Intentional paediatric poisoning presentations to emergency departments during the COVID-19 pandemic.

OBJECTIVE: To characterise paediatric poisoning presentations to EDs and determine if the advent of the COVID-19 pandemic was associated with increased intentional paediatric poisoning presentations. METHODS: We performed a retrospective analysis of paediatric poisoning presentations to three EDs (two regional and one metropolitan). Simple and multiple logistic regression analysis were performed to determine the association between COVID-19 and intentional poisoning events. In addition, we calculated the frequency with which patients reported various psychosocial risk factors as being an implicating factor in engaging in an intentional poisoning event. RESULTS: A total of 860 poisoning events met inclusion criteria during the study period (January 2018-October 2021), with 501 being intentional, and 359 unintentional. There was an increased proportion of intentional poisoning presentations during the COVID-19 pandemic (261 intentional and 218 unintentional in the pre-COVID-19 period vs 241 intentional and 140 unintentional during the COVID-19 period). In addition, we found a statistically significant association between intentional poisoning presentations and an initial COVID-19 lockdown (adjusted odds ratio 26.32, P < 0.05). 'The COVID-19 lockdown' or 'COVID-19' was reported to be implicating factor for psychological stress in patients who presented with intentional poisonings during the COVID-19 pandemic. CONCLUSIONS: Intentional paediatric poisoning presentations increased during the COVID-19 pandemic in our study population. These results may support an emerging body of evidence that the psychological strain of COVID-19 disproportionately impacts adolescent females.

Characteristics and predictive factors of severe or fatal suicide outcome in patients hospitalized due to deliberate self-poisoning.

Prediction of clinical course of intoxication is essential for timely initiation of appropriate medical treatment in patients hospitalized due to suicidal self-poisoning. In this retrospective single-centre study in patients hospitalized due to suicidal poisoning in a specialized clinical toxicology unit, we aimed to identify predictive factors associated with severe or fatal course of self-poisoning. All patients underwent at least one psychiatric exploration during their inpatient stay. Severity of poisoning was assessed on admission and after 24 hours according to the Poison Severity Score index (PSS). Spearman's rank correlation coefficient was used to test the association of PSS with sociodemographic, anamnestic and (pre-)clinical parameters. Multivariable binomial logistic regression analysis was performed to determine predictive factors for severe and/or fatal self-poisoning. 1090 patients were included in the study. Median age was 39 years (range 13-91), 66.7% of patients were female. PSS was classified in the majority as "minor" (n = 558, 51.2%) or "moderate" (n = 264, 24.2%). 61 patients (5.6%) had PSS "severe"; 14 patients (1.3%) died. A higher severity of poisoning positively correlated with duration of inpatient therapy (p<0.001, Spearman's rho = 0.454) and duration of ventilation (p<0.001, rho = 0.474), and it inversely correlated with initial Glasgow Coma Scale (GCS) score (p<0.001, rho = -0.437). Multivariable analysis identified no alcohol co-ingestion (OR 3.23; 95%CI 1.3, 8.07; p = 0.012) and self-poisoning with non-medicinal substances (OR 5.4; 95%CI 1.78, 16.34; p = 0.003) as factors predictive for "severe" or "fatal" suicide outcome. In contrast, female gender (OR 0.4; 95%CI 0.2, 0.81; p = 0.011), not using an antidepressant as the method for self-poisoning (OR 0.27; 95%CI 0.12, 0.59; p = 0.001) and a higher initial GCS score (OR 0.79; 95%CI 0.73, 0.85; p<0.001) reduced the risk of a severe or fatal course of self-poisoning. The conclusion for clinical practice is that male patients hospitalized due to self-poisoning, with a low initial GCS score, who did not co-ingest alcohol, attempted suicide with non-pharmaceutical substances or antidepressants are at a higher risk of severe/fatal outcome of suicide. Determination of these risk factors at admission could be potentially used to guide treatment intensification in patients hospitalized due to deliberate self-poisoning.

