study of self- deliberate poisoned cases admitted to Menoufiya poisoning control center MPCC over one year [2004]

Suicide can be conceptualized as deviated behavior to way out of a problem that is causing suffering, associated with feelings of despair and hopelessness. Deliberate self poisoning is a frequent mean for committing suicide worldwide and in developing countries. Progress continues in research into the biological, psychological and social causes of suicide. The aim of the study was to provide socio-demographic circumstances, clinical severity characters, psychiatric assessment and outcomes of intentional self poisoned cases. The study was carried out on suicide poisoned cases [232 cases] admitted to Menoufiya poisoning control center throughout the year 2004. The study reflects the prevalence of suicide poisoned cases that represented 12.35% of all admitted cases [1852 cases] despite of the behavior, psychic built of Egyptian community and the religious factors that condemn for committing suicide. The highest rate of admission was during September. The most vulnerable age group was that of l9-<36years commonly female gender and singles. 52.6% of the represented cases were unemployed. So stress in society affecting the most vulnerable sensitive young adults, who are usually have little experience in dealing with problems e.g. as failure in love affair or forcing a female to go married to a dislike person are the factors attributable to the problem. Suicidal cases from rural and urban areas were nearly equal. 99.2% of the studied cases committed suicide in the victim's home by oral ingestion and most commonly by cholinergic insecticides. 43.9% of the cases were more significant at age group 7-<19 years while significant use of drugs to attempt suicide was at age group >50 years. The majority of cases in this study were of mild clinical severity [71.1%] and cholinergic insecticides poisoning was significantly represented with all clinical severity grades [mild, moderate and severe]. The high percentage of mild cases and the low I mortality rate [0.86%] may indicate that most of the studied cases didn't really want to kill themselves but only aimed at gaining attention. The present study revealed significant increase of emotional motives for suicide in females in age group 7-<19 years as within this age group; there are many emotional and psychological changes and troubles to females rendering them prone to suicidal tendency. Psychopathological study by psychiatrist was done on 193 cases i.e 83.2% of the total self-deliberate poisoning cases. 24.9% of psychoanalyzed cases had planned for suicide while 75.1% of the studied cases were impulsive. Most of the cases had mild attempt degree, believed that they would be saved [60.1%], [62.7%] respectively. Only 5.2% of the studied cases had previous suicide attempts. The present study revealed that about half of the psychiatric studied cases [50.3%] had depression and 37.3% suffered from agitation. This confirms the strong relationship between suicide and depression. 60.4% of the cases in the present study revealed psychiatric disorders in the form of affective disorder, personality changes and psychotic changes [26.4%], [18.8%] and [13.9%] respectively. So patients who attempt suicide may have psychiatric illness and need careful psychiatric evaluation with treatment before discharge. Regarding family history for psychiatric disorders and suicidal attempts, the present study revealed that 22.8% of the studied psychiatric cases had family history for suicidal attempt, and 18.6% of cases had members of their family received psychiatric treatment. This may reflect genetic predisposition for attempting suicide. So, it is recommended to alarm the people about the dangers of drug overdoses and the toxicity of cholinergic insecticides with restriction of the use of the dangerous toxic types for licensed especial issues. Also, self-deliberated poisoned patients are determined as medically fit for discharge by both toxicologist and psychiatrist Researches to improve management and find out ways of reducing deliberate self harm are urgently required. Keywords: self- deliberate Poisoning - suicide - demographic - cholinergic insecticides. Psychiatric

study on cholinergic insecticide poisoned cases admitted during 2002 to Menoufiya poisoning control center [MPCC]

Organophosphates and carbamates are the most frequently used insecticides worldwide. The aim of the present work is to study the problem of cholinergic insecticides among the patients admitted to MPCC, The study included 465 cases where it is clear that the cholinergic insecticides poisoned cases represented about quarter of the total number of poisoned cases admitted to MPCC during the year of 2002. The highest rate of admission was in the summer months specially June and July due to the prevalent use of pesticides during the summer season for agricultural demand. 49.6% of cases were between the ages of >18-50 years which is the age group of field working and handling of the pesticides. As regard the sex, females showed slightly higher% age [56.99%] than males [43.01%]. Patients from rural areas showed% age [66.23%] than those from urban ones [33.76%] due to conducting the study in agricultural governorate. Single subjects were [87.1%]. 60.43% of the total cases were affected indoors which may be secondary to improper storage and illegal use of insecticides. Males were more affected than females outdoors in the age group of 18-50 years due to the fact that in this age group males are exposed in farms as most of the cases were in the rural areas. As regards to the circumstances of poisoning, it was found that accidental cases had the highest% age [72.69%] which was mainly in farmers, while suicidal cases were [26.88%] which was mainly in students and females at the age group of >18-50 years. This age in the female represents the age of changeable emotional and psychological factors together with the exposure to educational, marital andsocio-economical stresses. Oral route represented the highest% age [64.5%] of cases. Females were significantly higher than males at age group of >18-50 years in taking the pesticides orally for committing suicides. As regards frequency of clinical manifestations among studied cases, it appeared that latent cases were [35.7%] of cases, the main manifestations were muscarinic [64.3%] especially constricted pupils. Patients with predominant nicotinic manifestations represented [21.9%], and [16.3%] of cases were unconscious. The severe cases were higher in children less than 7 years. It was found that cholinesterase activity is not sensitive test to measure severity of the poisoning if it is less than 10%, but it is highly specific test [98.4%] in exclusion of poisoning, if its activity is more than 50% of normal value. Analytical toxicological screening by TLC showed [8 1.93%] of cases were +ve for organophosphates, [11.82%] of cases were +ve for carbamates while [6.25%] of cases were +ve for both of them. As regards the MPCC schedule of treatment it is clear that emesis, activated charcoal and cathartics were the most common lines used in 35.7% of cases. 28.8% of cases had gastric lavage activated charcoal, cathartics and atropine. As regarding physiological antidotes, 64.3% of cases received atropine and only [1.72%] of cases were given atropine and pralidoxime, all cases received supportive treatment. As regard period of admission, the highest% age of cases [69.89%] were discharged after one day admission, [28.81%] were discharged after 2-7 days and [1.29%] after more than one week. Prognostic data showed that [96.6%] of cases were discharged with complete cure and only very low or even negligible fatality [0.4%], this may be attributed to the well organized medical facilities and the increasing experience of the medical staff in the diagnosis andtreatment of pesticide poisoning. It is clear that early ambulance to the hospital, rapid approach to diagnoses and management, are mandatory for the best outcome of the cases. it is recommended to apply laws, which limit the use of these pesticides, and their manufacture in strict circumstances, to lessen their hazards