Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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A Study on the Characteristics of Intentional Self-Poisoning Patients : Comparison between Non-Prescription and Prescription Drugs

일반의약품과 전문의약품 의도적 음독 자살 시도자 특성 분석 연구

  • Cho, Eulah (Department of Psychiatry, Seoul Medical Center) ;
  • Cho, Ji Hyun (Department of Social Welfare, Dongshin University) ;
  • Jho, Kyeng Hyeng (Department of Psychiatry, Maeumsarang Mental Hospital) ;
  • Sim, Hyun-Bo (Department of Psychiatry, Seoul Medical Center)
  • 조을아 (서울특별시 서울의료원 정신건강의학과) ;
  • 조지현 (동신대학교 사회복지학과) ;
  • 조경형 (마음사랑병원) ;
  • 심현보 (서울특별시 서울의료원 정신건강의학과)
  • Received : 2020.07.20
  • Accepted : 2020.09.11
  • Published : 2020.12.31
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Abstract

Objectives : Self-poisoning is the leading cause of visits to the emergency departments after a suicide attempts. This study is aimed to compare the patient characteristics according to the category of drugs ingested by the patients who attempted suicide. Methods : All medical charts were retrospectively reviewed from patients who visited the emergency center, at Seoul Medical Center, due to intentional self-poisoning from April of 2011 to July of 2019. We investigated the information regarding the subtype and quantity of the intoxication drug, how it was obtained, suicidal history, and psychiatric history, as well as, sociodemographic information. Variables were compared between prescription drug (PD) and non-prescription drug (NPD) poisoning groups. Results : The mean age of the NPD poisoning group was significantly lower than that of the PD poisoning group. The patient ratio of those enrolled in national health insurance and living with spouses were significantly higher in the NPD poisoning group. Compared to the NPD poisoning group, the PD poisoning group had a higher incidence of mental illnesses, underlying diseases and ratio of involuntary visit to the emergency department. Among the prescription drugs, the benzodiazepine poisoning group had a higher rate of self-prescription than the non-poisoning group, while the zolpidem poisoning group had a higher rate of the using someone else's prescription than other drugs. Each single drug poisoning group (benzodiazepine, zolpidem, and antidepressant single-agent) had a higher rate of no mental illness than each of the mixed-poisoning group. Conclusions : Guidelines for regulating non-prescription drugs are needed as a matter of suicide prevention. Also, this study suggests that clinicians need to be careful when issuing prescriptions and should suicidal risk according to patients' characteristics, duration of follow-up and type of drug packaging.

연구목적 자살시도로 응급실에 내원한 환자들 중 음독이 가장 높은 빈도를 보이고 있다. 본 연구에서는 음독 의약품에 따른 자살 시도자들의 특성을 분석하여 향후 임상 진료 현장에서 도움이 될 제언과 자살 예방 정책을 마련하는데 기초자료를 제공하고자 하였다. 방 법 2011년부터 2019년까지 서울 소재 1개 종합 병원 응급실에 음독 자살 시도 후 내원한 환자 574명의 의무기록을 후향적으로 검토하였다. 의무기록을 통해 인구통계학적 정보 및 자살 과거력, 정신건강의학과 과거력, 정신질환 외 기저질환력, 음독 약물의 종류 및 양, 획득 경로, 단일 혹은 혼합 음독여부 등에 대해서 조사 후 카이제곱 검정 및 독립표본 t-검정을 사용하여 통계 분석하였다. 유의한 결과에 대해서는 위험률 산출을 위해 오즈비를 구하였다. 결 과 일반의약품 음독군이 전문의약품 음독군에 비해 연령은 유의하게 낮았으며 국민건강보험 외 비율은 낮고 배우자가 있는 비율은 유의하게 높았다. 전문의약품 음독군은 일반의약품 음독군에 비해 비자발적 응급실 내원, 정신질환력 및 정신질환 외 기저질환력에서 높은 비율을 보였다. 전문의약품 중 벤조디아제핀 음독군은 비음독군에 비해 본인 처방 비율이 높은 반면 졸피뎀 음독군은 타인처방 비율이 높았다. 벤조디아제핀, 졸피뎀, 항우울제 단독 음독군이 복합 음독군에 비해 유의하게 정신질환력이 없는 비율이 높았다. 결 론 일반의약품 판매 규제에 대한 가이드라인이 필요할 것이며 임상 현장에서 자살 고위험군의 특성을 유념한 면담이 필요하다. 또한 자살 위험성이 높은 환자들에게 전문의약품 처방 시 추적 관찰 기간 및 처방 기간, 포장 방식에 대한 적극적인 고려가 필요할 것으로 보인다.

