The Experts below are selected from a list of 216 Experts worldwide ranked by ideXlab platform
Thilini Rajapakse - One of the best experts on this subject based on the ideXlab platform.
-
domestic violence and Self Poisoning in sri lanka
Psychological Medicine, 2020Co-Authors: Piumee Bandara, David Gunnell, Thilini Rajapakse, Andrew Page, Lalith Senarathna, Judi Kidger, Gene Feder, Duleeka KnipeAbstract:BACKGROUND There is increasing evidence that domestic violence (DV) is an important risk factor for suicidal behaviour. The level of risk and its contribution to the overall burden of suicidal behaviour among men and women has not been quantified in South Asia. We carried out a large case-control study to examine the association between DV and Self-Poisoning in Sri Lanka. METHODS Cases (N = 291) were patients aged ⩾18 years, admitted to a tertiary hospital in Kandy Sri Lanka for Self-Poisoning. Sex and age frequency matched controls were recruited from the hospital's outpatient department (N = 490) and local population (N = 450). Exposure to DV was collected through the Humiliation, Afraid, Rape, Kick questionnaire. Multivariable logistic regression models were conducted to estimate the association between DV and Self-Poisoning, and population attributable fractions were calculated. RESULTS Exposure to at least one type of DV within the previous 12 months was strongly associated with Self-Poisoning for women [adjusted OR (AOR) 4.08, 95% CI 1.60-4.78] and men (AOR 2.52, 95% CI 1.51-4.21), compared to those reporting no abuse. Among women, the association was strongest for physical violence (AOR 14.07, 95% CI 5.87-33.72), whereas among men, emotional abuse showed the highest risk (AOR 2.75, 95% CI 1.57-4.82). PAF% for exposure to at least one type of DV was 38% (95% CI 32-43) in women and 22% (95% CI 14-29) in men. CONCLUSIONS Multi-sectoral interventions to address DV including enhanced identification in health care settings, community-based strategies, and integration of DV support and psychological services may substantially reduce suicidal behaviour in Sri Lanka.
-
repetition of deliberate Self Poisoning in rural sri lanka
bioRxiv, 2018Co-Authors: P H G J Pushpakumara, Thilini Rajapakse, S U B Thennakoon, Ranil Abeysinghe, Andrew H. DawsonAbstract: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. The reason for these reported differences is not clear and has been suggested to due methodological differences or the impact of access to more lethal means of Self harm. This prospective study determines the rates and demographic pattern of deliberate Self-Poisoning, suicide and fatal and non fatal repeated deliberate Self-Poisoning in rural Sri Lanka. Details of deliberate Self Poisoning admission in all hospitals (n=46) and suicides reported to all the police stations (n=28) of a rural district were collected for 3 years, 2011-2013. Demographic details of the cohort of deliberate Self-Poisoning patients admitted to all hospitals in 2011 (N=4022), were screened to link with patient records and police reports of successive two years with high sensitivity using a computer program and manual matching was performed with higher specificity. Life time repetition was assessed in a randomly selected subset of DSP patients (n=438). There were 15,914 DSP admissions and 1078 suicides during the study period. Within the study area the deliberate Self Poisoning and suicide population incidences were, 248.3/100,000 and 20.7/100,000 in 2012. Repetition rate for four weeks, one-year and two-years were 1.9% (95% CI 1.5-2.3%), 5.7% (95% CI 5.0 to 6.4) and 7.9% (95% CI 7.1 to 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. Age and hospital stay of individuals with repetitive events were not significantly different from those who had no repetitive events. The two-year rate for suicide following DSP was 0.7% (95% CI 0.4-0.9%). Reported life time history of deliberate Self harm attempts was 9.5% (95% CI 6.7-12.2%). The low comparative repetition rates in rural Sri Lanka was not explained by higher rates of suicide or access to more lethal means or differences in methodology.
-
non fatal Self Poisoning across age groups in sri lanka
Asian Journal of Psychiatry, 2016Co-Authors: Thilini Rajapakse, Helen Christensen, Sue M Cotton, Kathleen M GriffithsAbstract:Attempted or non-fatal Self-Poisoning in common in Sri Lanka, but little is known about variation of psychiatric morbidity and suicidal intent across differing ages. The aim of this study was to investigate factors associated with non-fatal Self-Poisoning in Sri Lanka across three different age groups (namely 14-24 years, 25-34 years and ≥ 35 years). It was anticipated that the findings of the study would inform and guide development of preventive interventions for non-fatal Self-Poisoning in this country. 935 participants were interviewed within one week of admission to hospital for medical management of non-fatal Self-Poisoning, over a consecutive 14-month period. Socio-demographic factors, types of poison ingested, triggers and psychiatric morbidity was examined as a function of age. Results showed that a majority (83%) of participants were aged below 35 years. Younger participants aged <25 years were significantly more likely to ingest medicinal overdoses, compared to older persons (aged 25-34 years, and ≥ 35 years), who were more likely to ingest pesticides. Recent interpersonal conflict was a proximal trigger seen in all age groups, but suicidal intent, depression and alcohol use disorders increased with age. The overall study findings indicate that most who carry out acts of non-fatal Self-Poisoning in Sri Lanka are young (aged <35 years). Interpersonal conflict as a trigger is common to all age groups, but psychiatric morbidity and suicidal intent is higher in the older age groups, as is pesticide ingestion. Age specific interventions may be efficacious in the prevention of non-fatal Self-Poisoning in Sri Lanka.
