Suicide

Acetaminophen OD More Deadly if Taken in Stages

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Those who ingested more than 4,000 mg of acetaminophen in a single day spread out over more than one time point had a significantly higher mortality rate compared with those who overdosed at a single time point (37.3% versus 27.8%, P=0.025), according to Kenneth Simpson, MD, of the University of Edinburgh in Scotland, and colleagues.

The cohort analysis included 663 patients admitted with acetaminophen-induced severe liver injury from November 1992 through October 2008. About one-quarter (24.3%) overdosed in a staggered fashion, defined as taking at least two excessive doses separated by more than eight hours and adding up to more than 4,000 milligrams in one day. The rest of the patients ingested that much at a single time point.

Most of the patients who had a staggered overdose (58.2%) said that pain relief was the reason they repeatedly took an excessive dose. Another 34.3% said it was a suicide attempt.

via Medical News: Acetaminophen OD More Deadly if Taken in Stages – in Pain Management, Pain Management from MedPage Today.

Learn more at Acetaminophen Toxicity.

Personally I rarely take the stuff.  It’s pure poison for the liver.

Prescription Drug OD Deaths Up in Florida

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Medical News: Alprazolam Among Top Causes of Fatal Overdoses in Florida – in Public Health & Policy, Public Health from MedPage Today

Deaths in Florida involving prescription drugs in 2009 were four times as common as those related to illicit drugs, with alprazolam (Xanax) joining opioids among the top killers, the CDC reported.

From 2003 to 2009, the death rate in Florida from overdoses of prescription drugs increased 84.2%, from 7.3 to 13.4 per 100,000 population, according to data from the Florida Medical Examiners Commission analyzed by the CDC in the July 8 issue of Morbidity and Mortality Weekly Report.

Time to tighten up your anxiety/depression underwriting guidelines?  How about script checks at lower amounts?  Can you differentiate between the applicant who wants to off himself versus plain vanilla anxiety?

 

 

Suicides Are Up

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Amid persisting economic duress, worries rise about suicides – CSMonitor.com

Psychologists have long linked suicides to economic stresses such as unemployment or credit problems. The recent economic turmoil, in which many people have seen sliding home values, job loss, and evaporating savings, exacerbates the risk, says Nancy Zarse, an associate professor of clinical forensic psychology at The Chicago School of Professional Psychology. 

Suicide is historically linked to economic downturns. The rate peaked in 1933, the height of the Great Depression, at 17.4 per 100,000 people, according to the American Association of Suicidology, which studies suicidal behavior and advocates prevention. That peak came one year after the US unemployment rate reached 25 percent, a stark contrast to the jobless rate of 0.04 percent just a few years earlier.

The suicide rate has never revisited that 1933 level, but it has increased this decade – from 10.7 per 100,000 people in 2000 to 11.5 in 2007, the last year tabulated by the Centers for Disease Control and Prevention. (Those latest figures predate the worst of the Great Recession.)

Anticonvulsant Meds and Suicide Risk

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JAMA — Abstract: Anticonvulsant Medications and the Risk of Suicide, Attempted Suicide, or Violent Death, April 14, 2010, Patorno et al. 303 (14): 1401

Results: The study identified 26 completed suicides, 801 attempted suicides, and 41 violent deaths in 297 620 new episodes of treatment with an anticonvulsant (overall median follow-up, 60 days). The incidence of the composite outcomes of completed suicides, attempted suicides, and violent deaths for anticonvulsants used in at least 100 treatment episodes ranged from 6.2 per 1000 person-years for primidone to 34.3 per 1000 person-years for oxcarbazepine. The risk of suicidal acts was increased for gabapentin (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.11-1.80), lamotrigine (HR, 1.84; 95% CI, 1.43-2.37), oxcarbazepine (HR, 2.07; 95% CI, 1.52-2.80), tiagabine (HR, 2.41; 95% CI, 1.65-3.52), and valproate (HR, 1.65; 95% CI, 1.25-2.19), compared with topiramate. The analyses including violent death produced similar results. Gabapentin users had increased risk in subgroups of younger and older patients, patients with mood disorders, and patients with epilepsy or seizure when compared with carbamazepine.

Conclusion: This exploratory analysis suggests that the use of gabapentin, lamotrigine, oxcarbazepine, and tiagabine, compared with the use of topiramate, may be associated with an increased risk of suicidal acts or violent deaths.