Keywords

References

  1. OECD. Health at a Glance 2019 OECD INDICATORS. Paris: 2019.OECD Publishing.
  2. Statistics Korea. Annual report on the causes of death statistics;2019. p.75
  3. Korea Suicide Prevention Center. 2019 WHITE BOOK;2019.
  4. Kim SY, Song HS, Kim KD, Lee KK. A study of patients with suicidal attempt. J Korean Soc Emerg Med 1999;10:560-567.
  5. Choi KS, Woo JH, Lim YS, Kim JJ, Jang JH, Choi WS, Min KJ, Cho SJ, Kang SG, Na KS. The characteristics of first suicide attempt patients with self-poisoning: comparison of patients with self-injury. J Korean Soc Emerg Med 2017;28:493-501.
  6. Kwak MH, Kang HY, Lee SJ, Han KS, Kim SJ, Lee EJ, Lee SW. Self-poisoning as a target group for prevention of suicide. J Korean Soc Clin Toxicol 2018;16:93-101. https://doi.org/10.22537/JKSCT.2018.16.2.93
  7. Hur JM, Chun WC, Min YG, Jung YS. Analyses of suicide victims admitted via the emergency department-based on psychiatric histories, past suicidal attempts and psychiatric diagnoses. J Korean Soc Clin Toxicol 2004;2:106-115.
  8. Lee WJ, Park KN, Choi SP, Lee MJ. Trends analysis of suicidal poisoning in Korea-comparison before and after the IMF crisis and the economic recession. J Korean Soc Clin Toxicol 2005;3:33-39.
  9. Kim SH, Kim H, Lee JS, Park JM, Park J, Kim KH, Shin DW, Kim H, Jeon W. Pharmaceutical drug poisoning after deregulation of over the counter drug sales: emergency department based in-depth injury surveillance. J Korean Soc Clin Toxicol 2018;16:141-148. https://doi.org/10.22537/jksct.16.2.141
  10. Kim HJ, Kim HM, Kim HJ, Cho YS, Lee MG, Jun DH, Go CY. Association of Prescribed Drug intoxication and Neuropsychiatric history. J Korean Soc Clin Toxicol 2011;9:77-80.
  11. Lee OS, Cheon YJ, Kim JT, Lim SC. Evaluation of drugs for suicide attempt and antidote uses in emergency room of a hospital in Korea. Kor J Clin Pharm 2012;22:304-315.
  12. Alexandre M, Omaid T, Gilles L, Pierre-Andre D, Youssef H, Alain L, CP L Nancy, Suzanne L, Santokh S, Elham R. Over-the-counter drugs and other substances used in attempted suicide presented to emergency departments in montreal, Canada: a cross-sectional study. Crisis 2019;40:166-75. https://doi.org/10.1027/0227-5910/a000545
  13. Lo A, Shalansky S, Leung M, Hollander Y, Raboud J. Patient characteristics associated with nonprescription drug use in intentional overdose. Can J Psychiatry 2003;48:232-236. https://doi.org/10.1177/070674370304800406
  14. Oh S, Park H. Analysis of the prescription patterns of medications that list suicide in use cautions using the HIRA claims data. Korean J Clin Pharn 2019;29:202-208. https://doi.org/10.24304/kjcp.2019.29.3.202
  15. Pitman A, Tham SG, Hunt IM, Webb RT, Appleby L, Kapur N. Access to means of lethal overdose among psychiatric patients with co-morbid physical health problems: analysis of national suicide case series data from the United Kingdom. J Affect Disord 2019;257:173-179. https://doi.org/10.1016/j.jad.2019.06.027
  16. Statistical analyses team. 2018 Suicidal statistics documents. 2019.Korea suicide prevention center 2019, 2019 Contract No.: 2019-013.
  17. Coimbra DG, Pereira E Silva AC, de Sousa-Rodrigues CF, Barbosa FT, de Siqueira Figueredo D, Araújo Santos JL, Barbosa MR, de Medeiros Alves V, Nardi AE, de Andrade TG. Do suicide attempts occur more frequently in the spring too? A systematic review and rhythmic analysis. J Affect Disord 2016; 196:125-137. https://doi.org/10.1016/j.jad.2016.02.036
  18. Kim CY, Lee EJ, Lee SW, Kim SJ, Han KS. Changes in toxicological characteristics after sales of nonprescription drugs in convenience stores. J Korean Soc Clin Toxicol 2018:42-48.
  19. Support Team Emergency Department. Analysis of demographic characteristics and follow-up service results of suicide attempters who visited the emergency room: focused on the agency that performed the post-mortem suicide attempter management project based on the emergency room in 2017. KSPC Research Brief 2018, 2018.
