The Profile of deliberate self-poisoning cases presenting at the emergency department of pelonomi regional hospital

Background Deliberate self-poisoning (DSP) remains a common method employed for suicide worldwide. Despite its frequent occurrence and the high cost required in its management, only few studies have been carried out on this subject in South Africa. Inadequate research into DSP in South Africa is a great concern as this may inadvertently result in an inadequate knowledge of health professionals on the general approach to victims presenting at emergency departments. This may consequently result in a poor clinical outcome of these cases. This study was aimed at determining the demographics of DSP cases presenting to the emergency department (ED) of Pelonomi hospital and also to enquire into the drugs/agents commonly used, reasons for DSP and the clinical outcome of these cases

The burden of intentional self-poisoning on a district-level public Hospital in Cape Town, South Africa

Introduction:Intentional self-poisoning is a significant part of the toxicological burden experienced by emergency centres. The aim of this study was to describe all adults presenting with intentional self-poisoning over a six-month period to the resuscitation unit of Khayelitsha Hospital, Cape Town.Methods:Adult patients with a diagnosis of intentional self-poisoning between 1 November 2014 and 30 April 2015 were retrospectively analysed after eligible patients were obtained from the Khayelitsha Hospital Emergency Centre database. Missing data and variables not initially captured in the database were retrospectively collected by means of a chart review. Summary statistics were used to describe all variables.Results:A total of 192 patients were included in the analysis. The mean age was 27.3 years with the majority being female (n = 132, 68.8%). HIV-infection was a comorbidity in 39 (20.3%) patients, while 13 (6.8%) previously attempted suicide. Presentations per day of the week were almost equally distributed while most patients presented after conventional office hours (n = 152, 79.2%), were transported from home (n = 124, 64.6%) and arrived by ambulance (n = 126, 65.6%). Patients spend a median time of 3h37m in the resuscitation unit (interquartile range 1 h 45 m­7 h 00 m; maximum 65 h 49 m). Patient acuity on admission was mostly low according to both the Triage Early Warning Score (non-urgent n = 100, 52.1%) and the Poison Severity Score (minor severity n = 107, 55.7%). Pharmaceuticals were the most common type of toxin ingested (261/343, 76.1%), with paracetamol the most frequently ingested toxin (n = 48, 25.0%). Eleven patients (5.7%) were intubated, 27 (14.1%) received N-acetylcysteine, and 18 (9.4%) received benzodiazepines. Fourteen (7.3%) patients were transferred to a higher level of care and four deaths (2%) were reported.Discussion:Intentional self-poisoning patients place a significant burden on emergency centres. The high percentage of low-grade acuity patients managed in a high-acuity area is of concern and should be investigated further

Attitudes of prehospital providers on transport decision-making in the management of patients with a suicide attempt refusing care: a survey based on the mental health care act of 2002

Background: Given the frequency of suicidal patients making attempts prior to a completed suicide, emergency access to mental health care services could lead to significant reduction in morbidity and mortality for these patients. Aim: To describe the attitudes of prehospital providers and describe transport decision-making around the management of patients with a suicide attempt. Setting: Cape Town Metropole. Methods: A cross-sectional, vignette-based survey was used to collect data related to training and knowledge of the Mental Health Care Act, prehospital transport decision-making and patient management. Results: Patients with less dramatic suicidal history were more likely to be discharged on scene. Few respondents reported the use of formal suicide evaluation tools to aid their decision. Respondents displayed negative attitudes towards suicidal patients. Some respondents reported returning to find a suicidal patient dead, while others reported patient attempts at suicide when in their care. Eighty per cent of respondents had no training in the management of suicidal patients, while only 7.0% had specific training in the Mental Health Care Act. Conclusion: A critical lack in the knowledge, training and implementation of the Mental Health Care Act exists amongst prehospital providers within the Western Cape. A further concern is the negative feelings towards suicidal patients and the lack of commitment to transporting patients to definitive care. It is essential to urgently develop training programmes to ensure that prehospital providers are better equipped to deal with suicidal patients

epidemiologie des patients suicidants dans le service de Reanimation medicale du Centre Hospitalier Universitaire d'Antananarivo

Introduction. Decrire l'epidemiologie hospitaliere des patients suicidants; et connaitre les differents facteurs de risque sur un echantillon de population malgache. Methode. Il s'agit d'une etude prospective; allant du mois de Janvier 2009 au mois de Decembre 2009; des suicidants hospitalises dans le service de Reanimation medicale du CHU Antananarivo. Resultats. Cent soixante quatorze cas (14;83) sur les 1173 patients hospitalises ont ete retenus pour cette etude. L'age moyen etait de 26;20 ans et le sex ratio de 0;74. La majorite (52;29) de nos patients etait celibataire. Cinquante quatre patients (31;03) ont des antecedents medico-chirurgicaux; dont 8 avec des antecedents psychiatriques (4;60); et 26 patients (15) avec des antecedents de tentative de suicide. Le contexte de depression a ete retrouve dans 36;78; les troubles psychotiques dans 6;32et l'impulsivite dans 56;89. Le moyen le plus frequemment utilise etait l'intoxication aux organo-phosphores (55;17); et l'intoxication aux antipaludiques de synthese (16;67). Conclusion. La tentative de suicide est une realite et une actualite qu'il ne faut pas negliger a Madagascar. Les plus vulnerables sont ceux qui presentent des comorbidites psychiatriques; et ceux qui vivent dans un environnement pathologique. Il serait souhaitable que tous patients suicidants recoivent une evaluation psychiatrique approfondie pour eviter la recidive