Intoxicaciones en la tercera edad / Poisoning among the elderly

Objetivos Las intoxicaciones siguen siendo un problema de salud pública importante. En el presente estudio evaluamos la epidemiología de las intoxicaciones en la tercera edad. Métodos Estudio de cohorte retrospectivo realizado entre 2011 y 2019 en un hospital universitario. Analizamos variables demográficas, tipo de tóxico involucrado, naturaleza suicida o accidental de la intoxicación y la probabilidad de ingreso o muerte en el hospital. Resultados Un total de 880 (6,1%) de las 14.300 intoxicaciones atendidas en el mismo período sucedieron en mayores de 65 años. El grupo más numeroso fueron individuos entre 65-69 años (39%), seguidos por el grupo de 70-75 años (20%), siendo varones el 57%. En el 88% de los casos participó un único tóxico, por orden de frecuencia alcohol (51,6%), fármacos (29,5%) y productos domésticos o industriales (12,8%). Las intoxicaciones por alcohol predominaron en hombres hasta los 75 años y por encima de esta edad predominó la intoxicación farmacológica o suicida, principalmente en mujeres. Ingresaron un total de 145 (16%) sujetos, siendo los fármacos más frecuentemente implicados digoxina y benzodiacepinas. La probabilidad de ingreso se asoció con la intoxicación por metformina, digoxina, litio o la edad del paciente (OR por año = 1,03; IC 95%: 1,0-1,06). Fallecieron 19 pacientes (2,16%), principalmente por ingestas cáusticas suicidas (OR = 5,7: IC 95%: 1,4-23,6) o por fármacos, relacionados directamente con la metformina (OR = 10,1; IC 95%: 2,4-42,4). Conclusiones La prevalencia de intoxicaciones en la tercera edad no es despreciable, y los médicos deben sospecharlas ante situaciones clínicas complejas (AU)

Objectives Poisonings continue to be an important public health problem. Herein, we analyzed the epidemiology of poisonings in elderly individuals. Methods Retrospective cohort study conducted between 2011 and 2019 in a university hospital. We analyzed demographic variables, type of poison involved, suicidal or accidental nature of the poisoning, and the probability of admission, or death to the hospital. Results A total of 880 (6.1%) of the 14,300 poisonings treated in the same period occurred in people over 65 years of age. The most numerous group were individuals between 65-69 years-old (39%), followed by the group of 70-75 years-old (20%), being men 57%. In 88% of the cases a single poison participated, being by frequency alcohol (51.6%), drugs (29.5%), and household or industrial products (12.8%). Alcohol intoxication predominated in men up to 75 years of age, and above this age drug or suicidal intoxication predominated, mainly in women. A total of 145 (16%) subjects were hospitalized, the drugs most frequently implicated being digoxin and benzodiazepines. The probability of hospital admission was associated with intoxication by metformin, digoxin, lithium or with the age of the patient (OR per year = 1.03; 95% CI: 1.0-1.06). A total of 19 patients died (2.16%), mainly due to suicidal caustic ingestion (OR = 5.7: 95% CI: 1.4-23.6) or by drugs, directly related to metformin (OR = 10.1; 95% CI: 2.4-42.4). Conclusions The prevalence of poisoning in the elderly is not negligible, and physicians should have a high index of suspicion in a complex situation (AU)

Hospital presentations for self-poisoning during COVID-19 in Sri Lanka: an interrupted time-series analysis.

