Substance use and self-poisoning in schizophrenia: 11-year findings from a national clinical survey of suicide in mental health patients in the UK.

Suicide is the leading cause of unnatural death among people with schizophrenia. Substance use is a highly prevalent comorbid feature of schizophrenia and a modifiable risk factor for suicide. However, no studies have examined changes in the frequency of substance use or self-poisoning in those who died by suicide over time. Knowing this could support more tailored approaches to reducing specific risk factors and access to means in those with schizophrenia who are at risk of suicide. We conducted an 11-year observational study on a clinical survey of people with schizophrenia in the UK who died by suicide within 12 months of contact with mental health services between 2010 and 2020 (n = 2718). Overall, alcohol, cannabis and stimulants were the most frequently reported substances. The odds of lifetime use significantly increased over time for cannabis, stimulants, heroin, and benzodiazepines. There were differences in socio-demographic, behavioural and clinical factors between those with recent and historical alcohol and drug use before death. Deaths by hanging, jumping and self-poisoning were the most common suicide methods. Though deaths by hanging significantly increased over time, deaths by self-poisoning significantly decreased, especially by means of psychotropic medication and opioids. To improve risk management, clinical efforts should focus on identifying and treating people with schizophrenia using specific substances. Nationwide initiatives for improving safety in prescribing could be contributing to reduced risks of suicide via self-poisoning in this group.

Risk factors for deliberate self-poisoning among children and adolescents in The Netherlands.

INTRODUCTION: In the past decade, the number of deliberate self-poisonings involving young people has increased strongly worldwide. This study aimed to gain insight into risk factors associated with deliberate self-poisonings among children and adolescents reported to the Dutch Poisons Information Center. METHODS: A study was performed between 1 February 2022 and 31 January 2023 involving those aged 8-17 years of age with deliberate self-poisoning. Data were collected on patient characteristics (age, gender, body mass index and living situation) and exposure characteristics (type of toxicant, way of acquiring toxicant and day of exposure). RESULTS: The Dutch Poisons Information Center was consulted about 1,424 deliberate self-poisonings among children and adolescents (10-17 years old). A high percentage of patients were female (85 percent), had a body mass index classified as overweight/obese (27 percent) and lived in a mental healthcare facility (13 percent). Patients mainly exposed themselves to pharmaceuticals, especially over-the-counter medications such as paracetamol (46 percent) and ibuprofen (15 percent). Young people living with parents/caregivers had higher odds of ingesting prescription pharmaceuticals or over-the-counter medication, while those living in a mental healthcare facility were more likely to ingest household products, personal care products or foreign bodies (predominantly batteries). DISCUSSION: This study sheds light on the pervasive issue of deliberate self-poisoning among children and adolescents, advocating for poisoning prevention strategies and promoting mental health of youth. Limitations include reliance on self-reported data from patients and the absence of clinical outcome data. CONCLUSIONS: Female gender, a high body mass index and living in a mental healthcare facility are associated with in increased risk of deliberate self-poisonings in children and adolescents (10-17 years old). Prevention of deliberate self-poisonings among youth could focus on restricting access to medication and other potentially hazardous non-pharmaceuticals, such as household products and batteries, as well as limiting the sales of over-the-counter medication, especially paracetamol, to this young population.

Strong metal support interaction (SMSI) and MoO3 synergistic effect of Pt-based catalysts on the promotion of CO activity and sulfur resistance.

In industrial applications, Pt-based catalysts for CO oxidation have the dual challenges of CO self-poisoning and SO2 toxicity. This study used synthetic Keggin-type H3PMo12O40 (PMA) as the site of Pt, and the Pt-MoO3 produced by decomposition of PMA was anchored to TiO2 to construct the dual-interface structure of Pt-MoO3 and Pt-TiO2, abbreviated as Pt-P&M/TiO2. Pt-0.125P&M/TiO2 with a molar ratio of Pt to PMA of 8:1 showed both good CO oxidation activity and SO2 tolerance. In the CO activity test, the CO complete conversion temperature T100 of Pt-0.125P&M/TiO2 was 113 ℃ (compared with 135 ℃ for Pt/TiO2). In the SO2 resistance test, the conversion efficiency of Pt-0.125P&M/TiO2 at 170 ℃ remained at 60% after 72 h, while that of Pt/TiO2 was only 13%. H2-TPR and XPS tests revealed that lattice oxygen provided by TiO2 and hydroxyl produced by MoO3 increased the CO reaction rate on Pt. According to the DFT theoretical calculation, the electronegative MoO3 attracted the d-orbital electrons of Pt, which reduced the adsorption energy of CO and SO2 from - 4.15 eV and - 2.54 eV to - 3.56 eV and - 1.52 eV, respectively, and further weakened the influence of strong CO adsorption and SO2 poisoning on the catalyst. This work explored the relationship between catalyst structure and catalyst performance and provided a feasible technical idea for the design of high-performance CO catalysts in industrial applications.

