Exposure to psychotropic medications prior to overdose: a case-control study

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• 作者：Yasuyuki Okumura ; Hisateru Tachimori ; Toshihiko Matsumoto…
• 关键词：Drug poisoning ; Acute poisoning ; Drug dependence ; Deliberate self ; harm ; Parasuicide ; Suicide ; Benzodiazepines ; Psychotropic medications
• 刊名：Psychopharmacology
• 出版年：2015
• 出版时间：August 2015
• 年：2015
• 卷：232
• 期：16
• 页码：3101-3109
• 全文大小：202 KB
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• 作者单位：Yasuyuki Okumura (1)
  Hisateru Tachimori (2)
  Toshihiko Matsumoto (3)
  Daisuke Nishi (2)
  
  1. Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
  2. Department of Mental Health Administration, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
  3. Department of Drug Dependence Research/Center for Suicide Prevention, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
  
• 刊物类别：Biomedical and Life Sciences
• 刊物主题：Biomedicine
  Pharmacology and Toxicology
  Psychiatry
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-2072

文摘

Rationale Little is known about psychotropic medication prescriptions prior to drug overdose. Objectives We aimed to examine the possible associations between the risk of overdose and exposures to various psychotropic medications. Methods We conducted a matched case-control study of 3 groups of patients aged 12-4?years, using a large-scale health insurance claims database in Japan (population 1.2 million). A total of 351 cases with drug poisoning were compared with two control groups without overdose: 1755 patients with any treatment (general controls) and those with depression (high-risk controls). Current, past, and nonusers were patients most recently exposed to psychotropic medications ?0?days, 91-80?days, and ?80?days before the index date. Results Current sedative-hypnotic use was associated with an increased odds of overdose relative to general control nonusers (odds ratio [OR], 21.5; 95?% confidence interval [CI], 9.7-7.8) and high-risk control nonusers (OR, 2.6; 95?% CI, 1.9-.5). In the comparison of cases and high-risk controls, the ORs for overdose were higher among excessive dosage users than among usual dosage users (OR, 4.3; 95?% CI, 3.0-.1), among barbiturate users than among benzodiazepine/Z-drug only users (OR, 4.5; 95?% CI, 2.3-.7), and among multiple provider episodes than among single provider episodes (OR, 4.4; 95?% CI, 1.7-1.0). Psychiatrists prescribed more than 77?% of potentially questionable prescriptions. Conclusions These results highlight the need for psychiatrists to monitor prescribed medications and balance the benefits and risks of pharmacological treatments.