-
Non-fatal Self-Poisoning in Sri Lanka: associated triggers and motivations
BMC public health, 2015Co-Authors: Thilini Rajapakse, Kathleen M Griffiths, Helen Christensen, Sue M CottonAbstract:Background: Attempted or non-fatal Self-Poisoning is common in Sri Lanka. To date, most preventive strategies have focused on limitation of access to toxic pesticides, which has reduced the rates of fatal Self-Poisoning. However the ongoing phenomenon of non-fatal Self-Poisoning indicates the need for exploration of alternate preventive strategies. Self-Poisoning in Sri Lanka has been described as impulsive, with little premeditation, but the motivations associated with this act have not been studied in depth. This research describes the triggers and motivations associated with non-fatal Self-Poisoning in Sri Lanka. It is anticipated that the findings would help guide future preventive strategies. Methods: Two studies were carried out, at Teaching Hospital Peradeniya, Sri Lanka, each using a different methodology – Study 1 consisted of qualitative semi-structured interviews, and Study 2 was a cross sectional survey. Both studies were conducted among those who had recently attempted Self-Poisoning, and explored associated triggers and motivations associated with the act of Self-Poisoning. There was no overlap between participants of the two studies. Results: A total of 24 persons participated in the semi-structured interviews (Study 1), and 921 took part in the cross-sectional survey (Study 2). Interpersonal conflict was the most common trigger prior to the act of non-fatal Self-Poisoning. A mixture of motivations was associated with the act of Self-Poisoning, including intent to die, to escape, and difficulty tolerating distress associated with interpersonal conflict. Conclusions: Development of interpersonal skills and interpersonal problem solving skills, particularly in adolescents and young people, emerges as a key primary preventive strategy. Further, there is value in exploring and helping people to develop more adaptive strategies to cope with emotional distress associated with interpersonal conflict. While distress tolerance and interpersonal skill training strategies used in the West may be considered, it is also important to adapt and develop strategies suited to the local cultural background. Further research is needed to develop and evaluate such strategies, and findings may have implications not only to Sri Lanka but also for other countries in South Asia.
-
a comparison of non fatal Self Poisoning among males and females in sri lanka
BMC Psychiatry, 2014Co-Authors: Thilini Rajapakse, Kathleen M Griffiths, Helen Christensen, Sue M CottonAbstract:Background: In the recent past Sri Lanka has had a high rate of attempted suicide by pesticide ingestion, among both males and females. Recent evidence suggests that these trends in Self-Poisoning may be changing, with increasing medicinal overdoses and changing gender ratios. In the past, attempted suicide in Sri Lanka has been described as impulsive acts, but research regarding aspects such as suicidal intent is limited, and there has been no comparison between genders. The objective of this study was to describe gender differences in non-fatal Self-Poisoning in Sri Lanka with respect to substances ingested, triggers, stressors, suicidal intent and psychiatric morbidity. Methods: Persons admitted to Teaching Hospital Peradeniya, Sri Lanka, for medical management of non-fatal Self-Poisoning over a consecutive 14-month period were eligible for the study. Participants were interviewed within one week of admission, with regard to demographic details, poison type ingested, triggers, psychiatric morbidity and suicidal intent. 949 participants were included in the study, of whom 44.2% were males, with a median age of 22 years. Results: Males were significantly more likely to ingest agrochemicals, whereas females were more likely to overdose on pharmaceutical drugs. Interpersonal conflict was a common trigger associated with non-fatal Self-Poisoning for both males and females. Alcohol use disorders and high suicidal intent were significantly more likely in males. There was no difference in rates of depression between the genders. Multiple regression for both genders separately showed that the presence of depression and higher levels of hopelessness was the strongest predictor of suicidal intent, for both genders. Conclusions: Patterns of non-fatal Self-Poisoning in Sri Lanka appear to be changing to resemble Western patterns, with females having a greater rate of Self-Poisoning and more medicinal overdoses than males. Alcohol use disorder is a gender specific risk factor associated with non-fatal Self-Poisoning among males, indicating a need for specific intervention. However there are also many common risk factors that are common to both genders, particularly associations with interpersonal conflict as an acute trigger, and psychiatric morbidity such as depression and hopelessness being related to increased suicidal intent.
Michael Eddleston - One of the best experts on this subject based on the ideXlab platform.
-
Acute human Self-Poisoning with imidacloprid compound: a neonicotinoid insecticide.