Incorporation of Epoxy Carbon onto CeO2-Supported Pt to Tackle the CO Self-Poisoning Issue.

The catalytic oxidation of carbon monoxide (CO) under ambient conditions plays a crucial role in the abatement of indoor CO, which poses risks to human health. Despite the notable activity exhibited by Pt-based catalysts in CO oxidation, their efficacy is usually diminished by the CO self-poisoning issue. In this work, three different Pt/CeO2-based catalysts, which have distinct coordinative environments of Pt but an identical Pt/CeO2 substrate structure, were synthesized by activating the catalyst with CO using different temperatures and durations. Compared with clean and graphite-covered Pt on CeO2, the one modified by epoxy carbon showed higher activity and stability. The combination of characterizations and density functional theory modeling demonstrated that the clean Pt on CeO2 rapidly deactivated due to the CO self-poisoning albeit high initial activity, and conversely, low initial activity was observed for the more stable graphite-covered catalyst due to the obstruction of the Pt site. In contrast, epoxy carbon species on Pt shifted the d-band of Pt to lower energy, weakening the Pt-CO binding strength. Such a modification mitigated the self-poisoning effect while maintaining ample active sites and enabling the complete oxidative removal of CO under ambient conditions. This work may provide a general approach to tackling the self-poisoning issue.

Evaluation of the rate and pattern of suicide attempts and deaths by self-poisoning among Egyptians before and during the COVID-19 pandemic.

Background: Concerns about increased suicidal attempts, especially by self-poisoning as a consequence of Coronavirus disease 2019 (COVID-19) pandemic have been raised worldwide. Aim of the study: This study aimed to evaluate the rate and pattern of suicide attempts and deaths by self-poisoning among patients admitted to Tanta University Poisoning Control Center one year before and following COVID-19 pandemic declaration in Egypt. It was conducted on the medical records of 3,200 poisoned patients, from March 2019 to February 2021. Demographic, toxicological data and patients' outcomes were collected. Results: During the pandemic year, 63.8% of total admitted patients alleged suicidal self-poisoning. Adults significantly decreased from 59% to 52.3%, while adolescents significantly increased from 34.6% to 41.7%. Monthly numbers of admitted suicidal self-poisoned patients significantly decreased during the lockdown but significantly increased from 7% to 26.5%, during the peak of the second wave of the pandemic as well as suicidal deaths (increased from 1.9% to 21.2%). Suicidal self-poisoning in females increased late in the pandemic year and suicidal self-poisoning deaths were significantly reported from rural areas (P = 0.025). The delay time was significantly longer, length of hospital stay was significantly shorter, intensive care unit admission rates and suicidal deaths were significantly increased during the pandemic year (P < 0.001, 0.026, <0.001, <0.001, respectively). Phosphides were the most commonly used poison for committing suicide and suicidal deaths during this year. Conclusion: Psychological support should be directed to females and adolescents, especially from rural areas in Egypt to help reduce suicidal attempts and deaths by self-poisoning during any future pandemics and lockdowns.

Banning highly hazardous pesticides saves the lives of young people, particularly females, in low- and middle-income countries.

Pesticide self-poisoning is a public health problem mostly affecting low- and middle-income countries. In Sri Lanka, India and China suicide rates have reduced among young people, particularly females, following highly hazardous pesticides (HHP) bans. This success story requires attention to encourage more research on differential effects of HHP bans.

Acute Methemoglobinemia Due to Crop-Flowering Stimulant (Nitrobenzene) Poisoning: A Case Report.

