What are the Predictive Factors for the Treatment Outcomes in Multi Drug Poisoning Including Antidepressants/Antipsychotic Drugs?

Ghasemi, Mohadeseh; Yaraghi, Ahmad; Farajzadegan, Ziba; Sabzghabaee, Ali Mohammad; Eizadi-Mood, Nastaran

What are the Predictive Factors for the Treatment Outcomes in Multi Drug Poisoning Including Antidepressants/Antipsychotic Drugs?

Document Type : Original Article

Authors

¹ Department of Clinical Toxicology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

² Department of Anesthesiology, Isfahan Clinical Toxicology Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

³ Department of Social Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

⁴ Isfahan Clinical Toxicology Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

⁵ Department of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: There have been studies on the outcome of acute intoxication with antidepressants or antipsychotics. We performed outcome prediction analysis in acute poisoning patients with antidepressants/antipsychotics with or without combination with other drugs. Materials and Methods: A cross-sectional study was performed in Khorshid (PBUH) University Hospital affiliated with Isfahan University of Medical Sciences from March 2016 to May 2017. Patients with acute poisoning ingested antidepressants and antipsychotics with or without other drugs were included in the study. The outcome was categorized as survived without complications and complications/death. Binary regression analysis was performed for outcome prediction. Results: The data from 239 patients were analyzed. Most of the patients were female (68.2%), 5.9% of patients admitted to the Intensive Care Unit. About 94.99% of patients survived without complications. There was a significant difference between patients with and without complications with respect to the level of consciousness, hypotension, seizure, electrocardiography findings, pulse rate after 24 hours (h) of admission, and need to endotracheal intubation (P < 0.0001). Binary logistic regression analysis showed admission level of consciousness (stupor/coma) (odds ratio [OR] =8.07; P = 0,005), hypotension (OR = 12.16; P = 0.001), seizure (OR = 11.15; P = 0.009), tachycardia after 24 h of admission (OR = 22.50; P = 0.003), and need for endotracheal intubation (OR = 10.47; P = 0.002) were determinant factors in outcome prediction. Conclusions: Stupor/coma and hypotension were the predictive factors for outcome. Patients with seizure and tachycardia after 24 h of admission; and those intubated and received mechanical ventilation had a higher chance of complications.

