Dernbach Matthew Robert, Seery Erin, Rasimas J J, Connery Hilary S
Department of Emergency Medicine, Emory University, Atlanta, GA, USA.
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
Clin Toxicol (Phila). 2025 Feb;63(2):75-82. doi: 10.1080/15563650.2024.2447490. Epub 2025 Jan 27.
Overdose is frequently categorized dichotomously: an inadvertent therapeutic or recreational misadventure versus a deliberate overdose for self-injurious or suicidal purposes. Categorizing overdoses based on this dichotomy of intention is fraught with methodological problems and may result in potentially inappropriate and/or divergent care pathways.
OVERDOSE-RELATED INTENT LIES ALONG A CONTINUUM: Suicidality can rapidly shift in magnitude and frequency at different points in time. A patient's overdose may reflect varying degrees of desire to die, ambivalence about living, disregard for risk, or pleasure-seeking. Careful assessment of overdose-related cognitions is warranted in all overdose patients.
There is an irreducibly subjective character to an overdose such that a collaborative understanding of an overdose episode can only be discovered by spending time in dialogue with the patient. At the same time, the objective risk factors for and circumstances of the overdose need to be integrated with the subjective experience for a comprehensive prevention approach.
Some overdoses might be wholly inadvertent or simply impulsive. However, if there is some degree of intent present, then the patient who overdosed has attempted to communicate something by means of that overdose, and this message might include something other than the desire to die.
Overdose-related intent and motivation may be targeted with treatment plans to reduce elevated risk states. Some patient-specific overdose risk factors are modifiable, such as managing mental health and other psychosocial issues, reducing access to lethal means, and promoting safe prescribing and medication administration practices. Other risk factors are either unmodifiable (e.g., personal history of overdose) or involve public health systems.
Overdose-whether involving medications, illicit substances, hazardous chemicals, or otherwise-can be conceptualized as a single behavioral episode with variable intentionality, personal motivations, and risk factors. Clinical/medical toxicologists are uniquely positioned to contribute to personalized risk reduction post-overdose.
过量用药通常被二分法分类：无意的治疗或娱乐性意外与出于自我伤害或自杀目的的故意过量用药。基于这种意图二分法对过量用药进行分类存在诸多方法学问题，可能导致潜在不适当和/或不同的护理途径。
自杀倾向在不同时间点的严重程度和频率可能会迅速变化。患者的过量用药可能反映出不同程度的求死欲望、对生存的矛盾心理、对风险的漠视或寻求快感。对所有过量用药患者进行与过量用药相关认知的仔细评估是必要的。
过量用药具有不可简化的主观性，以至于只有通过与患者进行对话才能共同理解过量用药事件。同时，过量用药的客观风险因素和情况需要与主观体验相结合，以形成全面的预防方法。
一些过量用药可能完全是无意的或仅仅是冲动的。然而，如果存在某种程度的意图，那么过量用药的患者试图通过该过量用药传达某些信息，而这个信息可能包括求死欲望之外的其他内容。
与过量用药相关的意图和动机可以通过治疗计划来针对，以降低升高的风险状态。一些特定于患者的过量用药风险因素是可改变的，例如管理心理健康和其他心理社会问题、减少获取致命手段的机会以及促进安全处方和药物管理实践。其他风险因素要么是不可改变的（例如，过量用药的个人史），要么涉及公共卫生系统。
过量用药——无论是涉及药物、非法物质、有害化学品还是其他——都可以被概念化为一个具有可变意图、个人动机和风险因素的单一行为事件。临床/医学毒理学家在过量用药后降低个性化风险方面具有独特的地位。