Nitrobenzene poisoning is an uncommon but serious form of intoxication. Nitrobenzene is used in dyes, paints, lubricating oils, and crop-flowering stimulants. Ingestion produces acute methemoglobinemia and cyanosis, which fails to produce improvement in high-flow oxygen therapy. We present here a case of a 25-year-old male presenting with diffuse headache, fatigue, and cyanosis after attempting suicide by consumption of 15 mL of 20% nitrobenzene. Oxygen saturation (SpO2) was 85% on room air and was not improving on oxygen therapy. Serum methemoglobin level was 22% of hemoglobin. The patient was treated with IV methylene blue and oral ascorbic acid along with supportive management. He attained recovery by day three and was subsequently discharged. Acute methemoglobinemia following nitrobenzene poisoning is of grave concern and demands timely identification and diligent management with methylene blue and ascorbic acid alongside supportive measures.

Differences in the characteristics of people who purchase pesticides from shops for self-harm versus those who use pesticides available in the domestic environment in Sri Lanka.

OBJECTIVE: Data from South Asia indicate that for 15%-20% of suicide attempts, pesticides are purchased from shops; otherwise, pesticides are obtained from an individual's house or nearby environment. We aimed to investigate the difference between individuals who directly purchase pesticides from shops for suicide attempts and suicide deaths versus those related to accessing the pesticides from an individual's house or nearby environment. METHODS: We conducted two comparative studies in rural Sri Lanka: (1) non-fatal shop cases (n = 50) were survivors of self-poisoning with pesticides who ingested the pesticides after purchasing them from a shop; non-fatal domestic cases (n = 192) were survivors who accessed pesticides from their house or nearby environment. (2) fatal shop cases (n = 50) were individuals who died after ingesting pesticides they purchased for the act; fatal domestic cases (n = 102) were patients who died after ingesting pesticides they accessed at house or nearby environment. Logistic regression analysis was used to assess the characteristics which distinguished between the shop and domestic cases. RESULTS: Data indicate that 20.7% and 32.9% of individuals who used pesticides for suicide attempts and suicide deaths had purchased them from shops, respectively. Being a non-farmer was the main distinguishing characteristic of shop cases: adjusted odds ratios (AOR) 8.9, 95% confidence intervals (CI) 3.2-24.4 for non-fatal shop cases, and AOR 4.0, 95% CI 1.5-10.6 for fatal shop cases. Non-fatal shop cases also had higher suicide intent (AOR 3.0, CI 1.0-8.9), and ingesting an insecticide (AOR 4.8, CI 1.8-1.0-8.9) than non-fatal domestic cases. CONCLUSION: A high suicide intent of individuals who purchase pesticides for the event explains the high proportion of such fatal cases. Such high suicide intent makes the prevention implications difficult to spell out for those individuals who purchase pesticides for self-poisoning. However, our findings are valuable for clinicians to assess pesticide poisoning cases in hospitals.

A lethal cocktail - shining a light on the relationship between alcohol use and pesticide self-poisoning.

INTRODUCTION: Alcohol and pesticides are toxic substances that each cause acute and chronic harm to humans. Alcohol plays an important and complex role in pesticide self-poisoning, involving toxicological, public health, and social aspects important for research, prevention, and interventions. ALCOHOL USE DISORDER AND SOCIAL HARMS: While the evidence on alcohol co-ingestion in the context of pesticide self-poisoning is limited, it appears that alcohol use increases complications. Even fewer studies address alcohol use disorder and dependence among pesticide self-poisoning patients. The harmful use of alcohol also impacts social life, families, and communities in several ways, including pesticide self-poisoning among individuals around the alcohol user. This, however, is vastly understudied. OUTSIDE INFLUENCES: Agrochemicals and alcohol are produced by industries with financial interests, and the outcome of individual acts of pesticide self-poisoning depends on the lethality of the pesticide purchased and ingested. The promotion of acutely toxic pesticides by companies must be acknowledged within this issue. CONCLUSION: The relationship between alcohol and pesticide self-poisoning is increasingly clear, but more studies are needed to guide management. We cannot ignore that pesticide self-poisoning and harmful use of alcohol occur within the context of wider, often structural, stressors and are influenced by commercial entities.