BACKGROUND: There is widespread concern over the impact of public health measures, such as lockdowns, associated with COVID-19 on mental health, including suicide. High-quality evidence from low-income and middle-income countries, where the burden of suicide and self-harm is greatest, is scarce. We aimed to determine the effect of the pandemic on hospital presentations for self-poisoning. METHODS: In this interrupted time-series analysis, we established a new self-poisoning register at the tertiary care Teaching Hospital Peradeniya in Sri Lanka, a lower-middle-income country. Using a standard extraction sheet, data were gathered for all patients admitted to the Toxicology Unit with self-poisoning between Jan 1, 2019, and Aug 31, 2020. Only patients classified by the treating clinician as having intentionally self-poisoned were included. Data on date of admission, age or date of birth, sex, and poisoning method were collected. No data on ethnicity were available. We used interrupted time-series analysis to calculate weekly hospital admissions for self-poisoning before (Jan 1, 2019-March 19, 2020) and during (March 20-Aug 31, 2020) the pandemic, overall and by age (age <25 years vs ≥25 years) and sex. Individuals with missing date of admission were excluded from the main analysis. FINDINGS: Between Jan 1, 2019, and Aug 31, 2020, 1401 individuals (584 [41·7%] males, 761 [54·3%] females, and 56 [4·0%] of unknown sex) presented to the hospital with self-poisoning and had date of admission data. A 32% (95% CI 12-48) reduction in hospital presentations for self-poisoning in the pandemic period compared with pre-pandemic trends was observed (rate ratio 0·68, 95% CI 0·52-0·88; p=0·0032). We found no evidence that the impact of the pandemic differed by sex (rate ratio 0·64, 95% CI 0·44-0·94, for females vs 0·85, 0·57-1·26, for males; pinteraction=0·43) or age (0·64, 0·44-0·93, for patients aged <25 years vs 0·81, 0·57-1·16, for patients aged ≥25 years; pinteraction=0·077). INTERPRETATION: This is the first study from a lower-middle-income country to estimate the impact of the pandemic on self-harm (non-fatal) accounting for underlying trends. If the fall in hospital presentations during the pandemic reflects a reduction in the medical treatment of people who have self-poisoned, rather than a true fall in incidence, then public health messages should emphasise the importance of seeking help early. FUNDING: Elizabeth Blackwell Institute University of Bristol, Wellcome Trust, and Centre for Pesticide Suicide Prevention. TRANSLATIONS: For the Sinhalese and Tamil translations of the abstract see Supplementary Materials section.

Severe carbamates intoxication of 43-year-old farmer - case report.

INTRODUCTION: Carbamate insecticides are methyl carbamic acid esters and reversible cholinesterase inhibitors. In contrast to the long-term action of organophosphate insecticides, this complex undergoes rapid hydrolysis. CASE REPORT: A suicidal poisoning by exposure to carbofuran in a 43-year-old farmer is reported. The patient had a sudden respiratory and cardiac arrest in the mechanism of bradycardia asystole. He was additionally diagnosed with metabolic acidosis and massive aspiration pneumonia. After applied treatment, the patient's general condition improved - alignment of efficiency of both respiratory and circulatory efficiency were reached. CONCLUSION: Carbofuran is one of the most toxic carbamate insecticides. It is therefore important to react quickly and choose the right treatment. Differentiation between organophosphate and carbamate intoxication is essential.

[Unusual cause of a PCT-elevation]. / Ungewöhnliche Ursache einer PCT-Erhöhung.

INTRODUCTION: Procalcitonin (PCT) is an established marker for bacterial infection. Elevation of PCT can occur due to various reasons and is not specific, as we outline in the following case report. HISTORY: We report on a 29 year old patient, who was presented by the psychiatric department because of obscure abdominal pain, nausea and vomiting since two days. Taking the patients history did not result in conclusive findings at first. FINDINGS AND DIAGNOSIS: The clinical examination did not result in conclusive findings. The patient was afebrile. Blood work showed an elevation of transaminases and a massive elevation of PCT. In ultrasound no abnormalities were shown, serological investigations for viral hepatitis were negative. Blood cultures remained sterile, the search for an infectious focus remained unremarkable. THERAPY AND COURSE: In the course of the in-patient stay the patient reported the ingestion of approximately 40 g of acetaminophen in suicidal intention two days before. Therapy with N-acetylcysteine (NAC) was initiated. The transaminases and PCT were regressive the next day. Antibiotic therapy was foregone. CONCLUSIONS: This case illustrates that PCT-elevation is not specific for a bacterial infection and must be seen in correlation to patient's history and clinical findings.

Unwitting adult marijuana poisoning: a case series.

