Cara Katz1, Jason R Randall2, Christine Leong3, Jitender Sareen4, James M Bolton5. 1. Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: katzc@myumanitoba.ca. 2. Injury Prevention Centre, School of Public Health, University of Alberta, Edmonton, Alberta, Canada. 3. College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada. 4. Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada. 5. Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.
Abstract
OBJECTIVE: The rates of annual emergency department (ED) visits in the United States for suicidal behaviour has nearly doubled over the last 10-15 years, with a decreased rate of hospitalizations, indicating the importance of intervention in the ED presentation. This paper describes the patterns of psychotropic use immediately before and after emergency department presentation to enhance understanding of interventions for increasing safety in these individuals. METHODS: 5070 adults seen in psychiatric consultation in two tertiary EDs with linkage to population-based administrative data to describe psychotropic prescriptions immediately before and after ED presentation. RESULTS: 55.9% of suicide attempts were by overdose, with 13.4% of suicide attempts occurring in the 18-21 age group. While no causal relationship can be inferred, half of those who presented to the ED with suicidal ideation or behaviour or non-suicidal self-injury were prescribed an antidepressant prior to ED presentation, with a spike in new prescriptions in the month immediately prior. 20% of those who presented to the ED with thoughts or behaviour received a new or different prescription for an antidepressant in the 1-month post-presentation. Prescribing of tricyclic antidepressants and opioids were decreased following ED presentation, however 21% of people still received opioids after a suicide attempt. Rates of antipsychotic prescriptions were increased. CONCLUSION: Patients are seeking help in the one-month prior to emergency presentation. Clinicians must consider the risk in this period of heightened clinical distress, especially among those under age 21. It is important to consider the changes that can be made in the ED to impact safety.
OBJECTIVE: The rates of annual emergency department (ED) visits in the United States for suicidal behaviour has nearly doubled over the last 10-15 years, with a decreased rate of hospitalizations, indicating the importance of intervention in the ED presentation. This paper describes the patterns of psychotropic use immediately before and after emergency department presentation to enhance understanding of interventions for increasing safety in these individuals. METHODS: 5070 adults seen in psychiatric consultation in two tertiary EDs with linkage to population-based administrative data to describe psychotropic prescriptions immediately before and after ED presentation. RESULTS: 55.9% of suicide attempts were by overdose, with 13.4% of suicide attempts occurring in the 18-21 age group. While no causal relationship can be inferred, half of those who presented to the ED with suicidal ideation or behaviour or non-suicidal self-injury were prescribed an antidepressant prior to ED presentation, with a spike in new prescriptions in the month immediately prior. 20% of those who presented to the ED with thoughts or behaviour received a new or different prescription for an antidepressant in the 1-month post-presentation. Prescribing of tricyclic antidepressants and opioids were decreased following ED presentation, however 21% of people still received opioids after a suicide attempt. Rates of antipsychotic prescriptions were increased. CONCLUSION:Patients are seeking help in the one-month prior to emergency presentation. Clinicians must consider the risk in this period of heightened clinical distress, especially among those under age 21. It is important to consider the changes that can be made in the ED to impact safety.
Authors: Kendiss Olafson; Ruth Ann Marrie; James M Bolton; Charles N Bernstein; O Joseph Bienvenu; Maia S Kredentser; Sarvesh Logsetty; Dan Chateau; Yao Nie; Marcus Blouw; Tracie O Afifi; Murray B Stein; William D Leslie; Laurence Y Katz; Natalie Mota; Renée El-Gabalawy; Murray W Enns; Christine Leong; Sophia Sweatman; Jitender Sareen Journal: Intensive Care Med Date: 2021-09-08 Impact factor: 17.440
Authors: Vincent Besch; Christian Greiner; Charline Magnin; Mélanie De Néris; Julia Ambrosetti; Nader Perroud; Emmanuel Poulet; Martin Debbané; Paco Prada Journal: Int J Environ Res Public Health Date: 2020-11-24 Impact factor: 3.390
Authors: Carla Gramaglia; Maria Martelli; Lorenza Scotti; Lucia Bestagini; Eleonora Gambaro; Marco Romero; Patrizia Zeppegno Journal: Front Public Health Date: 2022-01-03