Suicide Trends in Jordan in Correlation With the COVID-19 Pandemic: A Forensic Medicine Perspective.

Background This study aimed to examine the suicide trends among Jordanians who died by suicide before and during the coronavirus disease 2019 (COVID-19) pandemic and assess their correlation with demographic data, including gender, age, marital status, and the method used for suicide, from a forensic medicine perspective. Methodology This was a retrospective, observational, autopsy-based study. Of the 731 medicolegal autopsies performed at the Al-Hussein New Hospital at Al Salt City between 2017 and 2022, 41 confirmed cases of suicide were identified. Results The study indicated that 75% of the subjects committed suicide during the COVID-19 pandemic period, of whom 13% were children. The average age of those who died by suicide was 32.1 (SD = 12.2) years. Overall, 58.5% were single, 61.0% unemployed, and 53.7% had a mental illness. Males were four times more likely to commit suicide than females. Hanging represented 60.61% of all male suicides, followed by firearms (27.27%); however, females used poisoning. Around 60% and 25% of the study subjects were in the age group of 21-40 years and 41 and more, respectively. The study also identified a statistically significant association between gender, age, and the time of suicide (during COVID-19). The findings of this study could not confirm any association between suicide and mental illness, marital status, and employment status. Conclusions The suicide rate in Jordan increased during the COVID-19 pandemic, and it is alarming that most of those who committed suicide were at a young age and in their productive years.

Psychosocial Factors Behind Deliberate Self-Poisoning in a Tertiary Care Hospital of Bangladesh: A Cross-Sectional Study.

INTRODUCTION: Deliberate self-poisoning (DSP) is an important cause of hospital admissions and subsequent mortality. We conducted a cross-sectional observational study in a tertiary-level teaching hospital situated in the northeastern part of Bangladesh to analyze the psychosocial factors responsible for DSP. METHODS: This cross-sectional observational study was carried out among patients with DSP admitted to the medicine ward from January to December 2017, irrespective of gender, except for cases involving poisoning due to spoiled food, food contaminated by infectious organisms, poisoning by venomous animals, and street poisoning (commuter or travel-related poisoning). Consultant psychiatrist in accordance with the Diagnostic & Statistical Manual of Mental Disorder - IV (DSM-IV) confirmed psychiatric disorders. Data were analyzed by SPSS (Statistical Package for social sciences) version 16.0 (IBM Corp., Armonk, NY). RESULTS: Total 100 patients were enrolled. Among them, 43% were male and 57% were female. The majority (85%) of the patients were young, aged below 30 years. The mean age of male patients was 26.2 years and that of females was 21.69 years. Most of the DSP patients were from the lower economic class (59%). The population sample was remarkable for students (Prevalence 37%). The highest percentage of patients (33%) had their educational status at the secondary level. The common reasons for DSP were a family problem in 31% patients, quarrel with boy/girlfriend in 20%, quarrel with a spouse in 13%, quarrel with parents or other family member in 7%, failure in examination in 6%, poverty in 3%, and unemployment in 3%. Prescription medication was the most common poison material (38%), followed by insecticides (36%), household cleaners (17%), and rodenticides (8%). Seven (7%) patients reported previous deliberate self-harm events and co-morbid psychiatric disorder was present in 30% patients among them major depressive disorder was found in 60%, and schizophrenia in 23.3% cases. CONCLUSION: DSP remains a problem mainly for the young with gender ratio-favoring females. The majority of DSPs were educated up to secondary level, unmarried, residents of rural areas, student, and belonged to the lower class. Familial disharmony and quarrel with spouse or friends were the common reason behind DSP. Prescription medication and insecticides were commonly used for DSP. Psychiatric disorders, primarily depressive disorder, and schizophrenia were common in cases of DSP.

Surveillance of pesticide poisoning in an East and a West Malaysian hospital: characteristics of pesticide poisoning and the early impact of a national Paraquat ban.

