Abstract

Amaç: Suisit kişinin kendini öldürmek amaçlı kendine zarar vermesi davranışıdır ve eğer ölümle sonuçlanmazsa buna suisit girişimi denir. Sıralama ülkeden
ülkeye değişse de ilaçla intihar her zaman en sık kullanılan ilk üç yöntem arasındadır. Bu çalışmanın amacı acil servise (AS) ilaçla intihar girişimi nedeniyle
başvurmuş hastaların verilerini incelemektir.
Gereç ve yöntem: Bu çalışma bir araştırma hastanesinde yapılmış retrospektif, kesitsel, gözlemsel, tek merkezli bir çalışmadır. 01.01.2019 ve 31.12.2019
tarihlerinde 18 yaş üstü ilaçla intihar girişimi nedeniyle acil servise başvuran hastalar dahil edilmiştir. Yaş, cinsiyet, başvuru şikayeti, psikiyatrik hastalık ve
ilaç kullanım öyküsü, suisit amaçlı kullanılan ilaçlar, AS’de takip süresi, hasta sonlanımı, AS’de psikiyatri konsültasyonu istenip istenmediği incelenmiştir.
Bulgular: Toplam 330 hasta dahil edilmiştir. Hastaların dörtte üçü (74.8%) kadındır ve medyan yaş 31 (IQR 23 – 38)’dir. On (3%) hasta göçmendir. Hastaların
sadece 51 (15.5%)’inde bilinen psikiyatrik hastalık öyküsü vardır. İntihar girişimi amaçlı en sık kullanılan ilaçlar parasetamol, NSAIDler (Non Steroid Anti-inflamatuar
İlaçlar), antibiyotikler ve antidepresanlardır. Antidepresan ve antipsikotikler ile intihar girişimi psikiyatrik hastalık öyküsü pozitif olanlarda belirgin
olarak yüksektir. AS’de medyan takip süresi 375 dkdır IQR 221 - 642) ve hastaların çoğu (81.7%) taburcu olmuştur. Psikiyatri ile konsülte edilen hasta sayısı
sadece 63 (19.1%)’dür.
Sonuç: Çalışmamız kadın, genç, göçmen, psikiyatrik hastalık sahibi olmanın ve yılın sıcak aylarında olmanın artmış intihar girişimi ile ilgili olduğunu göstermiştir.
Prasetamol, NSAID ve antibiyotikler en sık kullanılan ilaçlardır ve antidepresan ve antipsikotikler ile intihar girişimi psikiyatrik hastalık varlığında
anlamlı olarak yüksektir. Çoğu zaman ilaçla intihar girişimi vakalarının klinik seyri benindir ve AS’deki takip sonrası taburcu edilmişlerdir. Psikiyatrist ile konsültasyon
sıklığı çok düşüktür. Suisit bir halk sağlığı sorunudur ve AS’e kendine zarar verme nedenli başvuruların gelecekte tamamlanmış bir intihar için en
yüksek risk faktörü olduğu tahmin edilmektedir. Bu yüzden AS’e intihar girişimi ile başvuran tüm hastaların gelecekteki intihar davranışı açısından risklerin
değerlendirilmesi ve hedefe yönelik tedavi yaklaşımlarının uygulanması için psikiyatrist ile konsülte edilmeleri gerekir.

Keywords

• Suisit,ilaç-ilişkili,toksisite,psikiyatri konsültasyonu

Evaluation of Patients Admitted to Emergency Department Due to Drug-Related Suicide Attempt

