Erkalp K*, Ozdemir H, Abut Y, Süren M and Saidoglu L
Department of Anesthesia and Reanimation, Vakif Gureba Hospital, Istanbul, Turkey
Received date: January 16, 2013; Accepted date: February 26, 2013; Published date: March 02, 2013
Citation: Erkalp K, Ozdemir H, Abut Y, Süren M, Saidoglu L (2013) Suicide Attempt after Deliberate Self-Poisoning in the ICU. J Anesth Clin Res 4:284. doi: 10.4172/2155-6148.1000284
Copyright: © 2013 Erkalp K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Delibrate self poisoning (DSP) is a major health problem with significant morbidity and survivors of DSP will remain at high risk of dying especially suicide in the future . After DSP, hospitalized parasuicidal patients may still want to kill themselves in the intensive care unit (ICU). Identification and assessment of suicide risk is important for an intensive care specialist for preventing repeated attemps in the ICU. We report a 19-year-old man who was interned to the ICU after DSP with an organophosphate (OP). The socio-cultural and economic level of the patient’s family was very low. He attempted suicide by poisoning himself due to recurrent unipolar major depression. He was under a medical treatment including selective serotonin reuptake inhibitors (SSRIs).
The patient was admitted to the ICU after gastric lavage, active charcoal administration and providing haemodynamic stability. He was treated with a bolus-2 mg intravenous (IV) and continuous injection (1 mg IV, repeated every 30 min as needed until symptoms dissipate) of atropine and symptomatic therapy. The first day passed uneventfully. No hemodynamic instability and no motoric/psyhic agitation. On the second day while stuff was dealing with an arrested patient, a nurse noticed that he was trying to strangle himself with the noninvasive blood pressure cable. The patient could be stopped by sedation with IV haloperidol 2 mg and midazolam 5 mg and tied to his bed. After gaining his consciousness a phyciatry concultation was done and revealed no suicide ideas but a depressed mode. After his treatment was completed in the ICU, the patient was transferred to the psyciatry ward.
Catatonia, stupor, central serotonine syndrome, malignant neuroleptic syndrome, suicide risk, delirium and agitation are psychiatric emergencies in the ICU . Although we have seen patients who wanted their life support to be withdrawn, this is the first suicide attempt in our ICU. Since the propensity of suicide is high in depressive patients, a suicide attempt by other means may occur even in an ICU. ICU specialists do not usually have enough psychiatric experience to assess risk factors (drug or alcohol abuse, past history of suicides in the family, or psychiatric disorders) and management of acute suicidal crisis. Close surveillance of DSP patients secure their surroundings obtaining past history of psychiatric illnes substance abuse or suicidality will assure safety and save lives . Atropine is an antimuscarinic agent of choice for treatment of OP. The suicide attempt of our patient may be due to atropinisation that is used in treatment of OP.
Suicidal behaviors do not usually occur in the very early stages of depression but as a significant part of depressive patients, he was stoped their medication during the first four weeks of the treatment . Parasuicidal patients were found with current antidepressants therapy and presented with self-poisoning using their antidepressant therapy or other medications. Parasuicidal risks for selective serotonin reuptake inhibitors were significantly lower than those of tricyclic antidepressants, therefore in suicide prevention, risks and benefits of an antidepressant should be taken into account when choosing treatment for depressive patients .
It is extremely important to take into consideration the risk factors in an acute suicidal crisis. The most important point for our intensivists is to prevent suicidal attempts, especially in the ICU. National Institute of Clinical Excellence (NICE) guidelines and the Royal College of Psychiatrists suggest that an immediate suicide risk assessment should be made on the patient's arrival in the department. Then, these patient should be offered a full mental health and social needs assessment by a mental health professional after their supportive therapy in the ICU. Experienced mental health professionals have an important role not only in education, but also in the continuing development of services and supervision of others .
In this case, we can learn the necessity of an immediate psychiatric consultation in the ICU. Joint working between emergency medicine, ICU specialist and psychiatry is indicated . After this case, we started consulting psychiatrists immediately in parasuicidal patients and suggest this to all colleagues.