BACKGROUND: Previous studies have shown that pesticide bans were associated with reduced fatal pesticide self-poisoning cases in high, and low-and-middle-income countries. We aimed to investigate the characteristics of pesticide poisoning patients admitted to two Malaysian hospitals and the early impact of the national paraquat ban implemented on 1st January 2020 in a culturally heterogenous South-East-Asian upper-middle-income setting. METHODS: Data were collected from an East (Bintulu) and a West (Ipoh) Malaysian hospital medical records in 2015-2021 and 2018-2021, respectively. Logistic regression analyses were conducted to investigate the association of aspects such as socio-demographic and clinical characteristics, paraquat ban with the types of pesticides involved (paraquat versus non-paraquat versus unknown) ,and the outcomes (fatal versus non-fatal). RESULTS: From the study sample of 212 pesticide poisoning patients aged 15 years or above, the majority were self-poisoning cases (75.5%) with a disproportionate over-representation of Indian ethnic minority (44.8%). Most pesticide poisoning cases had socio-environmental stressors (62.30%). The commonest stressors were domestic interpersonal conflicts (61.36%). 42.15% of pesticide poisoning survivors had a psychiatric diagnosis. Paraquat poisoning accounted for 31.6% of all patients and 66.7% of fatalities. Case fatality was positively associated with male gender, current suicidal intent, and paraquat poisoning. After the paraquat ban, the proportion of pesticide poisoning cases using paraquat decreased from 35.8 to 24.0%, and the overall case-fatality dropped slightly from 21.2 to 17.3%. CONCLUSIONS: Socio-environmental stressors in specific domestic interpersonal conflicts, seemed more prominent in pesticide poisoning compared to psychiatric diagnosis. Paraquat accounted for the majority of pesticide-associated deaths occurring in hospitals in the study areas. There was preliminary evidence that the 2020 paraquat ban led to a fall in case fatality from pesticide poisoning.

Predictors of prospective suicide attempts in a group at risk of personality disorder following self-poisoning.

Background: Patients with personality disorder (PD) are at risk for suicidal behavior and are frequently admitted for this reason to emergency departments. In this context, researchers have tried to identify predictors of their suicidal acts, however, the studies have been mostly retrospective, and uncertainty remains. To prospectively explore factors associated with suicide attempts (SA) in individuals screened for PD from the ecological context of emergencies. Methods: Patients were recruited from two emergency departments after a self-poisoning episode (n = 310). PDQ-4+ (risk of PD), TAS-20 (alexithymia), SIS (suicidal intent), H (hopelessness), BDI-13 (depression), AUDIT (alcohol consumption), and MINI (comorbidity) questionnaires were completed. SA over the subsequent two years were identified by mailed questionnaires and hospitals' active files. Logistic regression analyses were performed. Results: Having a previous suicidal attempt was linked to a 2.7 times higher chance of recurrence after 6 months, whereas the TAS-20 showed a 1.1 times higher risk at 18 months (OR = 1.1) and the BDI at 24 months (OR = 1.2). Each one-unit increment in TAS-20 and BDI-13 scores increased the risk of SA by 9.8 and 20.4% at 18 and 24 months, respectively. Conclusion: Some clinical features, such as alcohol dependence, suicide intent, and hopelessness, may not be reliable predictors of SA among PD patients. However, in the short term, previous SA and, in the long term, depression and alexithymia may be the most robust clinical predictors to consider in our sample of patients with self-poisoning SA.Clinical trial registration: [ClinicalTrials.gov], NCT00641498 24/03/2008 [#2006-A00450-51].

Significant Increase in Deliberate Self-Poisonings Among Adolescents During the Second Year of the COVID-19 Pandemic.

PURPOSE: The COVID-19 pandemic has been associated with a decline in mental health of adolescents. The aim of this study was to analyze the rate of deliberate self-poisonings (DSPs) among adolescents reported to the Dutch Poisons Information Center before and during the COVID-19 pandemic. METHODS: A retrospective study from 2016 until 2021 was performed to characterize DSPs among adolescents, and to analyze trends in the number of DSPs. All DSPs among adolescents with the age of 13 up to and including 17 years were included. DSP characteristics included: age, gender, bodyweight, used substance, dose, and treatment advice. Trends in the number of DSPs were analyzed using time series decomposition and Seasonal Autoregressive Integrated Moving Average models. RESULTS: Six thousand nine hundred fifteen DSPs in adolescents were recorded from January first 2016 until December 31st 2021. Females were involved in 84% of adolescent DSPs. A strong increase in the number of DSPs was observed in 2021 (45% increase compared to 2020), which deviated from the predicted trend based on previous years. This increase was most prominent in 13-, 14-, and 15-year-old female adolescents. Commonly involved drugs were paracetamol, ibuprofen, methylphenidate, fluoxetine, and quetiapine. The contribution of paracetamol rose from 33% in 2019 to 40% in 2021. DISCUSSION: The strong increase in the number of DSPs during the second year of the COVID-19 pandemic suggests that long-term containment measures such as quarantines, lockdowns, and school closures may enhance self-harm behavior among adolescents, especially among younger females (13-15 years of age), with a preference for paracetamol as DSP substance.