Keywords

References

1.	Kaicker J, Bostwick J. Co-ingestion of tricyclic antidepressants with selective norepinephrine reuptake inhibitors: Overdose in the emergency department. Can Fam Physician 2016;62:485-9.
2.	Mowry JB, Spyker DA, Brooks DE, Zimmerman A, Schauben JL 2015 annual report of the American association of poison control centers' national poison data system (NPDS): 33^rd annual report. Clin Toxicol (Phila) 2016;54:924-1109.
3.	Spina E, de Leon J. Metabolic drug interactions with newer antipsychotics: A comparative review. Basic Clin Pharmacol Toxicol 2007;100:4-22.
4.	Christensen AP, Boegevig S, Christensen MB, Petersen KM, Dalhoff KP, Petersen TS, et al. Overdoses with aripiprazole: Signs, symptoms and outcome in 239 exposures reported to the Danish poison information centre. Basic Clin Pharmacol Toxicol 2018;122:293-8.
5.	Carvalho AF, Sharma MS, Brunoni AR, Vieta E, Fava GA. The safety, tolerability and risks associated with the use of newer generation antidepressant drugs: A Critical review of the literature. Psychother Psychosom 2016;85:270-88.
6.	Little K, Lin CM, Reynolds PM. Delayed serotonin syndrome in the setting of a mixed fluoxetine and serotonin antagonist overdose. Am J Case Rep 2018;19:604-7.
7.	Trenton A, Currier G, Zwemer F. Fatalities associated with therapeutic use and overdose of atypical antipsychotics. CNS Drugs 2003;17:307-24.
8.	Yaraghi A, Eizadi-Mood N, Katani M, Farsaei S, Hedaiaty M, Mirhosseini SM, et al. Arterial blood gas analysis and the outcome of treatment in tricyclic antidepressants poisoned patients with benzodiazepine coingestion. Anesthesiol Res Pract 2015;2015:232401.
9.	Eizadi-Mood N, Sabzghabaee AM, Saghaei M, Gheshlaghi F, Mohammad-Ebrahimi B. Benzodiazepines co-ingestion in reducing tricyclic antidepressant toxicity. Med Arh 2012;66:49-52.
10.	Liebelt EL. An update of antidepressant toxicity: An evaluation of unique toxicities to master. Clin Pediatr Emerg Med 2008;9:24-6.
11.	Borg L, Julkunen A, Rørbaek Madsen K, Strøm T, Toft P. Antidepressant or antipsychotic overdose in the Intensive Care Unit – Identification of patients at risk. Basic Clin Pharmacol Toxicol 2016;119:110-4.
12.	Menchetti M, Gozzi BF, Saracino MA, Mercolini L, Petio C, Raggi MA, et al. Non-fatal overdose of duloxetine in combination with other antidepressants and benzodiazepines. World J Biol Psychiatry 2009;10:385-9.
13.	Salvo F, Pariente A, Shakir S, Robinson P, Arnaud M, Thomas S, et al. Sudden cardiac and sudden unexpected death related to antipsychotics: A meta-analysis of observational studies. Clin Pharmacol Ther 2016;99:306-14.
14.	Nelson JC, Spyker DA. Morbidity and mortality associated with medications used in the treatment of depression: An analysis of cases reported to U.S. poison control centers, 2000-2014. Am J Psychiatry 2017;174:438-50.
15.	Vijayakumar L. Suicide in women. Indian J Psychiatry 2015;57:S233-8. [PUBMED] [Full text]
16.	Rijcken CA, Knegtering H, Bruggeman R, Tobi H, de Jong-van den Berg LT. Sex differences in concomitant medication with benzodiazepines or antidepressants in first-break schizophrenic patients treated with antipsychotic medication. Psychiatry Res 2005;134:143-50.
17.	Tsirigotis K, Gruszczynski W, Tsirigotis M. Gender differentiation in methods of suicide attempts. Med Sci Monit 2011;17:65-70.
18.	Petrushevska T, Jakovski Z, Poposka V, Stefanovska VV. Drug-related deaths between 2002 and 2013 with accent to methadone and benzodiazepines. J Forensic Leg Med 2015;31:12-8.
19.	Tiihonen J, Suokas JT, Suvisaari JM, Haukka J, Korhonen P. Polypharmacy with antipsychotics, antidepressants, or benzodiazepines and mortality in schizophrenia. Arch Gen Psychiatry 2012;69:476-83.
20.	Toft S, Horwitz H, Dalhoff KP. Long-term mortality after poisoning with antipsychotics. Clin Toxicol (Phila) 2017;55:267-74.
21.	Ngo A, Ciranni M, Olson KR. Acute quetiapine overdose in adults: A 5-year retrospective case series. Ann Emerg Med 2008;52:541-7.
22.	Anderson J, Mitchell PB, Brodaty H. Suicidality: Prevention, detection and intervention. Aust Prescr 2017;40:162-6.
23.	Mino A, Bousquet A, Broers B. Substance abuse and drug-related death, suicidal ideation, and suicide: A review. Crisis 1999;20:28-35.
24.	Zemrak WR, Kenna GA. Association of antipsychotic and antidepressant drugs with Q-T interval prolongation. Am J Health Syst Pharm 2008;65:1029-38.
25.	Haddad PM, Dursun SM. Neurological complications of psychiatric drugs: Clinical features and management. Hum Psychopharmacol 2008;23 Suppl 1:15-26.
26.	Eizadi-Mood N, Aboofazeli E, Hajhashemi V, Gheshlaghi F, Badri S, Sabzghabaee AM, et al. Effect of intravenous midazolam on cardiac parameters in acute tricyclic antidepressants poisoning. ARYA Atheroscler 2016;12:195-200.

Advanced Biomedical Research