Suizidalität aus toxikologischer Sicht

ZUSAMMENFASSUNG

Das Wissen um Charakteristika suizidal intendierter Selbstvergiftungen sowie Faktoren, die mit einem wiederholten Suizidversuch assoziiert sind, ist für die Identifikation von potenziellen Risikopatienten und -konstellationen wertvoll. Daher wurden in einer prospektiven Beobachtungsstudie in einem Zeitraum von 12 Monaten Daten von 1238 Patienten mit suizidalen Intoxikationen, zu denen unser Giftnotruf kontaktiert wurde, gesammelt und ausgewertet. Die erhobenen Informationen umfassen neben demografischen Daten auch Angaben zu Symptomen, eingenommenen Substanzen bzw. deren Quelle, somatisch-psychiatrischen Komorbiditäten, früheren Suizidversuchen, Vorliegen einer Substanzkonsumstörung sowie einer Koingestion von Alkohol oder illegalen Drogen.

53 % der Patienten waren zwischen 18 und 44 Jahre alt, 66 % waren weiblich. 79 % der Patienten litten an einer psychiatrischen Erkrankung, 45 % hatten mindestens einen Suizidversuch hinter sich. Patienten mit einer psychiatrischen Störung nahmen am häufigsten Antidepressiva und Neuroleptika ein, während Patienten ohne psychiatrische Vorerkrankung vorwiegend periphere Analgetika, insbesondere Ibuprofen, verwendeten. Im Vergleich zu Patienten mit einem Erstereignis wiesen diejenigen mit einem wiederholten Suizidversuch häufiger eine psychiatrische Erkrankung oder eine Substanzkonsumstörung auf und ingestierten bevorzugt Antidepressiva und Neuroleptika, jedoch seltener periphere Analgetika. Neben der Identifikation von Charakteristika vorsätzlicher Selbstvergiftungen konnten mit dem Vorliegen einer psychiatrischen Erkrankung, eines gestörten Substanzgebrauchs sowie der Ingestion von Antidepressiva oder Neuroleptika Risikofaktoren für einen wiederholten Suizidversuch detektiert werden, auf deren Basis individuelle Präventivmaßnahmen für Risikogruppen entwickelt werden können.

ABSTRACT

Knowledge of characteristics of suicidally intended self-poisonings as well as factors associated with a repeated suicide attempt is extremely valuable for the identification of potential risk patients and constellations. Therefore, in a prospective observational study, data of 1238 patients with suicidal intoxications for whom our Poison Control Centre was contacted were collected and analyzed over a period of 12 months. The information collected includes demographic data as well as information on symptoms, substances taken or their source, somatic-psychiatric comorbidities, previous suicide attempts, presence of a substance use disorder and co-ingestion of alcohol or illicit drugs.

53 % of the patients were between 18 and 44 years old, 66 % were female. 79 % of the patients suffered from a psychiatric disorder, 45 % had had at least one suicide attempt. Patients with a psychiatric disorder most frequently used antidepressants and neuroleptics, while patients without a psychiatric history predominantly used peripheral analgesics, especially ibuprofen. Compared to patients with a first event, those with repeated suicide attempts were more likely to have a psychiatric disorder, or a substance use disorder and preferentially ingested antidepressants and neuroleptics, but less frequently peripheral analgesics. In addition to the identification of characteristics of deliberate self-poisonings, the presence of a psychiatric disease, of a substance use disorder and the ingestion of antidepressants or neuroleptics could be detected as risk factors for a repeated suicide attempt, on the basis of which individual preventive measures for risk groups can be developed.

