RESUMO
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.
RESUMO
BACKGROUND: Organophosphate (OP) poisoning is the most common cause (27.64%) and has the highest death rate (13.88%) of poisoning in Bangladesh. It leads to three main syndromes notably acute cholinergic syndrome, intermediate syndrome, and delayed polyneuropathy. It rarely causes cardiac arrhythmia, pancreatitis and hepatic dysfunction. We present the case of a middle-aged Asian woman suffering from organophosphate poisoning with dual complications. CASE PRESENTATION: A middle aged Asian woman with depression was brought to emergency attention after drinking of 60 milliliter of organophosphate insecticide in a suicidal attempt. She had vomiting, excessive retching, diarrhoea, miosis, hypersalivation and bilateral crepitation on chest during admission. After immediate resuscitation, atropinization was done and it required total of 36 milligram. The patient also received pralidoxime. While on maintenance, features of toxicity re-appeared and she again required atropine in bolus dose. On the fifth day of management she complained of generalized weakness, inability to control her neck and to sit or stand without support. But there was no respiratory muscle involvement and all deep tendon reflexes were normal. On the same day the patient also developed severe upper abdominal pain along with nausea and vomiting. Investigations revealed neutrophilic leucocytosis (30,000/cubic millimeter; 86%) with high serum lipase (770 Unit/Liter) and alanine transaminase (379 Unit/Liter) and low serum potassium (3.0 millimol/Liter). On the basis of above mentioned features organophosphate induced intermediate syndrome and pancreatitis was diagnosed. The patient recovered completely with appropriate management. CONCLUSION: Organophosphate poisonings causes up to 25% mortality worldwide. A major contributing factor for that are different complications. Awareness of these complications can reduce both mortality and morbidity. Early diagnosis of complications and timely therapeutic measures can improve prognosis.
