Evaluation of Intentional Overdose Neuropsychotropic Medication Ingestion Cases Presenting to The Emergency Room

Abstract

OBJECTIVE: To determine the role of neuropsychotropic (anxiolytic-hypnotic, antipsychotic, antidepressant and antiepileptic) drugs (NPD) in patients with intentional drug overdose (IDO) in the emergency room (ER) and their differences from those not taking NPD (non-NPD).

METHODS: Demographic characteristics, drug groups, time interval between ingestion and ER visit (TI), clinical characteristics, treatment&outcomes of patients (> 18 years) with IDO (January-June 2019) presenting to ER were retrospectively recorded from their files and NPD and non-NPD groups were compared.

RESULTS: The study included 248 patients (F/M=184/64) with a median age of 32 years (min-max: 18-74). 44.6% of the patients received at least one NPD [antidepressants (25%), antipsychotics (10.1%), benzodiazepines (9.7%)]. SSRIs and atypical antipsychotics were the most commonly used sub-groups. There was no significant difference between two groups in terms of age, gender, TI, presence of previous suicide attempts, cardiovascular and respiratory symptoms. In the NPD group, the rates of suicidal ideation, psychiatric comorbidities, use of their own prescribed drug in the attempt, and central nervous system symptoms/findings were significantly higher (p<0.001; p=0.043; p>0.001; p<0.001, respectively). The total number of ingested drug groups, multiple drug group use and gastrointestinal symptoms/findings were significantly higher in the non-NPD group (p=0.009; p=0.013; p=0.005, respectively). Of all patients, the rates of hospitalization (ward/intensive care unit) or referral were 13.3%, and no significant difference was found between the groups.

CONCLUSION: NPD cases accounted for about half of IDO cases, and were more likely to use their own prescribed medication and to have suicidal ideation in the attempt. The majority of patients did not require specific treatment in the ER.