STUDY PURPOSE: With increasing state legalization, marijuana use has become commonplace throughout much of the United States. Existing literature on unintentional exposure focuses primarily on children.We report on a cluster of adults with unwitting marijuana exposure. METHODS: A cluster of cases were referred to the Medical Toxicology Service after ingesting marijuana-contaminated food at a family event. We conducted a retrospective analysis of twelve subject charts and a qualitative analysis with six of these subjects who willingly consented to be interviewed about their experiences. The study was approved by the Institutional Review Board. RESULTS: Three of the subjects (25%) required prolonged observation due to persistent symptoms. Eleven (92%) were urine immunoassay positive for tetrahydrocannabinol (THC). Two subjects (17%) tested positive for ethanol in their blood. Common symptoms experienced by the subjects included confusion (50%), difficulty speaking (67%), nausea (25%), tremors (17%), and feelings of unreality (33%). All interviewed subjects reported sleepiness and three (50%) reported a negative impact on work. Subjects also reported multiple emotions, including anger, confusion, disbelief, and helplessness. None of the cases resulted in admission for critical care or death. CONCLUSIONS: Our series illuminates effects of unwitting and/or unintentional marijuana exposure in adults. Unintentional marijuana poisonings have increased, but legal and regulatory barriers have limited the study of marijuana outside highly controlled conditions. While the marijuana exposure in this study did not result in admission for critical care or death, it did result in psychological distress and adversely affected work in some cases.

Clinical and epidemiological analysis of suicide attempts in children assisted by a poison control center / Análise clínica e epidemiológica das tentativas de suicídio em crianças atendidas em um centro de informação e assistência toxicológica

ABSTRACT Objective: To assess suicide attempts in children seeking care at a Poison Control Center. Methods: Cross-sectional study with children (<12 years old) that attempted suicide and were cared at the Poison Control Center in Londrina, Paraná, Southern Brazil, from April 1985 to December 2018. Results: We identified 59 children, most of them females (74.6%), who used only one product (77.9%). Among the products involved, medications were the most important ones (88.1%). Neurological/psychiatric/muscular manifestations (61.0%) were the main symptoms presented. The main reason identified for the suicide attempt was conflicts with family and/or friends (27.1%). Suicide attempts were more frequent in 2001-2003 and 2016-2018. Conclusions: Suicide attempts occurred mainly in female children with a single agent (mainly medications), and the main reason was family conflicts..

RESUMO Objetivo: Analisar as tentativas de suicídio em crianças atendidas em um Centro de Informação e Assistência Toxicológica (CIATox-Londrina). Métodos: Estudo transversal com crianças (<12 anos) atendidas no CIATox-Londrina, Paraná, de abril/1985 a dezembro/2018, com tentativa de suicídio. Resultados: Identificaram-se 59 crianças, com predomínio do sexo feminino (74,6%) e com o uso de apenas um produto (77,9%). Entre os produtos envolvidos, destacaram-se os medicamentos (88,1%). As manifestações neurológicas/psíquicas/musculares (61,0%) foram os principais sintomas apresentados. O principal motivo identificado da tentativa de suicídio foram os conflitos com familiares e/ou amigos (27,1%). Houve maior frequência de tentativas de suicídio nos triênios 2001-2003 e 2016-2018. Conclusões: As tentativas de suicídio ocorreram predominantemente nas crianças do sexo feminino, com um único agente (em geral, medicamentos), em que o principal motivo foram os conflitos familiares, observando-se um aumento ao longo dos anos.

CLINICAL AND EPIDEMIOLOGICAL ANALYSIS OF SUICIDE ATTEMPTS IN CHILDREN ASSISTED BY A POISON CONTROL CENTER.

OBJECTIVE: To assess suicide attempts in children seeking care at a Poison Control Center. METHODS: Cross-sectional study with children (<12 years old) that attempted suicide and were cared at the Poison Control Center in Londrina, Paraná, Southern Brazil, from April 1985 to December 2018. RESULTS: We identified 59 children, most of them females (74.6%), who used only one product (77.9%). Among the products involved, medications were the most important ones (88.1%). Neurological/psychiatric/muscular manifestations (61.0%) were the main symptoms presented. The main reason identified for the suicide attempt was conflicts with family and/or friends (27.1%). Suicide attempts were more frequent in 2001-2003 and 2016-2018. CONCLUSIONS: Suicide attempts occurred mainly in female children with a single agent (mainly medications), and the main reason was family conflicts..