Schlüsselwörter

Suizid - Selbstvergiftung - Intoxikation - Suizidprävention

Key words

Suicide - self-poisoning - intoxication - suicide prevention

Publication History

Article published online:
04 April 2022

• Literatur

• 1 Suizide in Deutschland nach Methode. Statista. https://de.statista.com/themen/40/selbstmord/
• 2 Kim B, Ahn JH, Cha B. et al Characteristics of methods of suicide attempts in Korea: Korea National Suicide Survey (KNSS).. J Affect Disord 2015; 188: 218-25
• 3 Mergl R, Koburger N, Heinrichs K. et al What Are Reasons for the Large Gender Differences in the Lethality of Suicidal Acts? An Epidemiological Analysis in Four European Countries.. PLoS One 2015; 10 (07) e0129062
• 4 Cook R, Allcock R, Johnston M. Self-poisoning: Current trends and practice in a UK teaching hospital.. Clin Med J R Coll Physicians 2008; 08 (01) 37-40
• 5 Zahl DL, Hawton K. Repetition of deliberate self-harm and subsequent suicide risk: Long-term follow-up study of 11 583 patients.. Br J Psychiatry 2004; 185: 70-5
• 6 Ardani AR, Naghibzadeh B, Farid Hosseini F. et al Temperament and character personality profile and affective temperaments in self-poisoning nonlethal suicide attempters.. Psychiatry Res 2015; 229 1–2 394-400
• 7 Haukka J, Suominen K, Partonen T. et al Determinants and Outcomes of Serious Attempted Suicide: A Nationwide Study in Finland, 1996–2003.. Am J Epidemiol 2008; 167 (10) 1155-63
• 8 Freeman A, Mergl R, Kohls E. et al A cross-national study on gender differences in suicide intent.. BMC Psychiatry 2017; 17 (01) 8-11
• 9 Ghazinour M, Emami H, Richter J. et al Age and gender differences in the use of various poisoning methods for deliberate parasuicide cases admitted to loghman hospital in Tehran (2000–2004).. Suicide Life Threat Behav 2009; 39 (02) 231-9
• 10 Prescott K, Stratton R, Freyer A. et al Detailed analyses of self-poisoning episodes presenting to a large regional teaching hospital in the UK.. Br J Clin Pharmacol 2009; 68 (02) 260-8
• 11 Mauri MMC, Cerveri G, Volonteri LLS. et al Parasuicide and drug self-poisoning: analysis of the epidemiological and clinical variables of the patients admitted to the Poisoning Treatment Centre (CAV), Niguarda General Hospital, Milan.. Clin Pract Epidemiol Ment Health 2005; 01: 1
• 12 Bilén K, Ottosson C, Castrén M. et al Deliberate self-harm patients in the emergency department: factors associated with repeated self-harm among 1524 patients.. Emerg Med J 2011; 28 (12) 1019-25
• 13 Oh SH. et al Deliberate self-poisoning: factors associated with recurrent self-poisoning.. Am J Emerg Med 2011; 29 (08) 908-12
• 14 Hunt IM, Swinson N, Palmer B. et al Method of suicide in the mentally ill: a national clinical survey.. Suicide Life Threat Behav 2010; 40 (01) 22-34
• 15 Hendrix L, Verelst S, Desruelles D. et al Deliberate self-poisoning: characteristics of patients and impact on the emergency department of a large university hospital.. Emerg Med J 2013; 30: 1
• 16 Lee HL, Lin HJ, Yeh STY. et al Presentations of patients of poisoning and predictors of poisoning-related fatality: Findings from a hospital-based prospective study.. BMC Public Health 2008; 08 (01) 7
• 17 Buykx P, Loxley W, Dietze P. et al Medications used in overdose and how they are acquired – An investigation of cases attending an inner Melbourne emergency department.. Aust N Z J Public Health. 2010; 34 (04) 401-4
• 18 Doak MW, Nixon AC, Lupton DJ. et al Self-poisoning in older adults: Patterns of drug ingestion and clinical outcomes.. Age Ageing 2009; 38 (04) 407-11
• 19 Sorge M, Weidhase L, Bernhard M. et al Selbstvergiftung in der Akutmedizin – 2005–2012. Anaesthesist 2015; 64 (06) 456-62
• 20 Verstraete AG, Buylaert WA. Survey of patients with acute poisoning seen in the Emergency Department of the University Hospital of Gent between 1983 and 1990.. Eur J Emerg Med 1995; 02 (04) 217-23
• 21 Buchanan WJ. A year of intentional self poisoning in Christchurch.. N Z Med J 1991; 104 (923) 470-2
