Chan Agnes N, Gunja Naren, Ryan Christopher J
Consultation- Liaison Psychiatry, Royal Prince Alfred Hospital, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia.
J Med Toxicol. 2010 Jun;6(2):116-21. doi: 10.1007/s13181-010-0013-x.
To compare the clinical features of deliberate self-poisoning with venlafaxine and selective serotonin reuptake inhibitors (SSRIs) presenting to the emergency department of an Australian tertiary referral hospital. A retrospective cohort study comparing all 36 patients who presented with venlafaxine self-poisoning with 44 randomly selected patients with SSRI self-poisoning between 1997 and 2006. Patients who had overdosed on venlafaxine were older (mean age 37.4 versus 28.8 years, p ≤ 0.001) and generally exhibited a higher degree of suicidal intent (p ≤ 0.017). Median venlafaxine dose taken was 35 defined daily doses (DDDs) compared with SSRIs 19.4 DDDs. Those who ingested venlafaxine were more likely to become confused (25% versus 0%; p = 0) and have mydriasis (19.4% versus 2%; p ≤ 0.02), than those who took SSRIs. One patient from the venlafaxine group died. Compared with SSRI self-poisoners, patients who deliberately ingested venlafaxine were more likely to exhibit serious suicide intent. They were also more likely to be older, take a higher DDD of the drug, and have confusion and mydriasis. This has implications for management of severely depressed and suicidal patients.
比较在澳大利亚一家三级转诊医院急诊科就诊的文拉法辛和选择性5-羟色胺再摄取抑制剂（SSRI）蓄意自我中毒的临床特征。一项回顾性队列研究，比较了1997年至2006年间所有36例因文拉法辛自我中毒就诊的患者与44例随机选取的因SSRI自我中毒的患者。服用文拉法辛过量的患者年龄更大（平均年龄37.4岁对28.8岁，p≤0.001），且通常表现出更高程度的自杀意图（p≤0.017）。文拉法辛的中位服用剂量为35限定日剂量（DDD），而SSRI为19.4 DDD。与服用SSRI的患者相比，服用文拉法辛的患者更易出现意识模糊（25%对0%；p = 0）和瞳孔散大（19.4%对2%；p≤0.02）。文拉法辛组有1例患者死亡。与SSRI自我中毒者相比，蓄意服用文拉法辛的患者更易表现出严重的自杀意图。他们也更可能年龄较大、服用药物的DDD更高，且出现意识模糊和瞳孔散大。这对重度抑郁和有自杀倾向患者的管理具有启示意义。