Acute Poisoning among Patients Presenting to the Emergency Department of a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: Acute poisoning is a major global public health problem contributing to one of the leading causes for a visit to an emergency department. This study aims to analyse the demographic and psychosocial characteristics of patients with acute poisoning presented to the emergency department. METHODS: This was a descriptive cross-sectional study conducted in a tertiary care hospital from June to December 2019 after obtaining ethical approval from Institutional review board (reference number. 041-075/0760). A convenient sampling method was applied. Epidemiological factors, types of poison consumed, reason, motive, and place to take poison, time elapse in the presentation to the hospital were studied. Statistical analysis was done using statistical package for the social sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 76 cases of acute poisoning, the organophosphorus poisoning was 18 (23.7%) followed by unknown 12 (15.8). Of total, 28 (36.8%) had quarrel before taking poison and 41 (53.9 %) had intention to commit suicide. Sixty-seven (88.2%) took a poison at home. The average elapsed time to the visit of the emergency department was 110±80 minutes. CONCLUSIONS: The most common poisoning was organophosphorus with a suicide being the most common intention. Quarrel was the most frequent reason to take poison and the home was the most common place to take poison.

Acute intentional poisonings within an urban agglomeration in Poland in 2004-2013.

OBJECTIVES: The aim of the research was to analyze the nature of changes and tendencies observed in the frequency, circumstances and causes of acute intentional poisonings within the agglomeration of Lódz, Poland. The study related to adults. MATERIAL AND METHODS: As the research material, medical records of patients hospitalized due to an acute poisoning in the Department of Toxicology in Lódz were used. Information on the hospitalized patients was gathered in the database created in accordance with the assumed criteria and an approved system of the collection of variables describing the issues of intentional acute poisonings. RESULTS: In the analyzed period, within the group of 18 918 adult patients hospitalized due to an acute poisoning, male patients prevailed, accounting for 57.17% of the whole group. Intentional poisonings constituted 40.19% of all poisonings, with women dominating within that group of patients - accounting for approximately 58.63%. The largest group was formed by young people, 18-35 years old, accounting for 43.22%. The average age of the intentionally poisoned patients showed an upward tendency; this tendency concerned women to a larger extent. Medications played the most powerful role in acute intentional poisonings. Within the whole population, they were responsible for 97.27% of intoxications. The analysis of the dynamics of changes in the percentage of patients referred for further mental treatment revealed that the number of patients continuing hospital treatment in psychiatric wards tended to grow. CONCLUSIONS: Observations indicating that women are more likely to attempt intentional poisoning, and that the number of patients with psychiatric disturbances tended to grow in the analyzed period, demonstrate an urgent need for preventive measures to be taken in the local communities. Int J Occup Med Environ Health. 2020;33(1):77-90.

Ethanol Intoxication of Young Children.

Ethanol intoxication of infants and young children can be a challenging diagnosis in the pediatric emergency department, and features of the poisoning may differ in comparison with adolescents. The sources of ethanol exposures in this age are varied and include unintentional, malicious, and iatrogenic etiologies. Young children exposed to ethanol often present with mixed clinical signs and symptoms that may not fit the traditional ethanol or sedative-hypnotic toxidrome. Pediatric ethanol intoxications are often managed supportively, and recovery is usually rapid. The purpose of this review is to describe the sources of ethanol poisoning among children 6 years and younger, highlight presenting symptoms and pharmacokinetic considerations unique to this age group, and review management strategies. In addition, published cases of ethanol poisoning due to ingestion among young infants are compiled for presentation.

[The phenomenology of delusions of poisoning in persons with paranoid schizophrenia]. / Die Phänomenologie des Vergiftungswahns bei Menschen mit paranoider Schizophrenie.

GOAL: The aim of the study was to investigate delusions of poisoning in people with paranoid schizophrenia. Specifically, how often delusions of poisoning occur, how the delusional content is represented and to what extent women and men differ in delusions of poisoning were analysed. METHODS & SAMPLE: Data were collected retrospectively from two psychiatric wards in Germany. Base material comprised the medical records of all persons receiving inpatient treatment due to their paranoid schizophrenia between 2010 and 2014 in one of the two psychiatric wards. The sample consisted of 156 people (96 women, 60 men) diagnosed with paranoid schizophrenia showing delusions of poisoning. RESULTS: Delusions of poisoning were a common delusional theme which significantly more often occurred in women than in men. Moreover, women were significantly more likely to have delusions of persecution in addition to their delusions of poisoning. Overall, people with delusions of poisoning often reported being poisoned by close relatives or health workers. Most of those affected assumed that poisoning was carried out through medication, food or drinks.

