch Psych iater zumindest über einen Zeitraum von 1 Jahr nach dem Suizidversuch zu keinem Unterschied gegenüber der nicht nachbetreuten Gruppe hinsicht lich der Rückfallhäufigkeit führt.…”