Psychiatric Follow-up after ED Discharge in Cases of Intentional Poisoning

ABSTRACT

PURPOSE: Many patients who intentionally poison themselves are reported to have underlying mental problems and to repeat the attempted suicidal poisoning. As a first step to prevent this regretful complication, we looked into the present status of psychiatric follow-up of the patients who intentionally poisoned themselves. METHODS: Using a chart review and telephone contact, we analyzed the psychiatric follow-up rate, the underlying psychiatric illness, the number of suicidal attempts, and the reasons for no follow-up for adult patients who intentionally poisoned themselves and who visited the Emergency Department of Severance Hospital from Mar. 2003 to Feb. 2004 with chart review, telephone contact. RESULTS: Forty-nine of 119 suicide patients (41.2%) chose poisoning as a means of suicide. The results of emergency treatment of those 119 patients were 4 deaths during treatment, 36 admissions (15 psychiatry, 21 others), and 79 discharges including 5 transfers. The most common underlying psychiatric problem based on 103 initial psychiatric interviews was depressive disorder in 52(50.5%) patients. Not counting the 19 deaths and psychiatry admissions, 26 patients received psychiatric follow-up during admission or after discharge, and the remaining 74 patients were subjected to telephone surveys. In the telephone surveys, only 53 patients were contacted; 25 patients declined to answer the questions and out of the 28 patients who answered them, 5 patients had received psychiatric follow-up at other hospitals. The most common reason given by the other 23 patients for no follow-up was that it was not necessary (39.1%, 9/23). The overall follow-up rate was 39.2% (31/79). Of the 48 patients who answered the question on repeated suicide attempts, 3 patients had repeatedly attempted suicide. CONCLUSION: To prevent further suicide attempts and resultant deaths in cases of patients who intentionally poisoned themselves, we urgently need an integrated psychiatric follow- up care program that is activated through a collaborative effort before discharge from the emergency department.