  20. Ahn WC, Cho JH, Moon JB, Park CW, Shin MC, Kim KE, Lee JY, Park YS, Hwang BS, Yang GE, Lee HY, Kim MS, Chun IK, Ohk TG. The pre-hospital analysis of intentional taking poison in Gangwon-do. J Korean Soc Emerg Med 2020; 31:23-38.
  21. Son CW, Kim JA. Reality of healthcare utilization and health behaviors of medical aid beneficiaries in Seoul 2017. The Seoul Institute p4-5, 40-47.
  22. Mellinger GD, Balter MB, Uhlenhuth EH. Insomnia and its treatment. Prevalence and correlates. Arch Gen Psychiatry 1985;42:225-232. https://doi.org/10.1001/archpsyc.1985.01790260019002
  23. Kim DM, Park WB, Lim YS, Kim JJ, Jang JH, Jang JY, Yang HJ, Lee G. Comparison of prescription patterns and clinical features according to clinical departments in sedativehypnotic intoxication. J Korean Soc Clin Toxicol 2014;12:54-62.
  24. Balestrieri M, Bortolomasi M, Galletta M, Bellantuono C. Patterns of hypnotic drug prescription in Italy. A two-week community survey. Br J Psychiatry 1997;170:176-180. https://doi.org/10.1192/bjp.170.2.176
  25. Chung HI, Kim HJ, Oh SH, Choi SP, Park KN. The potential risk factors of reattempt suicide by self-poisoning in older adults. J International Journal of Gerontology 2019;13:171-175.
  26. SNU R&D, Foundation. Selection of suicide risk group for primary medical institution patients and development of psychiatric treatment reinforcement model. Ministry of Health and Welfare;2019. p.47-60.
  27. Cato V, Hollandare F, Nordenskjold A, Sellin T. Association between benzodiazepines and suicide risk: a matched casecontrol study. BMC Psychiatry 2019;19:317. https://doi.org/10.1186/s12888-019-2312-3
  28. Gibbons R, Hur K, Lavigne J, Wang J, Mann JJ. Medications and suicide: high dimensional empirical bayes screening (iDEAS). Harvard Data Science Review 2019;1.
  29. Nomura K, Nakao M, Sato M, Yano E. Regular prescriptions for benzodiazepines: a cross-sectional study of outpatients at a university hospital. Intern Med 2006;45:1279-1283. https://doi.org/10.2169/internalmedicine.45.1758
  30. Kim H, Kim JW, Kang HJ, Kim SY, Lee JY, Kim JM, Shin IS, Yoon JS, Kim SW. Factors associated with suicidal behavior of psychiatric inpatients. J Korean Neuropsychiatr Assoc 2019;58:202-208. https://doi.org/10.4306/jknpa.2019.58.3.202
  31. Choi BK, Sung HG, Nam JH, Shin JY. Zolpidem use and suicide death in south Korea: a population-based case-control study. Suicide Life Threat Behav 2019;49:1653-1667. https://doi.org/10.1111/sltb.12548
  32. Lee JH, Yang SJ, Eun SW, Jin SC, Choi WI, Jung SW. Limitation of psychiatric intervention for suicidal drug intoxication patients in emergency room J Korean Soc Clin Toxicol 2016;14.
  33. Min HG, Choi HS, Kwon OY, Lee JS, Hong HP, Ko YG, Paik JW, Kim SC, Kim DP. Is a psychiatric consultation necessary for the non-suicidal intentional drug ingestion patient in an emergency department? J Korean Soc Emerg Med 2010;21.
  34. Gyamlani GG, R CR Parikh Chirag. Acetaminophen toxicity: suicidal vs accidental. J Critical Care 2002;6:155-159. https://doi.org/10.1186/cc1475
  35. White NC, Litovitz T, Clancy C. Suicidal antidepressant overdoses: a comparative analysis by antidepressant type. J Med Toxicol 2008;4:238-250. https://doi.org/10.1007/BF03161207
  36. Hawton K, Bergen H, Simkin S, Cooper J, Waters K, Gunnell D, Kapur N. Toxicity of antidepressants: rates of suicide relative to prescribing and non-fatal overdose. Br J Psychiatry 2010;196:354-358. https://doi.org/10.1192/bjp.bp.109.070219
  37. Crome P. The toxicity of drugs used for suicide. J Acta Psychiatrica Scandinavica 1993;87:33-37. https://doi.org/10.1111/j.1600-0447.1993.tb05371.x
  38. Kye SY, Park KH. Suicidal ideation and suicidal attempts among adults with chronic diseases: a cross-sectional study. Compr Psychiatry 2017;73:160-167. https://doi.org/10.1016/j.comppsych.2016.12.001
  39. Yip PSA, Caine E, Yousuf S, Chang SS, Wu KCC, Chen YY. Means restriction for suicide prevention. The Lancet 2012; 379:2393-2399. https://doi.org/10.1016/S0140-6736(12)60521-2