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Overdose: A Review of 100 Consecutive Cases

1. Evaluate and treat patients with significant overdose.

2. Understand risk factors for significant overdose.

Patients who overdose represent a significant challenge(1) for consultation-liaison psychiatrists. Methods: A retrospective chart review of 100 patients over 18 consecutively admitted from July through December, 1998 by the toxicology service following overdose warranting hospitalization was performed. Diagnoses were based on DSM-IV criteria. Results: Seventy-eight percent of the 100 toxicology cases reported suicidal intent. The age range was 18 to 79; the mean was 34.8. Fifty-five percent were female. The primary psychiatric diagnoses are as follows: 64% mood disorder, 16% substance related disorder, 8% adjustment disorder, 7% psychotic disorder, 2% anxiety disorder, 3% other. Sixty-eight percent had a prior Axis I diagnosis other than substance abuse. Forty-one percent were currently receiving psychiatric treatment. Sixty-four percent had co-existing substance abuse. Twenty-nine percent ingested at least one substance of abuse as part of the overdose. Forty-six percent had previously attempted suicide. Seventy-five percent identified a stressful life event. Conclusion: Adult overdose patients share risk factors(1,2) for suicidal behavior including the presence of an Axis I diagnosis, particularly a mood disorder; lack of current psychiatric treatment; history of prior suicide attempt; and significant life stressors. Substance abuse represents a significant independent and comorbid risk factor for overdose.

 

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