Trends and Prevalence of Hospital Admissions Related to Deliberate Self-Poisoning and Used Substances in Romanian Adolescents between 2016 and 2022.

Rates of self-poisoning are increasing substantially all around the world, with self-poisoning being the most common form of self-harm leading to hospitalization in children and adolescents. This study aims to investigate the trends in the number of deliberate self-poisoning admissions in Romanian adolescents during the period of 2016-2022, as well as the most frequently used substances and the impact of the COVID-19 pandemic on hospital admissions due to self-poisoning and substance use in relation to these episodes. The sample included 178 patients admitted to the Clinic of Pediatric Psychiatry in Cluj-Napoca from 2016 to 2022 due to an episode of self-poisoning. Data were collected on patients' sociodemographic characteristics, psychosocial characteristics, and medical histories. We report a slight overall increase in the self-poisoning admission rate during the studied period. There was a decrease during the initial period of the pandemic, with significantly increasing rates in the second year of the pandemic. The mean prevalence rate of hospital admissions due to self-poisoning episodes during the study period was 3.14% (95% CI 2.72, 3.63). Adolescent girls were identified as the most vulnerable group, with the female-to-male ratio increasing dramatically. In terms of substance use, benzodiazepines; over-the-counter analgesics, including paracetamol; and antidepressants were the most frequently used substances. We emphasize the importance of careful consideration in prescribing psychotropic drugs, as well as the need for regulation of over-the-counter drug dispensation.

Suspected suicides and suicide attempts involving antipsychotic or sedative-hypnotic medications reported to America's Poison Centers, 2000-2021.

OBJECTIVE: To investigate the patterns and trends of suspected suicides and suicide attempts involving antipsychotic or sedative-hypnotic medications reported to United States poison centers. METHODS: Data from the National Poison Data System for 2000 through 2021 were retrospectively analyzed. RESULTS: There were 972,975 suspected suicides and suicide attempts with antipsychotics or sedative-hypnotics ranked as the primary substance reported to poison centers from 2000-2021, averaging 44,226 cases annually. Most (85.6%) cases occurred among individuals >19 years old, females accounted for 63.5% of cases, and 51.8% were single-substance exposures. The rate of reported exposures per 100,000 United States population increased significantly from 27.2 in 2000 to 49.1 in 2008 (P < 0.0001), then plateaued to 49.6 in 2016 (P = 0.1497), followed by a significant decrease to 38.7 in 2021 (P < 0.0001). Individuals 13-19 years old demonstrated the greatest increase in rate from 28.4 in 2000 to 79.6 in 2021 (P < 0.0001). Approximately half (48.8%) of primary substance exposures were benzodiazepines, followed by antipsychotic medications (36.7%) and other types of sedative/hypnotic/anti-anxiety or antipsychotic medications (14.6%). Most primary substance exposures were admitted to a critical care or non-critical care unit (43.3%) or directly to a psychiatric facility (27.9%), and 36.1% were associated with in a serious medical outcome, including 1,330 deaths. Individuals >49 years old were more likely to experience a serious medical outcome (relative risk = 1.25, 95% CI: 1.24-1.26), including death (relative risk = 3.06, 95% CI: 2.74-3.41), or be admitted to a critical care or non-critical care unit (relative risk = 1.24, 95% CI: 1.23-1.24) than younger individuals. CONCLUSIONS: Suspected suicides and suicide attempts involving antipsychotic or sedative-hypnotic medications increased during the 22-year study period, especially among individuals 13-19 years old, and these cases often had severe clinical consequences. Based on the characteristics and trends identified in this study, increased prevention efforts are warranted to help prevent these suspected suicides and suicide attempts.

