Characteristics and outcomes and of patients with drug overdose requiring Intensive Care Unit admission
The present study indicated that during 2010 to 2013, 8.1% patients admitted to the ICU of Frankston Hospital, were patients with drug overdose. Therefore, 1/8th of patients admitted in the ICU were of drug overdose. This is quite high, with respect to patients admitted, in the ICU with other diseases. Out of such patients, 7.8% patients had multiple admissions during the three-year period. Hence, it reflected that such patients might have been suffering from chronic physical or psychiatric ailments. The prevalence of ICU admissions varied with respect to gender. 56.57% patients admitted with drug overdose were females and 41.7% were males. Therefore, the incidences of drug overdose in females were 36% higher than males. This reflects that females are prone and susceptible to drug overdose. Such phenomenon is not uncommon because the prevalence of depression is 2:1 in Females: Males. Hence, it can be speculated that due to depressive disorders the risk of drug overdose increases. However, with respect to mean age of admission with overdose, the figures nearly matched (39.3 years for males versus 40.6 years for females) and there was no statistically significant difference between these two figures (p> 0.05). Therefore, it may be speculated that males might have better-coping strategies to combat stress and depression compared to females. On the other hand, it might be so possible that the extent and intensity of stress and depression were higher in females. That is why; they must have opted for self-harm.
Such speculations were assumed to be true because the various forms of psychiatric disorders were more with females compared to males (69.4% versus 50.1%). The subcategory figures were personality disorders (43.3% versus 6.7%), depression (68.7% versus 53.3%), Bipolar disorders (23.9% versus 10.8%) and Schizophrenia (14.4% versus 3.3%). 52.8% of individuals who were admitted in the ICU during the three-year period had prior admissions for drug overdose. This indicated that quite a high number of patients admitted in ICU of the Frankston Hospital suffered from chronic illness. This was evident that apart from psychiatric illness, chronic pain was the commonest co-morbid factor inducing a drug overdose. Individuals who had multiple admissions were diagnosed with more psychiatric disorders compared to the individuals who were admitted for the first time (p<0.001). For depression (p<0.02), for personality disorder (p<0.001), for bipolar disorder (<0.02) , and for schizophrenia (p<0.008).
Individuals, who did not have a prior history of drug overdose, used recreational drugs like amphetamines, marijuana, or alcohol for overdosing compared to the traditional drugs (12.5% versus 5.9%) like tranquilizers, anxiolytics or anti-depressants. The data suggests that it is difficult to predict drug overdose or the likely incidence of drug overdose at the level of pharmacy. On the other hand individuals who had multiple admissions the drugs of choice used for overdose were Atypical-antipsychotics, tranquilizers, and sedatives. Moreover, the incidence of intentional overdose was more than accidental overdose, which reflected that patients with drug overdose have a self-harming behavior.
In the current study, a life-threatening stressor was present in almost 57.6% of cases. Such stressors included family conflicts or terminal illness (cancer). Alcohol was the most common recreational drug used for overdosing compared to marijuana and amphetamines. Altered GCS was the most common reason the individuals were admitted in the ICU. Endotracheal intubation was the most common intervention used to treat the patients for washing out the drug. The Frankston hospital ICU effectively manages drug overdose patients as because the average length of ICU stays was 2.8 days and overall 43% patients were discharged directly to home from ICU. Transfer to other hospitals was only 2.3% and such transfers were as per the choice of patients rather than the inefficiency of the hospital.
Our study was supplemented by an Irish study1. The results indicated that the ratio between males and females who were admitted were 41.5% versus 58.5%. In that study intentional drug overdose was also significantly more than the accidental drug overdose. However, the choice of drugs varied in case of intentional overdose (21% of patients used paracetamol for overdosing). This might be due to easy availability of acetaminophen (paracetamol) group of drugs in that country or a restricted use of recreational drugs. In this study, around 40% individuals used alcohol consumption for the purpose of overdose compared to around 22% individuals, in our study. In our study, 25% of individuals used opiates for the purpose of overdose which was much higher compared to the Irish study where opiates were used by 11% (averaged for both hospitals) individuals for the purpose of intentional overdose. In the present study tranquilizers were consumed by 39% individuals for overdosing purposes, compared to 22% in case of the Irish study. The comparison between the present study and the Irish study is quite significant. The comparison reflected that the choice of drugs used for overdosing purposes varied between Australia and Ireland. The overdosing history in our study reflected that due to stringent regulatory laws in Ireland, prescription medications like anti-depressants and anti-psychotics are not readily accessible to individuals for the purpose of overdosing. That is why; the Irish population who intend to overdose relies on recreational drugs, alcohol consumption, and paracetamol much more. However, in case of Australia tranquilizers, opiates are freely available and individuals who intend to overdose these types of serious drugs.
In another Irish study2 the demographics of age varied from our current study. It was reflected that during 2008-2009, incidences of drug overdose were higher in males and the mean age range was 20-24 years. On the other hand, in females the mean age range was 15-19 years). Such prevalence in increase in adolescents intention for self-harm might be attributed to the apprehension of economic recession in Ireland. Since, during the same period, we do not have any data, a direct comparison is not feasible. However, since Australia could beat economic recession during 2008-2009, it may be postulated that chances of adolescents engaging in self-harm increased during that period in Australia.
The incidence of drug overdose is prevalent across every country. Reports indicate that females are more prone to overdose than their male counterparts. To prevent drug overdose depression and anxiety must be managed in individuals, especially in the age range of 39 to 41 years in both the sexes. There should be restricted dispensing of mood elevators, antidepressants and anxiolytics, from the pharmacies. Chronic illness like pain should be adequately managed. Family conflicts and professional stress must be minimized, through various coping strategies. All such interventions would reduce the incidences of drug overdose, and help patients in achieving a quality of life.
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