PloS one, 2009Co-Authors: Fahim Mohamed, Michael Eddleston, Indika Gawarammana, Thomas Robertson, Michael S. Roberts, Chathura Palangasinghe, Shukry Zawahir, Shaluka Jayamanne, Jaganathan Kandasamy, Nicholas A. BuckleyAbstract:Background: Deliberate Self-Poisoning with older pesticides such as organophosphorus compounds are commonly fatal and a serious public health problem in the developing world. The clinical consequences of Self-Poisoning with newer pesticides are not well described. Such information may help to improve clinical management and inform pesticide regulators of their relative toxicity. This study reports the clinical outcomes and toxicokinetics of the neonicotinoid insecticide imidacloprid following acute Self-Poisoning in humans. Methodology/Principal Findings: Demographic and clinical data were prospectively recorded in patients with imidacloprid exposure in three hospitals in Sri Lanka. Blood samples were collected when possible for quantification of imidacloprid concentration. There were 68 patients (61 Self-ingestions and 7 dermal exposures) with exposure to imidacloprid. Of the Self-Poisoning patients, the median time to presentation was 4 hours (IQR 2.3–6.0) and median amount ingested was 15 mL (IQR 10–50 mL). Most patients only developed mild symptoms such as nausea, vomiting, headache and diarrhoea. One patient developed respiratory failure needing mechanical ventilation while another was admitted to intensive care due to prolonged sedation. There were no deaths. Median admission imidacloprid concentration was 10.58 ng/L; IQR: 3.84– 15.58 ng/L, Range: 0.02–51.25 ng/L. Changes in the concentration of imidacloprid in serial blood samples were consistent with prolonged absorption and/or saturable elimination. Conclusions: Imidacloprid generally demonstrates low human lethality even in large ingestions. Respiratory failure and reduced level of consciousness were the most serious complications, but these were uncommon. Substitution of imidacloprid for organophosphorus compounds in areas where the incidence of Self-Poisoning is high may help reduce deaths from Self-Poisoning.
-
the global distribution of fatal pesticide Self Poisoning systematic review
BMC Public Health, 2007Co-Authors: David Gunnell, Michael Eddleston, Michael R Phillips, Flemming KonradsenAbstract:Evidence is accumulating that pesticide Self-Poisoning is one of the most commonly used methods of suicide worldwide, but the magnitude of the problem and the global distribution of these deaths is unknown. We have systematically reviewed the worldwide literature to estimate the number of pesticide suicides in each of the World Health Organisation's six regions and the global burden of fatal Self-Poisoning with pesticides. We used the following data sources: Medline, EMBASE and psycINFO (1990–2007), papers cited in publications retrieved, the worldwide web (using Google) and our personal collections of papers and books. Our aim was to identify papers enabling us to estimate the proportion of a country's suicides due to pesticide Self-Poisoning. We conservatively estimate that there are 258,234 (plausible range 233,997 to 325,907) deaths from pesticide Self-Poisoning worldwide each year, accounting for 30% (range 27% to 37%) of suicides globally. Official data from India probably underestimate the incidence of suicides; applying evidence-based corrections to India's official data, our estimate for world suicides using pesticides increases to 371,594 (range 347,357 to 439,267). The proportion of all suicides using pesticides varies from 4% in the European Region to over 50% in the Western Pacific Region but this proportion is not concordant with the volume of pesticides sold in each region; it is the pattern of pesticide use and the toxicity of the products, not the quantity used, that influences the likelihood they will be used in acts of fatal Self-harm. Pesticide Self-Poisoning accounts for about one-third of the world's suicides. Epidemiological and toxicological data suggest that many of these deaths might be prevented if (a) the use of pesticides most toxic to humans was restricted, (b) pesticides could be safely stored in rural communities, and (c) the accessibility and quality of care for Poisoning could be improved.
-
choice of poison for intentional Self Poisoning in rural sri lanka
Clinical Toxicology, 2006Co-Authors: Michael Eddleston, Ayanthi Karunaratne, Nicholas A. Buckley, Manjula Weerakoon, Subashini Kumarasinghe, Manjula Rajapakshe, M Rezvi H Sheriff, David GunnellAbstract:Background. Although intentional Self-Poisoning is a major public health problem in rural parts of the Asia-Pacific region, relatively little is known of its epidemiology. We aimed to determine why Sri Lankan Self-Poisoning patients choose particular poisons, and whether acts of Self-harm with highly dangerous poisons were associated with more premeditation and effort. Methods. We interviewed 268 Self-Poisoning patients presenting to two district general hospitals in rural Sri Lanka. Results. Eighty-five percent of patients cited easy availability as the basis for their choice of poison. There was little premeditation: more than 50% ingested the poison less than 30 minutes after deciding to Self-harm. Patients had little knowledge about treatment options or lethality of the poison chosen. We found no difference in reasons for choice of poison between people ingesting different poisons, despite marked differences in toxicity, and between people who died and those who survived. Conclusions. Poisons were cho...
-
Epidemiology of intentional Self-Poisoning in rural Sri Lanka.
The British journal of psychiatry : the journal of mental science, 2005Co-Authors: Michael Eddleston, David Gunnell, Ayanthi Karunaratne, Dhammik De Silva, M H Rezvi Sheriff, Nicholas A. BuckleyAbstract:We investigated the epidemiology of intentional Self-Poisoning in rural Sri Lanka by prospectively recording 2189 admissions to two secondary hospitals. Many patients were young (median age 25 years), male (57%) and used pesticides (49%). Of the 198 who died,156 were men (case fatality 12.4%) and 42 were women (4.5%). Over half of female deaths were in those under 25 years old; male deaths were spread more evenly across age groups. Oleander and paraquat caused 74% of deaths in people under 25 years old; thereafter organophosphorous pesticides caused many deaths. Although the age pattern of Self-Poisoning was similar to that of industrialised countries, case fatality was more than 15 times higher and the pattern of fatal Self-Poisoning different.
