Department of Psychology, University of Oslo, Oslo, Norway.
J Clin Psychiatry. 2012 Apr;73(4):e548-54. doi: 10.4088/JCP.11m07209.
The availability of prescribed medication to patients who engage in deliberate self-poisoning (DSP) is not known, and it is not clear whether patients choose drugs prescribed to them for self-poisoning. The objectives of this study were to investigate (1) prescribed medication availability in DSP patients compared to the general population, (2) whether patients use their prescribed medication in their DSP episodes, (3) differences between patients who ingest prescribed medication and those who do not, and (4) the time between the last collection of prescribed medication used for DSP and the DSP episodes.
The design was longitudinal. We included 171 patients admitted for DSP to 3 hospitals in Eastern Norway between January 2006 and March 2007. Data on patients' prescriptions prior to admission were retrieved from the Norwegian Prescription Database (22.5 months of observation time). The primary outcome measure was type and amount of drugs ingested in the DSP episode.
DSP patients had a much greater prescribed medication load compared to the general population, with a mean of 30 prescriptions collected in the year prior to DSP. In total, 77.2% of patients ingested drugs that they had collected, whereas 25% of patients used drugs collected the week prior to admission. The tendency to ingest collected drugs increased with age (OR = 1.1, 95% CI = 1.01 to 1.11, P = .01). Patients who collected sedatives were more likely to use these for self-poisoning than patients who collected antidepressants.
The much greater medication load of DSP patients is particularly important given their tendency to ingest their prescribed medication in self-poisoning episodes. The study indicates that timing of collection of medication prior to an episode is less important than general medication load. More attention should be directed to the total medication load for individuals at risk of self-harm.
目前尚不清楚接受蓄意自我中毒（DSP）治疗的患者是否能获得处方药物，也不清楚患者是否选择服用为其开出的用于自我中毒的药物。本研究旨在：（1）调查 DSP 患者的处方药物可获得性与普通人群的差异；（2）患者在 DSP 发作期间是否使用他们的处方药物；（3）服用处方药物与未服用处方药物的患者之间的差异；（4）最后一次收集用于 DSP 的处方药物与 DSP 发作之间的时间间隔。
本研究设计为前瞻性队列研究。我们纳入了 2006 年 1 月至 2007 年 3 月期间在挪威东部 3 家医院接受 DSP 治疗的 171 名患者。入院前患者的处方数据来自挪威处方数据库（观察时间为 22.5 个月）。主要结局指标为 DSP 发作期间摄入的药物类型和数量。
与普通人群相比，DSP 患者的处方药物负荷明显更高，在 DSP 发作前一年共收集了 30 张处方。总共有 77.2%的患者摄入了他们收集的药物，而 25%的患者使用了入院前一周收集的药物。摄入收集药物的倾向随着年龄的增长而增加（OR=1.1，95%CI=1.01-1.11，P=0.01）。与收集抗抑郁药的患者相比，收集镇静剂的患者更有可能将这些药物用于自我中毒。
DSP 患者的药物负荷明显更高，这一点尤其重要，因为他们在自我中毒发作期间更倾向于摄入他们的处方药物。该研究表明，在发作前收集药物的时间与一般药物负荷相比不太重要。对于有自我伤害风险的个体，应更加关注其总体药物负荷。