• 22 Schwake L, Wollenschläger I, Stremmel W. et al Adverse drug reactions and deliberate self-poisoning as cause of admission to the intensive care unit: A 1-year prospective observational cohort study.. Intensive Care Med 2009; 35 (02) 266-74
• 23 Viertel A, Weidmann E, Brodt HR. Akute vergiftungen in der internistischen intensivmedizin.. Dtsch Medizinische Wochenschrift 2001; 126 (42) 1159-63
• 24 Furst S, Habscheid W. Patients admitted to a medical intensive care unit with acute poisoning.. Dtsch Medizinische Wochenschrift 1993; 118 (23) 849-53
• 25 Geith S, Didden C, Rabe C. et al Lessons to be learned: identifying high-risk medication and circumstances in patients at risk for suicidal self-poisoning.. Int J Ment Heal Syst 2022; 16 (01) 1-12
• 26 Spiller HHA, Ackerman JPJ, Smith GA. et al Suicide attempts by self-poisoning in the United States among 10–25 year olds from 2000 to 2018: substances used, temporal changes and demographics.. Clin Toxicol 2020; 58 (07) 676-87
• 27 Townsend E, Hawton K, Harriss L. et al Substances used in deliberate self-poisoning 1985–1997 trends and associations with age, gender, repetition and suicide intent.. Soc Psychiatry Psychiatr Epidemiol 2001; 36 (05) 228-34
• 28 Ajdacic-Gross V, Weiss MG, Ring M. et al Methods of suicide: international suicide patterns derived from the WHO mortality database.. Bull World Health Organ 2008; 86 (09) 726
• 29 El Majzoub I, El Khuri C, Hajjar K. et al Characteristics of patients presenting post-suicide attempt to an Academic Medical Center Emergency Department in Lebanon.. Ann Gen Psychiatry 2018; 17 (01) 1-10
• 30 Spiller HA, Ackerman JP, Spiller NE. et al Sex- and Age-specific Increases in Suicide Attempts by Self-Poisoning in the United States among Youth and Young Adults from 2000 to 2018.. J Pediat 2019; 210: 201-8
• 31 Robert Koch Institut, Schwerpunktbericht der Gesundheitsberichterstattung des Bundes – Gesundheit von Frauen und Männern im mittlerem Lebensalter. https://edoc.rki.de/handle/176904/3180
• 32 Brieger P, Menzel S, Hamann J. Wird die Rolle von psychischen Erkrankungen beim Suizid überbewertet?. Bundesgesundheitsblatt – Gesundheitsforsch – Gesundheitsschutz 2021; 65 (01) 25-9
• 33 Kim J. et al High Prevalence of Psychotropics Overdose among Suicide Attempters in Korea.. Clin Psychopharmacol Neurosci 2015; 13 (03) 302
• 34 Geith S, Ganzert M, Schmoll S. et al [Intoxications in Children and Adolescents in Germany].. Klin Padiatr 2018; 230 (04) 205-14
• 35 Alsén M. et al Medicine self-poisoning and the sources of the drugs in Lund, Sweden.. Acta Psychiatr Scand 1994; 89 (04) 255-61
• 36 Pires MC da C, da Silva T de PS, dos Passos MP. et al Fatores de risco para tentativa de suicídio por envenenamento: Revisão [Internet].. Trends in Psychiatry and Psychotherapy 2014: 63-74
• 37 Coupland C, Hill T, Morriss R. et al Antidepressant use and risk of suicide and attempted suicide or self harm in people aged 20 to 64: Cohort study using a primary care database.. BMJ 2015: 350
• 38 Salles J, Calonge J, Franchitto N. et al Factors associated with hospitalization after self-poisoning in France: Special focus on the impact of alcohol use disorder.. BMC Psychiatry 2018; 18 (01) 1-9
• 39 Gvion Y, Levi-Belz Y. Serious Suicide Attempts: Systematic Review of Psychological Risk Factors.. Front Psychiatry 2018; 00: 56
• 40 Doshi A, Boudreaux E, Wang N. et al National study of US emergency department visits for attempted suicide and self-inflicted injury, 1997–2001. Ann Emerg Med 2005; 46 (04) 369-75
• 41 Davidson CL, Wingate LR. et al Hope as a predictor of interpersonal suicide risk.. Suicide Life Threat Behav 2009; 39 (05) 499-507
• 42 Brown GK, Green KL. A review of evidence-based follow-up care for suicide prevention: where do we go from here?. Am J Prev Med 2014; 47 (Suppl. 03) 2
• 43 Stone DM, Crosby AE. Suicide Prevention.. Am J Lifestyle Med 2014; 08 (06) 404