Baca-García Enrique, Diaz-Sastre Carmen, Saiz-Ruiz Jeronimo, de Leon Jose
Department of Psychiatry, Hospital Ramon y Cajal, University of Alcala, Madrid, Spain.
Eur Psychiatry. 2002 Dec;17(8):466-70. doi: 10.1016/s0924-9338(02)00706-x.
This study assessed psychiatric medications and their potential lethality in a representative sample of suicide attempts.
During 1996-98, 563 suicide attempts were studied in a general hospital in Madrid (Spain). Medication overdose was used in 456 suicide attempts (81%). The ratio between dose taken and maximum prescription dose recommended was used to evaluate the medication toxicity.
Benzodiazepines were the drugs most often used in self-poisoning (65% of overdoses), followed by new antidepressants (11%), tricyclic antidepressants (TCAs) (10%), and antipsychotics (8%). An overdose with any of the three latter psychiatric medications was significantly more frequent in patients prescribed those medications. The overdoses for TCA were potentially lethal in 47% of the cases. However, all patients who overdosed on psychiatric medications recovered well and were discharged without any sequelae.
This study suggests that psychiatric medications, particularly benzodiazepines, new antidepressants and antipsychotics, are relatively safe when they are used for self-poisoning. If patients with mental illnesses are under treated, there is a clear and documented higher risk for suicide.
It is better to prescribe psychiatric medications, particularly the new ones, rather than withhold them due to an exaggerated fear of a lethal overdose
本研究评估了自杀未遂代表性样本中使用的精神科药物及其潜在致死性。
1996年至1998年期间，在西班牙马德里的一家综合医院对563例自杀未遂案例进行了研究。456例（81%）自杀未遂案例采用了药物过量服用的方式。服用剂量与推荐的最大处方剂量之比用于评估药物毒性。
苯二氮䓬类药物是最常用于自我中毒的药物（65%的过量服用案例），其次是新型抗抑郁药（11%）、三环类抗抑郁药（10%）和抗精神病药物（8%）。服用后三种精神科药物中任何一种过量服用的情况在开具了这些药物处方的患者中显著更常见。三环类抗抑郁药过量服用案例中47%具有潜在致死性。然而，所有服用精神科药物过量的患者恢复良好，出院时无任何后遗症。
本研究表明，精神科药物，尤其是苯二氮䓬类药物、新型抗抑郁药和抗精神病药物，用于自我中毒时相对安全。如果精神疾病患者治疗不足，自杀风险明显更高且有记录可查。
最好开具精神科药物，尤其是新型药物，而不是因过度担心致命过量服用而不开药。