Auteurs d'homicides et de tentatives d'homicides; quelles caracteristiques ? Etude portant sur des rapports d'expertises psychiatriques faits au Cameroun

L'objectif de ce travail etait de decrire les caracteristiques sociodemographiques; psychopathologiques et psycho criminologiques d'une population d'auteurs d'homicides et de tentatives d'homicides; recus a la clinique psychiatrique de l'hopital Jamot de Yaounde au Cameroun. L'echantillon comprenait 12 personnes ayant ete expertisees du 1er mars 2002 au 31 juillet 2006 a la demande d'un juge ou d'un officier de police judiciaire. Sur 12 auteurs d'homicides identifies il y avait 8 hommes (66;7) et 4 femmes (33;3); d'age moyen 18;3 ans. Le plus jeune des criminels avait 17 ans au moment des faits; le plus age avait 43 ans. Les 12 auteurs d'homicides ont fait un total de 16 victimes dont 14 meurtres et 2 blesses graves ayant survecu a leurs blessures grace a une intervention rapide des services medicaux. Dans 8 cas sur 12; l'acte criminel coincidait avec une periode particuliere de leur vie caracterisee par des difficultes personnelles alors que pour 4 autres; aucun evenement particulier n'etait mis en lien avec les faits. Pour commettre le crime; les auteurs d'homicides ont eu recours a la strangulation; aux coups et aux armes blanches (couteaux etmachettes) dans 87;5des cas et les victimes etaient le plus souvent attaquees chez elles (68;8des cas). Le diagnostic principal sur la base des criteres du CIM10 comprenait : la schizophrenie; n = 5 (41;7); les troubles delirants persistants; n = 3 (25;0) et la psychopathie; n = 1 (8;3). 9 auteurs (75;0) d'homicides ou de sa tentative avaient des antecedents personnels de maladie mentale dont 8; depuis au moins 6 mois avant le passage a l'acte criminel et 4 parmi eux avaient deja beneficie d'un suivi par un psychiatre dont 2 en hospitalisation pour un ou plusieurs episodes anterieurs de decompensation psychotique. Seize victimes ont ete enregistrees parmi lesquelles; 8 de sexe masculin et 8 de sexe feminin. Parmi elles; nous avons denombre 5 adultes (31;3) et 11 enfants (68;7). Parmi ces enfants; 9 etaient victimes de meurtres (81;8) et 2 victimes de tentatives de meurtre (18;2). Sur les 5 adultes victimes; 1 etait de sexe feminin et 4 de sexe masculin. Parmi les mineurs victimes d'homicide; il y avait 6 filles et 3 garcons dont un adolescent de 17 ans. L'age des autres mineurs etait compris entre 18 mois et 8 ans. L'etude releve trois indicateurs : la forte implication desmaladesmentaux dans les violences homicides (66;7) majoritairement des schizophrenes; l'existence d'une importante pedocriminalite (11 enfants sur 16 victimes); soulevant le probleme de la vulnerabilite des enfants qui necessitent des mesures de protection et de prevention particulieres; le probleme des malades mentaux errants et celui de leur dangerosite pour la societe

The profile analysis of attempted-suicide patients referred to Pelonomi Hospital for psychological evaluation and treatment from 1 May 2005 to 30 April 2006

Background. Suicide is an increasing phenomenon worldwide. A suicide occurs every 40 seconds; and there is 1 attempt every 1 to 3 seconds. By 2020; these figures may have doubled. No accurate statistics regarding the occurrence of attempted suicide (or non-fatal suicidal behaviour) in South Africa exist; because there has been no systematic data collection. Aim. The aim of the study was to determine the profile of patients who had attempted suicide and were referred to Pelonomi Hospital; Bloemfontein; for psychologicalevaluation and treatment during the period 1 May 2005 to 30 April 2006. Method. A descriptive; retrospective study was conducted. The study population comprised 258 attempted-suicide patients referred to Pelonomi Hospital for psychological evaluation and treatment. A data form was compiled to transfer the relevant information from patients' clinical files. Results. The majority of patients were female (68.9). The median age was 22 years. The most common method used in suicide attempts was drug overdose (66) - mostly antidepressants (19.7)) and analgesics (8.2). More females than males overdosed on drugs (p=0.0103). The main precipitating factors included problematic relationships (55.4); financial problems (22.9); psychiatric problems (22.1); arguments (19.8); abuse (emotional; sexual; physical - 18.2); low self-esteem/ worthlessness/hopelessness/humiliation (16.7); and recent life changes (13.2). Conclusion. The aim of the study was to determine the profile of patients who had attempted suicide. Possible factors associated with suicide attempts in our sample were identified and summarised in the form of a screening checklist. The value of the checklist is that it can be used as a screening method to identify possible suicide risk in patients