Association of mental health status between self-poisoning suicide patients and their family members: a matched-pair analysis.

BACKGROUND: The objective of this study was to examine the relationship of mental health status between self-poisoning suicide patients and their family members, and it also sought to identify potential patient's risk and parental factors for the prediction of suicide attempt, anxiety, and depression. METHODS: In this study, 151 poisoned patients were prospectively included, and they were matched 1:1 with 151 family members. We gathered information on patient's and their matched family member's demographics, lifestyle choices, mental health status, level of intimacy, and history of psychiatry disease. The relationship of patient's and their family member's mental health state was investigated using a correlation matrix. Multivariable analyses (multiple logistic regression) were conducted among patients and their matched family members, to identify potential risk factors for self-poisoning suicide, anxiety, and depression. RESULTS: Of the total patients, 67.55% (102/151) attempted self-poisoning suicide. Poisoned patients had more severe anxiety and depression symptoms than their matched family members, and this difference was even more pronounced among patients with self-poisoning suicide. Generalized anxiety disorder-7 (GAD-7) score for family members was significantly and favorably correlated with patient's GAD-7 score after eliminating non-suicide patients and their matched family members. The patient health questionnaire-9 (PHQ-9) score showed a similar pattern, and the family member's PHQ-9 score was strongly and favorably associated with patient's PHQ-9 and Beck hopelessness scale-20 (BHS-20) score. Multivariable analysis showed that married marital status (P = 0.038), quitting smoking (P = 0.003), sedentary time of 1 to 6 h (P = 0.013), and participation in a sports more than five times per week (P = 0.046) were all significantly associated with a lower risk of suicide by self-poisoning, while a more serious anxiety state (P = 0.001) was significantly associated with a higher risk of self-poisoning suicide. Multivariable analysis demonstrated that, specifically among self-poisoning suicide patients, married marital status (P = 0.011) and no history of psychiatry disease (P < 0.001) were protective factors for anxiety, while divorced or widowed marital status (P = 0.004), a sedentary time of 1 to 3 h (P = 0.022), and a higher monthly income (P = 0.027) were significant contributors to anxiety. The propensity of additional family-matched characteristics to predict patient's suicidality, anxiety, and depression was also examined. CONCLUSIONS: Self-poisoning suicide patients have severe mental health issues. Patients who self-poison have a close connection to their family member's mental health, particularly their levels of anxiety and depression. According to the findings, being married and adopting healthy lifestyle habits, such as quitting smoking and drinking, increasing their physical activity levels, and managing their idle time, are able to help patients with mental health concerns and even suicidal thoughts.

Self-Poisoning With Household Bleach in an Elderly Man.

Caustic self-poisoning is a major health hazard, which affects any age, but is particularly serious among the elderly. Household bleach is a caustic that contains 3% to 6% sodium hypochlorite solution, one of the most common agents in unintentional caustic poisoning. In this clinical case, we present a household bleach self-poisoning by an older man with no relevant medical history. He presented with extensive burns on the oral cavity mucosa and tongue, requiring orotracheal intubation by video laryngoscopy. He was then admitted to the intensive care unit, where he evolved poorly. Given the poor prognosis and the lack of physiological reserve for the invasiveness required for a surgical approach, a conservative strategy was chosen after a multidisciplinary team discussion. With the conservative strategy, the patient survived, being discharged to the general ward after one month, where he underwent a Stamm gastrostomy and placement of a percutaneous endoscopic gastrostomy. In the follow-up consultation three months later, the patient was found to be weakened, with high frailty status, presenting anxiety, depression, and causing high family burden.

Identification of risk factors for attempted suicide by self-poisoning and a nomogram to predict self-poisoning suicide.