Intensity of care delivered by prehospital emergency medical service physicians to patients with deliberate self-poisoning: results from a 2-day cross-sectional study in France.

Emergency management of deliberate self-poisoning (DSP) by drug overdose is common in emergency medicine. There is a paucity of data about the prehospital care of these patients. The principal aim was to describe the intensity of care received by patients with DSP who were managed by prehospital emergency medical service (EMS) physicians. A 48-h cross-sectional study was conducted in 319 EMS and emergency units in France. Patient and poisoning characteristics and treatments administered were recorded. Complications of poisoning, hospitalization, intensive care unit admission and death were recorded until day 30. The primary endpoint was the probability of receiving prehospital intensive care, including fluid resuscitation, vasopressor therapy, invasive ventilation, or antidotal treatments, depending whether prehospital treatment was carried out by an EMS physician or not. Data from 703 patients (median age was 43 [30-52] years, 288 (40%) men) were analyzed. One hundred and fifteen (16%) patients were attended by an EMS physician. Patients attended by EMS physicians were more likely to receive intensive treatment in the prehospital setting [odds ratio (OR) 7.4, 95% confidence interval 4.3-12.9]. These patients had more severe poisoning as suggested mainly by a lower Glasgow Coma Score (13 [8-15] vs. 15 [15-15]; p < 0.001) and a higher rate of admission to an intensive care unit [29 (25%) vs. 15 (2%), p < 0.001]. Patients with DSP attended by prehospital EMS physicians frequently received intensive care. The level of care seemed appropriate for the severity of the poisoning.

Behavioural and physiological assessments of dimethyl trisulfide treatment for acute oral sodium cyanide poisoning.

Sodium cyanide (NaCN) is a commonly and widely used industrial and laboratory chemical that is highly toxic. Its availability and rapid harmful/lethal effects combine to make cyanide a potential foodborne/waterborne intentional-poisoning hazard. Effective antidotes to cyanide poisoning are currently approved only for intravenous administration. Therefore, an effective cyanide antidote that can be administered intramuscularly in pre-hospital and/or mass-casualty settings is needed. Dimethyl trisulfide (DMTS) is a naturally occurring substance used as a flavour enhancer in foods. DMTS has shown antidotal efficacy in cyanide poisoning and is thought to act as both a sulphur donor and partial methaemoglobin inducer. In this study, an intramuscular injection of DMTS (6.25-200 mg/kg) was given to rats 1 minute after an oral dose of NaCN (98.2 mg/kg; twice the median lethal dose) to test the antidotal efficacy and safety of DMTS treatment. Toxic signs and survival were examined along with behavioural function (up to 30 hour after ingestion) using a previously established operant behavioural model. A large range of DMTS doses (6.25-100 mg/kg) increased survival after oral cyanide poisoning, and the lower DMTS doses (6.25-25 mg/kg) also proved to be behaviourally and physiologically safe. Larger DMTS doses (50-200 mg/kg) produced side effects (ie, inflammation and limping) that were more severe and protracted than those observed at lower DMTS doses. The 25 mg/kg DMTS proved to be the most efficacious (increasing survival from 20% to 75%) and also produced minimal side effects (eg, inflammation) that resolved within 24-72 hour. Thus, DMTS shows promise as an intramuscularly administered cyanide antidote useful for prompt pre-hospital or mass-casualty emergency medical treatment.

A Study on Deliberately Self-Poisoned In-Hospital Patients in a Tertiary Health Care Center in Northeast India: A Cross-Sectional Review.