-
Self Poisoning with pesticides
BMJ (Clinical research ed.), 2004Co-Authors: Michael Eddleston, Michael R PhillipsAbstract:WHO's recent recommendations on reducing deaths from Self harm will not help cut the high death rate from Self Poisoning in the Asia Pacific region Self inflicted violence accounts for around half of the 1.6 million violent deaths that occur every year worldwide.1 About 63% of global deaths from Self harm occur in the Asia Pacific region. Most of these deaths occur in rural areas, where easy access to highly toxic pesticides turns many impulsive acts of Self Poisoning into suicide. The World Health Organization's recent World Report on Violence and Health recommends that suicide prevention strategies focus on the identification and treatment of people with mental disorders.2 However, as impulsive Self Poisoning is often not associated with mental illness, this may not be the most effective approach for rural Asia. Self harm is a major problem in many nations in the Asia Pacific region, from the Pacific islands of Fiji and Samoa, to Asian nations as different as China and Sri Lanka.3 Suicide accounted for 71% (512 000/722 000) of all violent deaths in South East Asia and the Western Pacific region in 2000.2 Most deaths occur in rural communities: the incidence of fatal Self harm in rural China is three to five times that in urban China,4 and Self Poisoning is the commonest cause of inpatient death in some rural Sri Lankan districts but a rare cause in the capital city.5 Some experts believe that a distinction exists, particularly in terms of intent, between people who harm themselves (attempt suicide) and those who die (commit suicide).6 WHO's report on violence and health, however, acknowledges that, although an intent to die is a key element of suicide, determining the level of intent for an individual is difficult.2
David Gunnell - One of the best experts on this subject based on the ideXlab platform.
-
domestic violence and Self Poisoning in sri lanka
Psychological Medicine, 2020Co-Authors: Piumee Bandara, David Gunnell, Thilini Rajapakse, Andrew Page, Lalith Senarathna, Judi Kidger, Gene Feder, Duleeka KnipeAbstract:BACKGROUND There is increasing evidence that domestic violence (DV) is an important risk factor for suicidal behaviour. The level of risk and its contribution to the overall burden of suicidal behaviour among men and women has not been quantified in South Asia. We carried out a large case-control study to examine the association between DV and Self-Poisoning in Sri Lanka. METHODS Cases (N = 291) were patients aged ⩾18 years, admitted to a tertiary hospital in Kandy Sri Lanka for Self-Poisoning. Sex and age frequency matched controls were recruited from the hospital's outpatient department (N = 490) and local population (N = 450). Exposure to DV was collected through the Humiliation, Afraid, Rape, Kick questionnaire. Multivariable logistic regression models were conducted to estimate the association between DV and Self-Poisoning, and population attributable fractions were calculated. RESULTS Exposure to at least one type of DV within the previous 12 months was strongly associated with Self-Poisoning for women [adjusted OR (AOR) 4.08, 95% CI 1.60-4.78] and men (AOR 2.52, 95% CI 1.51-4.21), compared to those reporting no abuse. Among women, the association was strongest for physical violence (AOR 14.07, 95% CI 5.87-33.72), whereas among men, emotional abuse showed the highest risk (AOR 2.75, 95% CI 1.57-4.82). PAF% for exposure to at least one type of DV was 38% (95% CI 32-43) in women and 22% (95% CI 14-29) in men. CONCLUSIONS Multi-sectoral interventions to address DV including enhanced identification in health care settings, community-based strategies, and integration of DV support and psychological services may substantially reduce suicidal behaviour in Sri Lanka.
-
Self-Poisoning in rural Sri Lanka: small-area variations in incidence
BMC public health, 2008Co-Authors: Celie Manuel, David Gunnell, Wim Van Der Hoek, Andrew H. Dawson, Ishika K Wijeratne, Flemming KonradsenAbstract:Self-Poisoning is one of the most common methods of suicide worldwide. The intentional ingestion of pesticides is the main contributor to such deaths and in many parts of rural Asia pesticide Self-Poisoning is a major public health problem. To inform the development of preventive measures in these settings, this study investigates small-area variation in Self-Poisoning incidence and its association with area-based socioeconomic and agricultural factors. Ecological analysis of intentional Self-Poisoning in a rural area (population 267,613) of Sri Lanka in 2002. The geographic distribution of cases was mapped to place of residence. Using administrative division (GN), median population size 1416, as unit of analysis, associations with socioeconomic and agricultural indicators were explored using negative binomial regression models. The overall incidence of intentional Self-Poisoning in the study area was 315 per 100,000 (range: 0 – 2168 per 100,000 across GNs). Socioeconomic disadvantage, as indexed by poor housing quality (p = 0.003) and low levels of education (p < 0.001) but not unemployment (p = 0.147), was associated with a low Self-Poisoning incidence. Areas where a high proportion of the population worked in agriculture had low overall levels of Self-Poisoning (p = 0.002), but a greater proportion of episodes in these areas involved pesticides (p = 0.01). An association with extent of cultivated land was found only for non-pesticide Poisoning (p = 0.01). Considerable small-area variation in incidence rates of intentional Self-Poisoning was found. The noteworthy concentration of cases in certain areas and the inverse association with socioeconomic deprivation merit attention and should be investigated using individual-level exposure data.