Purpose: Suicide is a global concern, especially among young people. Suicide prediction models have the potential to make it easier to identify patients who are at a high risk of suicide, but they have very little predictive power when there is a positive value for suicide mortality. Therefore, the aim of the study is to uncover potential risk factors associated with suicide by self-poisoning and further to provide a trustworthy nomogram to predict self-poisoning suicide among poisoned patients. Methods: This study prospectively enrolled 237 patients who were treated for poisoning at the Fifth Medical Center of PLA General Hospital (Beijing) between May 2021 and May 2022. Patient's basic characteristics, daily activities, mental health status, and history of psychological illnesses were gathered to examine their predictive power for self-poisoning suicide. On developing a prediction model, patients were split 8:2 into a training (n = 196) group and a validation (n = 41) group at random via computer. The training group worked on model development, while the validation group worked on model validation. In this study, the Hosmer and Lemeshow test, accuracy, and area under the curve were the primary evaluation criteria. Shapley Additive exPlanations (SHAP) was determined to evaluate feature importance. To make the prediction model easy for researchers to utilize, it was presented in nomogram format. Two risk groups of patients were identified based on the ideal cut-off value. Results: Of all poisoned patients, 64.6% committed suicide by self-poisoning. With regard to self-poisoning attempted suicide, multivariate analysis demonstrated that female gender, smoking, generalized anxiety disorder-7 (GAD-7), and beck hopelessness scale-20 (BHS-20) were significant risk factors, whereas married status, relatively higher education level, a sedentary time of 1-3 h per day, higher sport frequency per week, higher monthly income were significant protective features. The nomogram contained each of the aforementioned nine features. In the training group, the area under curve (AUC) of the nomogram was up to 0.938 (0.904-0.972), whereas in the validation group, it reached a maximum of 0.974 (0.937-1.000). Corresponding accuracy rates were up to 0.883 and 0.927, respectively, and the P-values for the Hosmer and Lemeshow test were 0.178 and 0.346, respectively. SHAP demonstrated that the top three most important features were BHS-20, GAD-7, and marital status. Based on the best cut-off value of the nomogram (40%), patients in the high-risk group had a nearly six-time larger likelihood of committing suicide by self-poisoning than patients in the low-risk group (88.68 vs. 15.38%, P < 0.001). The dynamic nomogram was made available at the following address: https://xiaobo.shinyapps.io/Nomogramselfpoisoningsuicide/. Conclusions: This study proposes a prediction model to stratify patients at a high risk of suicide by self-poisoning and to guide individual preventive strategies. Patients in the high-risk group require further mental health counseling to alleviate anxiety and hopelessness, healthy lifestyle like quitting smoking and exercising more, and restriction of access to poison and psychiatric drugs.

Are People Who Die by Intentional Medication Poisoning Dispensed Those Medications in the Year Prior to Death?

OBJECTIVE: The rate of suicidal poisoning in the United States has increased substantially over the past 20 years. Understanding whether prescription medications used for self-poisoning were recently dispensed would help inform suicide prevention efforts. Alternatively, medications for self-poisoning could have been formerly dispensed or collected from friends, family, or illicit sources. METHODS: Among those who died by intentional opioid and psychotropic poisonings, we conducted a descriptive study to determine what proportion had a recently filled prescription that could have been the means of suicide. Subjects were all people who died by intentional poisoning across nine health-care systems within the NIH-funded Mental Health Research Network. RESULTS: Among the 3,300 people who died by suicide, 700 died by any poisoning and 194 died by intentional opioid or psychotropic/hypnotic medication poisoning. Among those who died by intentional opioid poisoning 73% were dispensed an opioid in the year prior. Among those who died by intentional psychotropic/hypnotic poisoning, 83% were dispensed any psychotropic and 61% were dispensed a hypnotic in prior year. Most people were continuously dispensed the same medications used in their intentional poisonings in the year prior to death. CONCLUSIONS: Our results indicate that most medications used in suicidal overdose were likely recently dispensed. Therefore, future suicide prevention studies and prevention resources should focus on medication safety interventions such as lethal-means counseling for medication access, limiting quantities dispensed, opioid antagonists, and blister packs. HIGHLIGHTSUnderstanding whether medications used for self-poisoning were recently dispensed or formerly/never dispensed would help inform future studies and suicide prevention efforts.We found that most people who died by intentional poisoning with opioids or psychotropic/hypnotic medications received frequent dispensings of the medication used for self-poisoning in the year prior to death.Future suicide prevention studies and efforts should focus on medication safety interventions such as lethal-means counseling for medication access, limiting quantities dispensed, opioid antagonists, and blister packs.