BACKGROUND: The nature and profile of different modes of poisoning vary significantly in different parts of India. The assessment of the magnitude of suicidal poisoning is an area of paramount importance not only for appropriate management but also for raising social awareness and framing government policies for the prevention of same. OBJECTIVES: We aimed to determine the pattern of poisoning, the sociodemographic profile of patients who poison themselves, and the in-hospital outcome of self-poisoned patients over a 1-year period. METHODS: This was a cross-sectional observational study conducted between May 2015 and April 2016 that included 492 patients >12 years of age who were admitted to our hospital after consuming poison with the intention of deliberate self-harm. Relevant history with respect to the nature and amount of poison ingested were taken and recorded, and the patients' sociodemographic profiles and outcome (as either discharge or death) were noted. RESULTS: Most of the patients were 13-28 years of age (69%). Males (n = 293 [59.55%]) predominated over females and the majority were farmers (n = 193 [39.23%]). Rural cases (n = 373 [75.81%]) outnumbered urban cases. The major causes of deliberate self-harm attempts were impulsive actions (n = 442 [89.84%]). Pesticides (n = 393 [79.88%]) were the most commonly consumed poison. The overall mortality rate was 12%, with paraquat (94.74%) topping the list of fatal substances. CONCLUSION: Young adults and males constitute majority of the population in this study. Agricultural poisons made up the bulk of the cases, mostly taken by rural population. Paraquat, an herbicide banned in several countries, had the highest mortality rate in this study.

Validation of the Poisoning Severity Score (PSS) in suicidal behavior by self-poisoning.

Intentional self-poisoning is the leading method of suicidal behavior leading to medical attention worldwide. The medical severity of self-poisoning events has major treatment, prognostic, and medico-legal implications, yet measures of severity are limited. The Poisoning Severity Score (PSS) is a widely used scale but validation data are limited, particularly in the study of suicidal behavior per se. The sample was a consecutive series of intentional self-poisoning patients aged 13 to 65 treated at a large university medical center (n = 673). PSS scores, with a range 0 (none) to 4 (death), were calculated along with other structured clinical data and analyzed in a series of linear regressions adjusted for age and sex. Higher PSS scores were consistently associated with greater medical morbidity and more intensive acute medical treatments, and nearly all effect sizes were large. Results support the validity of the PSS in hospital-treated self-poisoning patients.

A prospective study of repetition of self-harm following deliberate self-poisoning in rural Sri Lanka.

INTRODUCTION: Repetition of deliberate self-harm is an important predictor of subsequent suicide. Repetition rates in Asian countries appear to be significantly lower than in western high-income countries. Methodological differences in studies, and the impact of access to means of self-harm with comparatively higher lethality have been suggested as reasons for these reported differences. This prospective study determines the rates and demographic patterns of deliberate self-poisoning (DSP), suicide and repeated deliberate self-harm resulting non-fatal and fatal outcomes in rural Sri Lanka. METHODS: Details of DSP admission in all hospitals (n = 46) and suicides reported to all police stations (n = 28) in a rural district were collected for the years 2011, 2012 and 2013. Demographic details of the cohort of patients admitted to all hospitals in 2011 due to deliberate self-poisoning (N = 4022), were screened to link with patient records and police reports of the successive two years with high sensitivity using a computer program. Then high specificity manual matching of all screened links was performed to identify repetition within 2 years of initial presentation. Life time repetition was assessed in a randomly selected subset of DSP patients (n = 433). RESULTS: There were 15,639 DSP admissions, aged more than 9 years, and 1078 suicides during the study period. The incidence of deliberate self-poisoning and suicide in the population within the study area were 248.3/100,000 and 20.7/100,000 respectively, in 2012. Repetition rates at four weeks, one-year and two-years were 1.9% (95% CI 1.5-2.3%), 5.7% (95% CI 5.0-6.4) and 7.9% (95% CI 7.1-8.8) respectively. The median interval between two attempts were 92 (IQR 10-238) and 191 (IQR 29-419.5) days for the one and two-year repetition groups. The majority of patients used the same poison in the repeat attempt. The age and duration of hospital stay of individuals with repetitive events were not significantly different from those who had no repetitive events. The rate of suicide at two years following DSP was 0.7% (95% CI 0.4-0.9%). The reported life time history of deliberate self-harm attempts was 9.5% (95% CI 6.7-12.2%). CONCLUSIONS: The comparatively low rates of repetition in rural Sri Lanka was not explained by higher rates of suicide, access to more lethal means or differences in study methodology.