-
the global distribution of fatal pesticide Self Poisoning systematic review
BMC Public Health, 2007Co-Authors: David Gunnell, Michael Eddleston, Michael R Phillips, Flemming KonradsenAbstract:Evidence is accumulating that pesticide Self-Poisoning is one of the most commonly used methods of suicide worldwide, but the magnitude of the problem and the global distribution of these deaths is unknown. We have systematically reviewed the worldwide literature to estimate the number of pesticide suicides in each of the World Health Organisation's six regions and the global burden of fatal Self-Poisoning with pesticides. We used the following data sources: Medline, EMBASE and psycINFO (1990–2007), papers cited in publications retrieved, the worldwide web (using Google) and our personal collections of papers and books. Our aim was to identify papers enabling us to estimate the proportion of a country's suicides due to pesticide Self-Poisoning. We conservatively estimate that there are 258,234 (plausible range 233,997 to 325,907) deaths from pesticide Self-Poisoning worldwide each year, accounting for 30% (range 27% to 37%) of suicides globally. Official data from India probably underestimate the incidence of suicides; applying evidence-based corrections to India's official data, our estimate for world suicides using pesticides increases to 371,594 (range 347,357 to 439,267). The proportion of all suicides using pesticides varies from 4% in the European Region to over 50% in the Western Pacific Region but this proportion is not concordant with the volume of pesticides sold in each region; it is the pattern of pesticide use and the toxicity of the products, not the quantity used, that influences the likelihood they will be used in acts of fatal Self-harm. Pesticide Self-Poisoning accounts for about one-third of the world's suicides. Epidemiological and toxicological data suggest that many of these deaths might be prevented if (a) the use of pesticides most toxic to humans was restricted, (b) pesticides could be safely stored in rural communities, and (c) the accessibility and quality of care for Poisoning could be improved.
-
choice of poison for intentional Self Poisoning in rural sri lanka
Clinical Toxicology, 2006Co-Authors: Michael Eddleston, Ayanthi Karunaratne, Nicholas A. Buckley, Manjula Weerakoon, Subashini Kumarasinghe, Manjula Rajapakshe, M Rezvi H Sheriff, David GunnellAbstract:Background. Although intentional Self-Poisoning is a major public health problem in rural parts of the Asia-Pacific region, relatively little is known of its epidemiology. We aimed to determine why Sri Lankan Self-Poisoning patients choose particular poisons, and whether acts of Self-harm with highly dangerous poisons were associated with more premeditation and effort. Methods. We interviewed 268 Self-Poisoning patients presenting to two district general hospitals in rural Sri Lanka. Results. Eighty-five percent of patients cited easy availability as the basis for their choice of poison. There was little premeditation: more than 50% ingested the poison less than 30 minutes after deciding to Self-harm. Patients had little knowledge about treatment options or lethality of the poison chosen. We found no difference in reasons for choice of poison between people ingesting different poisons, despite marked differences in toxicity, and between people who died and those who survived. Conclusions. Poisons were cho...
-
Self-Poisoning suicides in England: a multicentre study
QJM : monthly journal of the Association of Physicians, 2005Co-Authors: Navneet Kapur, Pauline Turnbull, Keith Hawton, Sue Simkin, Lesley Sutton, Kevin Mackway-jones, Olive Bennewith, David GunnellAbstract:Background: Suicide by Self-Poisoning is an important cause of death worldwide. A substantial proportion of those with a fatal outcome may come into contact with medical services before they die. Aim: To estimate the proportion of Self-Poisoning suicides who reached hospital alive; to compare those who reached hospital alive with those who did not; to describe in detail the clinical characteristics and medical management of those dying in hospital. Design: Retrospective audit. Methods: We studied 24 coroners’ jurisdictions across England, reviewing coroners’ files and identifying all suicides by Self-Poisoning (drugs and other ingestible poisons) from 1 January 2001 to 31 December 2001. Results: Of the 214 individuals who completed suicide by Self-Poisoning during the study period, 49 (23%) reached hospital alive. Those reaching hospital were more likely to be female, more likely to have ingested paracetamol and less likely to have ingested co-proxamol. In the hospital sample, the commonest causes of death were respiratory ( n = 10), hepatic or hepatorenal ( n = 8), cardiac ( n = 5), or a result of hypoxic brain injury ( n = 5). Only 18% of in-hospital deaths occurred within 24 h of the overdose. Discussion: Extrapolating to England as a whole, we might expect 300 Self-Poisoning suicides per year to reach hospital alive (6% of all suicides). Improved medical management might produce a small but significant reduction in the rate of suicide. Such interventions should not be restricted to the emergency care domain. Further research will help to clarify the likely contribution of improved medical management to suicide prevention.
