M. Aylin ARICI, Aynur ŞAHİN, Neşe Çolak ORAY, Başak BAYRAM, Yeşim TUNÇOK

Antipsychotic Exposures in an Emergency Department

Purpose: We analyzed the antipsychotic medication exposures’ distribution in typical and atypical antipsychotic exposures and severity of the clinical signs and symptoms admitted to the Department of Emergency Medicine at Dokuz Eylul University EMDEU between 1993 and 2015.Methods: Demographics of patients, type of exposure, distribution according to the reason, the amount of the exposed antipsychotics, clinical findings, the length of hospital stay, and the outcome of the patients in typical and atypical antipsychotic exposures were analyzed.Results: Among all of the adult poisonings in EMDEU, 2.6% of them were due to exposure to antipsychotic medication. Most of the antipsychotic exposures were intentional 95.5% . Most antipsychotics exposed were atypical antipsychotics 77.3% . Frequently exposed atypical and typical antipsychotics were quetiapine 52.9% and chlorpromazine 26.7% , respectively. 46.7% of typical antipsychotics and 35.3% of atypical antipsychotics were in toxic doses. Tachycardia 39.4% was the most common symptom in typical 40.0% and atypical 39.2% antipsychotic exposures. Atypical antipsychotic exposure did not cause fewer clinical findings than that of typical antipsychotics. Gastric decontamination was applied to 56.1% of the patients. All of the patients exposed to antipsychotics recovered.Conclusion: Because of the widespread use of atypical antipsychotics, we observed atypical antipsychotic exposures more than typical antipsychotic exposures. Although mild and moderate clinical findings are common in both typical and atypical antipsychotic exposures, serious clinical findings can be observed in all intoxications. Therefore, all patients poisoned with typical or atypical antipsychotic toxic doses should be closely monitored in the emergency department

Keywords:

Antipsychotic, atypical, typical, poisoning, clinical finding,

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Khasawneh FT, Shankar GS. Minimizing cardiovascular adverse ef- fects of atypical antipsychotic drugs in patients with schizophrenia. Cardiol Res Pract 2014:1-8.
Levine M, Ruha AM. Overdose of atypical antipsychotics: clinical presentation, mechanisms of toxicity and management. CNS Drugs 2012; 26:601-611. [CrossRef]
Geddes J, Freemantle N, Harrison P, Bebbington P. Atypical antipsy- chotics in the treatment of schizophrenia: systematic overview and meta-regression analysis. BMJ 2000; 321:1371-1376. [CrossRef]
Samara MT, Cao H, Helfer B, Davis JM, Leucht S. Chlorpromazine versus every other antipsychotic for schizophrenia: a systematic review and meta-analysis challenging the dogma of equal effi- cacy of antipsychotic drugs. Eur Neuropsychopharmacol 2014; 24:1046-1055. [CrossRef]
Dold M, Samara MT, Li C, Tardy M, Leucht S. Haloperidol versus first-generation antipsychotics for the treatment of schizophrenia and other psychotic disorders. Cochrane Database Syst Rev 2015; 1:CD009831.
Divac N, Prostran M, Jakovcevski I, Cerovac N. Second-generation antipsychotics and extrapyramidal adverse effects. Biomed Res Int 2014:1-6.
Ciranni MA, Kearney TE, Olson KR. Comparing acute toxicity of first- and second-generation antipsychotic drugs: a 10-year, retrospec- tive cohort study. J Clin Psychiatry 2009; 70:122-129. [CrossRef]
Trenton A, Currier G, Zwemer F. Fatalities associated with therapeu- tic use and overdose of atypical antipsychotics. CNS Drugs 2003; 17:307-324. [CrossRef]
Casey PB, Dexter E, Michell J, Vale JA. The prospective value of the IPCS/EC/EAPCCT poisoning severity score in cases of poisoning. J Toxicol Clin Toxicol 1998; 36:215-217. [CrossRef]
Khudair IF, Jassim Z, Hanssens Y, Alsaad WA. Characteristics and determinants of adult patients with acute poisoning attending the accident and emergency department of a teaching hospital in Qa- tar. Hum Exp Toxicol 2013; 32:921-929. [CrossRef]
Tüfekçi IB, Curgunlu A, Sirin F. Characteristics of acute adult poison- ing cases admitted to a university hospital in Istanbul. Hum Exp Tox- icol 2004; 23:347-351. [CrossRef]
Lee HL, Lin HJ, Yeh SY, Chi CH, Guo HR. Etiology and outcome of patients presenting for poisoning to the emergency department in Taiwan: a prospective study. Hum Exp Toxicol 2008; 27:373-379. [CrossRef]
Afshari R, Majdzadeh R, Balali-Mood M. Pattern of acute poison- ings in Mashhad, Iran 1993-2000. J Toxicol Clin Toxicol 2004; 42:965- 975. [CrossRef]
Maignan M, Richard A, Debaty G, et al. Intentional Drug Poisoning Care in a Physician-manned Emergency Medical Service. Prehosp Emerg Care 2015; 19:224-231. [CrossRef]
Bakhaidar M, Jan S, Farahat F, Attar A, Alsaywid B, Abuznadah W. Pattern of drug overdose and chemical poisoning among patients attending an emergency department, Western Saudi Arabia. J Community Health 2015; 40:57-61. [CrossRef]
Tsirigotis K, Gruszczynski W, Tsirigotis M. Gender differentiation in methods of suicide attempts. Med Sci Monit 2011; 17:65-70. [CrossRef]
Oray NC, Hocaoglu N, Oray D, Demir O, Atilla R, Tuncok Y. Seda- tive-hypnotic medication exposures and poisonings in Izmir,Turkey. Basic Clin Pharmacol Toxicol 2008; 103:380-385. [CrossRef]
Yıldıztepe E, Hocaoğlu Aksay N, et al. Analysis of 2007 Data from Dokuz Eylul University Drug and Poison Information Center, Turkey. Turkish J of Med Sci 2010; 30:1622-1630.
Akbaba M, Nazlican E, Demirhindi H, Sütoluk Z, Gokel Y. Etiological and demographical characteristics of acute adult poisoning in Ad- ana, Turkey. Hum Exp Toxicol 2007; 26:401-406. [CrossRef]
Hocaoglu N, Kalkan S, Akgun A, Capar S, Tuncok Y. A retrospective evaluation of analgesic exposures from Izmir, Turkey. Hum Exp Toxi- col 2007; 26:629-636. [CrossRef]
Kalkan S, Hocaoglu N, Oransay K, Unverir P, Tuncok Y. Cardiovascu- lar medication exposures and poisonings in Izmir, Turkey: a 14-year experience. Hum Exp Toxicol 2011; 30:347-353. [CrossRef]
Minns AB, Clark RF. Toxicology and overdose of atypical antipsy- chotics. J Emerg Med 2012; 43:906-913. [CrossRef]
Bushe CJ, Taylor M, Haukka J. Mortality in schizophrenia: a measur- able clinical endpoint. J Psychopharmacol 2010; 4:17-25. [CrossRef]
Bateman DN, Good AM, Afshari R, Kelly CA. Effects of licence change on prescribing and poisons enquiries for antipsychotic agents in England and Scotland. Br J Clin Pharmacol 2003; 55:596- 603. [CrossRef]
Magdalan J, Wasyko-Smolarek M, Antończyk A, Kochman K, Prze- włocki M, Porebska B. Intoxications with atypical antipsychotic drugs--data of the Acute Intoxication Unit in Wrocław. Przegl Lek 2004; 61:392-396.
Stargardt T, Edel MA, Ebert A, Busse R, Juckel G, Gericke CA. Effec- tiveness and cost of atypical versus typical antipsychotic treatment in a nationwide cohort of patients with schizophrenia in Germany. J Clin Psychopharmacol 2012; 32:602-607. [CrossRef]
Machado-Alba JE, Morales-Plaza CD. Antipsychotic prescription patterns in patients affiliated to the Social Security Health System in Colombia. Biomedica 2013; 33:418-428.
Ngo A, Ciranni M, Olson KR. Acute quetiapine overdose in adults: a 5-year retrospective case series. Ann Emerg Med 2008; 52:541-547. [CrossRef]
Lind CC, Carchedi CL, Staudenmeier LJ, Diebold LP. Atypical pre- sentations of atypical antipsychotics. Psychiatry (Edgmont) 2005; 2:32-39.
Erermis S, Bildik T, Tamar M, Gockay A, Karasoy H, Ercan ES. Zuclo- penthixol-induced neuroleptic malignant syndrome in an adoles- cent girl. Clin Toxicol (Phila) 2007; 45:277-280. [CrossRef]
Thompson TM, Theobald J, Lu J, Erickson TB. The general approach to the poisoned patient. Dis Mon 2014; 60:509-524. [CrossRef]
Bartos M, Knudsen K. Use of intravenous lipid emulsion in the re- suscitation of a patient with cardiovascular collapse after a se- vere overdose of quetiapine. Clin Toxicol (Phila) 2013; 51:501-504. [CrossRef]
Greene S, Harris C, Singer J. Gastrointestinal decontami- nation of the poisoned patient. Pediatr Emerg Care 2008; 24:176-186.[CrossRef]

Journal of Basic and Clinical Health Sciences-Cover

Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2016
Yayıncı: DOKUZ EYLÜL ÜNİVERSİTESİ

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