Abstract

Introductıon: Suicide is the self-injurious behavior that is intended to kill oneself and it is called as suicide attempt if not resulted with death. Although the ranking varies by countries, the drug-related suicide attempt is always in the top three methods. The aim of this study was to investigate the data of the patients admitted to emergency department (ED) due to drug-related suicide attempt. Material-Methods: This is a retrospective, cross sectional, observational, single centered study that was conducted in a research hospital. Patients over 18 years of age admitted to ED with a drug-related suicide attempt between 01.01.2019 and 31.12.2019 were included. Age, gender, nationality, admission complaints, presence of psychiatric illness and medication usage history, drugs used for suicidal intervention, follow-up duration at ED, patient outcome, psychiatric consultation status at ED were checked. Results: A total of 330 patients were included. Three fourth (74.8%) of the patients were female and median age was 31 (IQR 23 – 38). Ten (3%) patient were refugees. Only 51 (15.5%) of patients had a known history of psychiatric illness. Most commonly used drugs for suicidal intervention were paracetamol, NSAIDs (Non Steroid Anti-inflammatory Drugs), antibiotics and antidepressants. Suicide attempt with antipsychotic and antidepressant drugs were significantly higher at patients with positive psychiatric illness history. Median follow-up duration at ED was 375 min (IQR 221 - 642) and most of the patients (81.7%) were discharged. Number of patients consulted with psychiatrist was only 63 (19.1%). Conclusion: Our study demonstrated that being female, young, being a migrant, having a psychiatric illness and being in the warmer months of the year were related with the increased suicide attempts. Parasetamol, NSAID and antibiotics were most commonly used drugs and suicide attempt with antidepressants and antipsychotic drugs were significantly higher in the presence of psychiatric illness history. Most of the time the clinical course of drug-related suicide attempt cases were benign and they were discharged after follow-up at ED. Frequency of consultation with a psychiatrist was very low. Suicide is a public health problem and it is estimated that an ED admission related to self-injury is the highest risk factor for a future completed suicide. Therefore all patients admitted to ED due to suicide attempt must be consulted with the psychiatrist for further evaluation in terms of risk of future suicidal behavior and implementation of targeted treatment approaches.

Keywords

• Suicide,drug-related,toxicity

References

1. 1. World Health Organization. Programmes: Mental health. Available from: https://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ Accessed 03 March 2020.
2. 2. Türkiye İstatistik Kurumu: Temel İstatistikler, Nüfus ve Demografi, Hayati İstatistikler, İntihar sayısı ve kaba intihar hızı Avaliable from: http://tuik.gov.tr/UstMenu.do?metod=temelist Accesed 03 March 2020.
3. 3. Zalar B, Kores Plesničar B, Zalar I, Mertik M. Suicide and Suicide Attempt Descriptors by Multimethod Approach. Psychiatr Danub. 2018;30(3):317-322.
4. 4. Geyik FD, Töre Altun G, Çitak N, Akarsu Ayazoğlu T, Gül YG, Toptaş M. Evaluation of Patients Hospitalized in Intensive Care Unit Due to Drug-Related Suicide Attempt and Access to Drugs: A Single Center Prospective Study. Medical Bulletin of Haseki. 2014; 52(2): 111-115
5. 5. Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A et al. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry. 2008;192(2):98-105.
6. 6. Akça HŞ, Özdemir S, Kokulu K, Algın A, Eroğlu SE. Psychiatric Evaluation of Suicidal Drug Intake in the Emergency Department. Eurasian J Tox. 2019;1(3):91-96
7. 7. Utlu SG. Demographic Analysis of Suicide Victims Presenting to The Emergency Department with Drug-induced Intoxication. Eurasian J Tox. 2019; 1 (1): 25-28
8. 8. Pereira AS, Willhelm AR, Koller SH, Almeida RMM. Risk and protective factors for suicide attempt in emerging adulthood. Cien Saude Colet. 2018; 23(11): 3767-3777.

9. 9. Yüzbaşıoğlu Y, Çıkrıkçı Işık G. Retrospective analysis of forensic cases in refugees admitted to emergency department. Am J Emerg Med. 2019;37(9):1691-1693.
10. 10. Aguglia A, Serafini G, Solano P, Giacomini G, Conigliaro C, Salvi V et al. The role of seasonality and photoperiod on the lethality of suicide attempts: A case-control study. J Affect Disord. 2019;246:895-901.
11. 11. Tandoğan M, Emektar E, Dağar S, YüzbaşıoğluY, Karaatlı RH, Çevik Y. Acil Servise Parasetamol İntoksikasyonu Nedeniyle Başvuran Hastaların Değerlendirilmesi. Eurasian J Tox. 2019; 1 (1): 11-14
12. 12. Sawa M, Koishikawa H, Osaki Y. Risk Factors of a Suicide Reattempt by Seasonality and the Method of a Previous Suicide Attempt: A Cohort Study in a Japanese Primary Care Hospital. Suicide Life Threat Behav. 2017;47(6):688-695
13. 13. Leon AC. The revised warning for antidepressants and suicidality: unveiling the black box of statistical analyses. Am J Psychiatry. 2007;164(12):1786-9.
14. 14. Pawlak JM, Miechowicz I, Dmitrzak-Węglarz M, Szczepankiewicz A, Zaremba D, Kapelski P et al. Are suicide risk factors gender specific? Psychiatr Pol. 2018;52(1):21-32
15. 15. Zeppegno P, Gramaglia C, Castello LM, Bert F, Gualano MR, Ressico F et al. Suicide attempts and emergency room psychiatric consultation. BMC Psychiatry. 2015;15:13.