Keith Hawton - One of the best experts on this subject based on the ideXlab platform.
-
prescribed medication availability and deliberate Self Poisoning a longitudinal study
The Journal of Clinical Psychiatry, 2012Co-Authors: Bergljot Gjelsvik, Fridtjof Heyerdahl, Keith HawtonAbstract:Objective: The availability of prescribed medication to patients who engage in deliberate Self-Poisoning (DSP) is not known, and it is not clear whether patients choose drugs prescribed to them for Self-Poisoning. The objectives of this study were to investigate (1) prescribed medication availability in DSP patients compared to the general population, (2) whether patients use their prescribed medication in their DSP episodes, (3) differences between patients who ingest prescribed medication and those who do not, and (4) the time between the last collection of prescribed medication used for DSP and the DSP episodes. Method: The design was longitudinal. We included 171 patients admitted for DSP to 3 hospitals in Eastern Norway between January 2006 and March 2007. Data on patients’ prescriptions prior to admission were retrieved from the Norwegian Prescription Database (22.5 months of observation time). The primary outcome measure was type and amount of drugs ingested in the DSP episode. Results: DSP patients had a much greater prescribed medication load compared to the general population, with a mean of 30 prescriptions collected in the year prior to DSP. In total, 77.2% of patients ingested drugs that they had collected, whereas 25% of patients used drugs collected the week prior to admission. The tendency to ingest collected drugs increased with age (OR = 1.1, 95% CI = 1.01 to 1.11, P = .01). Patients who collected sedatives were more likely to use these for Self-Poisoning than patients who collected antidepressants. Conclusions: The much greater medication load of DSP patients is particularly important given their tendency to ingest their prescribed medication in Self-Poisoning episodes. The study indicates that timing of collection of medication prior to an episode is less important than general medication load. More attention should be directed to the total medication load for individuals at risk of Self-harm.
-
a comparative study of non fatal Self Poisoning with antidepressants relative to prescribing in three centres in england
Journal of Affective Disorders, 2010Co-Authors: Helen Bergen, Navneet Kapur, Jayne Cooper, Elizabeth Murphy, Carol Stalker, Keith Waters, Keith HawtonAbstract:Abstract Background Antidepressants are used frequently in non-fatal Self-Poisoning. There are national guidelines for prescribing antidepressants. There have been few investigations of how non-fatal Self-Poisoning with antidepressants varies in relation to prescribing and to patient characteristics. Methods A comparative study of the use of specific antidepressants (amitriptyline and dosulepin (tricyclics), citalopram, fluoxetine, paroxetine and sertraline (selective serotonin reuptake inhibitors) and venlafaxine (serotonin norepinephrine reuptake inhibitor)) for non-fatal Self-Poisoning (episode-based), relative to prescribing, in three centres in England, 2004 to 2006. Results There was marked variation between centres in the ratio of rates of Self-Poisoning to prescribing for specific antidepressants. Higher rates of Self-Poisoning relative to prescribing for all antidepressants combined, and for venlafaxine, were found in the centre with greater proportions of patients with a history of Self-harm and/or previous psychiatric treatment. Within each centre, higher rates of Self-Poisoning relative to prescribing were found for citalopram and fluoxetine than amitriptyline. However, rates of Self-Poisoning relative to prescribing for either amitriptyline or dosulepin were also similar to sertraline, which is of concern given the known toxicity of tricyclics. Limitations An ecological study, where prescriptions were for all indications and not specifically for the patients who Self-poisoned. Conclusions Marked differences found in ratios of Self-Poisoning with antidepressants to levels of prescribing, in three centres in England, are likely to reflect differences in both prescribing practices (despite clear national guidance) and patient characteristics. Risk of overdose and toxicity should be considered when local prescribing policy and clinical practice relating to antidepressants are under review.
