Improving house physicians' assessments of self-poisoning

Article Abstract:

Every year in the United Kingdom alone, about 100,000 people take overdoses of drugs, in many cases intentionally. The assessment of these patients presents a problem, insofar as hospital physicians may not be trained in the assessment of attempted suicide and, consequently, may not competently manage cases of drug overdose. The suggestion of the Department of Health in the UK that all such cases be reviewed by a psychiatrist prior to discharging the patient is fraught with unnecessary expenditures of resources, and is not really a viable alternative. At the same time, it is impractical to demand that all hospital-based physicians receive training in caring for cases of attempted suicide. A short, easy-to-use questionnaire has been developed to help house physicians to evaluate the status of the overdose patient. The questionnaire is intended to analyze such issues as severity of depression, purpose of the self-poisoning act, suicidal intent, whether the overdose was premeditated, diagnosis of mental disorder, risk of a repeat attempt, and future management. To evaluate the effectiveness of the questionnaire, a study of 24 house physicians was conducted. Half the group was given the questionnaire to use, while the other half asked the patients whatever questions they deemed necessary. A research assistant then blindly assessed the same 150 patients. Results were statistically analyzed. More agreement was found between the researcher and the questionnaire group in a number of areas, especially in regard to ascertaining the purpose of the act, suicidal intent, diagnosis, and further management. The most important finding was agreement between those using the questionnaire and the researcher concerning future management. This short questionnaire appears to be a useful tool for the accurate assessment of overdose patients by hospital staff who are not thoroughly trained in evaluating such cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Risk factors, Suicide, Surveys, Self-poisoning, Self poisoning

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Prescription-event monitoring of 10895 patients treated with alprazolam

Article Abstract:

Benzodiazepine drugs provide antianxiety and muscle-relaxant effects. Alprazolam (a triazolobenzodiazepine) has been shown to provide additional antidepressant effects. In Great Britain, prescription-event monitoring (PEM) is one of two national systems of drug safety monitoring. Through PEM, all patients treated with alprazolam for several months or more, along with their doctors, were identified. Of those patients, 10,895 were followed-up for an average of 8.3 months after treatment ended to evaluate the drug's effects. The doctors were asked to record any event (e.g., new problem or diagnosis), suspected drug reaction, or illness which occurred during or after treatment. Of the 10,895 patients, almost 75 percent were women. Most (70.8 percent) took alprazolam for anxiety. Others were given the drug for depression (16.4 percent), and various other problems. During treatment the most common effects reported were drowsiness and depression. Drowsiness was found to be almost non-existent after treatment. Depression showed a slight increase after treatment, which was more likely due to the disorder being treated than to the drug. Although previous reports have linked mania and hostility with alprazolam treatment, only three patients became manic during treatment, and aggression was observed in only nine patients (two post-treatment). Sexual dysfunctions were found in two patients during treatment and in three patients after treatment. Overall results indicate a lack of significant negative side-effects during or after treatment with alprazolam. Addictive properties of alprazolam were not examined in this study and still need to be investigated. (Consumer Summary produced by Reliance Medical Information, Inc.)

United Kingdom, Research, Usage, Social policy, Great Britain, Alprazolam

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Chronic benzodiazepine dependence: a comparative study of abrupt withdrawal under propranolol cover versus gradual withdrawal

Article Abstract:

Soon after they were developed, it was claimed that benzodiazepines, a class of drugs used to treat anxiety, had little potential to cause dependence. Later it was found that the potential is in reality between 15 percent and 44 percent in long-term users. Stopping treatment elicits symptoms of withdrawal. Prescription guidelines have thus changed. Slow withdrawal is recommended by most, but in practice it may be slow, abrupt ('cold turkey'), or aided by other medication. It is possible that too long a weaning-off process may lead to lower success rates because people get frustrated with the unpleasant feelings experienced during the withdrawal. To help further identify the characteristics of withdrawal and the best course to use to initiate it, a study of 34 outpatients was conducted. Subjects were rated initially for symptoms of depression and anxiety, severity of specific symptoms, severity of illness, other substances used; pulse rate and blood pressure were measured to reflect any physiological changes. Ratings were repeated after six months. The patients were administered either a placebo or propranolol. Of the 31 patients completing the study, it was found that a slow withdrawal over 10 weeks was most successful and led only to mild symptoms. Abrupt withdrawal, even with the use of alternate medication such as propranolol, yielded a lower success rate and more severe symptoms. Symptoms included anxiety, which often led patients to discontinue withdrawal. Symptoms were absent for both groups after successful withdrawal. Implications are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Complications and side effects, Physiological aspects, Propranolol hydrochloride, Propranolol, Drug withdrawal symptoms, Substance withdrawal syndrome

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