-
Psychiatric assessment and management of deliberate Self-Poisoning patients
Medicine, 2007Co-Authors: Keith HawtonAbstract:Deliberate Self-Poisoning is one of the most common for general hospital presentation. The majority of the individuals involved are young, with females outnumbering males. Self-Poisoning occurs in people from a variety of social backgrounds, but is associated with socio-economic deprivation and social fragmentation. Common precipitants include relationship problems, often in the context of depression and alcohol abuse. Analgesics and psychotropic drugs are the substances most frequently involved in Self-Poisoning in the UK. The risks of repetition of Self-harm and of suicide following Self-Poisoning are substantial. General hospitals should have special Self-harm services for clinical management. Psychosocial assessment of patients should include investigation of the events and problems preceding the act, suicidal intent and other motives for the act, psychiatric disorder, personality traits and disorder, family and personal history, psychiatric history, including of Self-harm, risk of further Self-harm and suicide, and coping resources and support. Aftercare should be arranged according to the patient's needs and risk. There is good evidence that psychological therapy is effective. Prevention of Self-Poisoning and its consequences should be based on a range of initiatives, including school-based programmes, detection of those at risk in primary care, reduced availability of toxic amounts of therapeutic drugs, and effective aftercare for those who have Self-poisoned. © 2007 Elsevier Ltd. All rights reserved
-
Self-Poisoning suicides in England: a multicentre study
QJM : monthly journal of the Association of Physicians, 2005Co-Authors: Navneet Kapur, Pauline Turnbull, Keith Hawton, Sue Simkin, Lesley Sutton, Kevin Mackway-jones, Olive Bennewith, David GunnellAbstract:Background: Suicide by Self-Poisoning is an important cause of death worldwide. A substantial proportion of those with a fatal outcome may come into contact with medical services before they die. Aim: To estimate the proportion of Self-Poisoning suicides who reached hospital alive; to compare those who reached hospital alive with those who did not; to describe in detail the clinical characteristics and medical management of those dying in hospital. Design: Retrospective audit. Methods: We studied 24 coroners’ jurisdictions across England, reviewing coroners’ files and identifying all suicides by Self-Poisoning (drugs and other ingestible poisons) from 1 January 2001 to 31 December 2001. Results: Of the 214 individuals who completed suicide by Self-Poisoning during the study period, 49 (23%) reached hospital alive. Those reaching hospital were more likely to be female, more likely to have ingested paracetamol and less likely to have ingested co-proxamol. In the hospital sample, the commonest causes of death were respiratory ( n = 10), hepatic or hepatorenal ( n = 8), cardiac ( n = 5), or a result of hypoxic brain injury ( n = 5). Only 18% of in-hospital deaths occurred within 24 h of the overdose. Discussion: Extrapolating to England as a whole, we might expect 300 Self-Poisoning suicides per year to reach hospital alive (6% of all suicides). Improved medical management might produce a small but significant reduction in the rate of suicide. Such interventions should not be restricted to the emergency care domain. Further research will help to clarify the likely contribution of improved medical management to suicide prevention.
-
Psychiatric assessment and management of deliberate Self-Poisoning patients
Medicine, 2003Co-Authors: Keith HawtonAbstract:Deliberate Self-Poisoning is one of the most common reasons for general hospital presentation. The majority of the individuals involved are young, but it occurs across the life cycle. Females outnumber males. Self-Poisoning occurs in people from a variety of social backgrounds, but is associated with socioeconomic deprivation and social fragmentation. Common precipitants include relationship problems, often in the context of depression and alcohol abuse. The risks of repetition of Self-harm and of suicide following Self-Poisoning are substantial. Psychosocial assessment of patients should include investigation of the events and problems preceding the act, suicidal intent and other motives for the act, psychiatric disorder, personality traits and disorder, family and personal history, psychiatric history, including of Self-harm, risk of further Self-harm and suicide, and coping resources and support. Aftercare should focus on the patient's needs and reducing their risk.
Nicholas A. Buckley - One of the best experts on this subject based on the ideXlab platform.
-
Acute human Self-Poisoning with imidacloprid compound: a neonicotinoid insecticide.
PloS one, 2009Co-Authors: Fahim Mohamed, Michael Eddleston, Indika Gawarammana, Thomas Robertson, Michael S. Roberts, Chathura Palangasinghe, Shukry Zawahir, Shaluka Jayamanne, Jaganathan Kandasamy, Nicholas A. BuckleyAbstract:Background: Deliberate Self-Poisoning with older pesticides such as organophosphorus compounds are commonly fatal and a serious public health problem in the developing world. The clinical consequences of Self-Poisoning with newer pesticides are not well described. Such information may help to improve clinical management and inform pesticide regulators of their relative toxicity. This study reports the clinical outcomes and toxicokinetics of the neonicotinoid insecticide imidacloprid following acute Self-Poisoning in humans. Methodology/Principal Findings: Demographic and clinical data were prospectively recorded in patients with imidacloprid exposure in three hospitals in Sri Lanka. Blood samples were collected when possible for quantification of imidacloprid concentration. There were 68 patients (61 Self-ingestions and 7 dermal exposures) with exposure to imidacloprid. Of the Self-Poisoning patients, the median time to presentation was 4 hours (IQR 2.3–6.0) and median amount ingested was 15 mL (IQR 10–50 mL). Most patients only developed mild symptoms such as nausea, vomiting, headache and diarrhoea. One patient developed respiratory failure needing mechanical ventilation while another was admitted to intensive care due to prolonged sedation. There were no deaths. Median admission imidacloprid concentration was 10.58 ng/L; IQR: 3.84– 15.58 ng/L, Range: 0.02–51.25 ng/L. Changes in the concentration of imidacloprid in serial blood samples were consistent with prolonged absorption and/or saturable elimination. Conclusions: Imidacloprid generally demonstrates low human lethality even in large ingestions. Respiratory failure and reduced level of consciousness were the most serious complications, but these were uncommon. Substitution of imidacloprid for organophosphorus compounds in areas where the incidence of Self-Poisoning is high may help reduce deaths from Self-Poisoning.
-
choice of poison for intentional Self Poisoning in rural sri lanka
Clinical Toxicology, 2006Co-Authors: Michael Eddleston, Ayanthi Karunaratne, Nicholas A. Buckley, Manjula Weerakoon, Subashini Kumarasinghe, Manjula Rajapakshe, M Rezvi H Sheriff, David GunnellAbstract:Background. Although intentional Self-Poisoning is a major public health problem in rural parts of the Asia-Pacific region, relatively little is known of its epidemiology. We aimed to determine why Sri Lankan Self-Poisoning patients choose particular poisons, and whether acts of Self-harm with highly dangerous poisons were associated with more premeditation and effort. Methods. We interviewed 268 Self-Poisoning patients presenting to two district general hospitals in rural Sri Lanka. Results. Eighty-five percent of patients cited easy availability as the basis for their choice of poison. There was little premeditation: more than 50% ingested the poison less than 30 minutes after deciding to Self-harm. Patients had little knowledge about treatment options or lethality of the poison chosen. We found no difference in reasons for choice of poison between people ingesting different poisons, despite marked differences in toxicity, and between people who died and those who survived. Conclusions. Poisons were cho...
-
Epidemiology of intentional Self-Poisoning in rural Sri Lanka.
The British journal of psychiatry : the journal of mental science, 2005Co-Authors: Michael Eddleston, David Gunnell, Ayanthi Karunaratne, Dhammik De Silva, M H Rezvi Sheriff, Nicholas A. BuckleyAbstract:We investigated the epidemiology of intentional Self-Poisoning in rural Sri Lanka by prospectively recording 2189 admissions to two secondary hospitals. Many patients were young (median age 25 years), male (57%) and used pesticides (49%). Of the 198 who died,156 were men (case fatality 12.4%) and 42 were women (4.5%). Over half of female deaths were in those under 25 years old; male deaths were spread more evenly across age groups. Oleander and paraquat caused 74% of deaths in people under 25 years old; thereafter organophosphorous pesticides caused many deaths. Although the age pattern of Self-Poisoning was similar to that of industrialised countries, case fatality was more than 15 times higher and the pattern of fatal Self-Poisoning different.
-
A model for the management of Self-Poisoning
The Medical journal of Australia, 1997Co-Authors: Ian M Whyte, Andrew H. Dawson, Nicholas A. Buckley, Gregory Carter, Cathterine M LeveyAbstract:OBJECTIVE: To describe the development and activity of a multidisciplinary service to manage Self-Poisoning. DESIGN: Descriptive, comparative study with prospective data collection. SETTING: Regional toxicology treatment centre in the Hunter area of New South Wales (NSW) with primary and secondary referral service to 385,000 people and tertiary referral service to a further 100,000. PATIENTS: All patients (1987-1995) with Poisoning or envenomation presenting to the Hunter Area Toxicology Service (HATS). MAIN OUTCOME MEASURES: Average length of stay for HATS compared with national and NSW hospitals; mortality data for HATS compared with NSW. RESULTS: Average length of stay for HATS was 0.53-1.22 days shorter than for all Australian hospitals, potentially saving 518 bed-days, valued at $468,000 per year. Average length of stay was 0.94-3.39 days shorter than for all NSW hospitals, saving 1470 bed-days at $1.4 million per year. Inpatient mortality (0.2%; 95% confidence interval, 0.0-1.1) was not significantly different from NSW (0.5%; 95% CI, 0.2-0.8). Standardised mortality ratios showed no greater all-cause suicide mortality. CONCLUSIONS: In our centralised model for managing Self-Poisoning, all toxicology patients in an area health service are diverted to one hospital, where all patients with deliberate Self-Poisoning are admitted under the one multidisciplinary team, and all receive psychiatric assessment. This model has substantially reduced bed stay, with considerable savings to the Hunter Area Health Service manifested as an increase in beds available for other purposes. Language: en
-
Self-Poisoning in Newcastle, 1987-1992.
The Medical journal of Australia, 1995Co-Authors: Nicholas A. Buckley, Andrew H. Dawson, Ian M Whyte, Peter Mcmanus, Nicholas W FergusonAbstract:OBJECTIVE: To examine the morbidity and mortality associated with Self-Poisoning with different drug classes. DESIGN: Prospective cohort study with limited follow-up. Retrospective analysis of coronial data. SETTING: Primary and tertiary referral toxicology centre covering Newcastle and Lake Macquarie, Australia, 1987-1992. RESULTS: There were 1969 admissions after ingestion of 3724 substances (2424 prescription drugs and 1300 non-prescription items). The coroner investigated 83 drug-related deaths. Only 12 of these people presented to hospital and, for most of these, death was inevitable at presentation. The most frequently ingested substances were benzodiazepines, alcohol, paracetamol, antidepressants, neuroleptics and anticonvulsants. Since 1980, the percentage of Self-Poisonings involving benzodiazepines has fallen, while it has risen for those involving antidepressants. Over 50% of deaths were due to tricyclic antidepressants or opioid analgesics. CONCLUSIONS: As death usually occurs out of hospital, interventions to decrease mortality from Self-Poisoning must focus on prevention, and targeting drugs that are frequently taken or frequently lethal in overdose. Consideration should be given to the use of antidepressants that are safer in overdose. The use of antidepressants, barbiturates or chloral hydrate as sedatives should be discouraged. Language: en