الفهرس 
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Abstract
Suicide is a global public health problem, yet it is still under-reported in Egypt due to religious and social factors. Among the most popular methods of suicide, deliberate self-poisoning (DSP). The method of deliberate self-poisoning depends on the cultural and social variables of each area, as well as the toxicants and drugs available. Psychoactive drugs and prescription pain relievers are the most widely used drugs in poison-related suicides, followed by the use of pesticides which occur mainly in rural agricultural areas in low- and middle-income countries.
The present study was carried out to evaluate the pattern of the deliberate self-poisoning cases admitted to Alexandria poison center (APC).
The study was carried out on 201 patients admitted to APC with deliberate self-poisoning during a six -month period starting from 1st of January to 30th of June 2020. Informed consent was obtained from all patients or their guardians. All included patients were interviewed and assessed according to biosocial data, poisoning data, previous suicidal attempts, history of psychiatric diseases, medications, full clinical examination, management, and outcome. The data were recorded in a specially designed sheet.
The study showed the following results:
The age of patients ranged from 10 to 60 years with a mean of 24.75 ± 9.25 years, the age group of 20 to 30 years was the most common (41.3%). Females outnumbered males (73.6% and 26.4%) respectively.
Regarding residence of the admitted cases, patients form urban regions (64.2%) were more than those coming from rural areas. In addition, the greatest percentage of the studied cases completed their basic education (64.2%).
More than half of the cases were single (55.7%), and no significant difference was noted between sex and the marital status.
Nearly half of the cases (48.3%) were unemployed. Significant relation was noticed between sex of the patients and occupation. the greatest percentage of males were employed, in the contrary the greatest number of females were unemployed.
The majority of the cases (81.1%) did not have any history of organic diseases, moreover more than two thirds of cases (72.6%) did not take any medications.
Small percentage of admitted cases gave history of psychiatric diseases (13.9%), with major depression was the most common (11.4%), followed by personality disorder (2.5%). In addition, most of the cases (84.6%) did not have any previous suicidal attempts.
A significant relation was noted between previous suicidal attempts and psychiatric diseases, as well as the use of medications.
Regarding substances used in self-poisoning, CNS depressant drugs and rodenticides constitute the highest percentage of poisoning (26.4% and 24.9% respectively). Analgesics also represent a considerable percentage of poisoning (16.4%), followed by cardiovascular drugs (12.9%). In addition, a significant number of cases (18.4%) reported the use of diuretics, antidiarrheals, laxatives, muscle relaxants, antihistaminics, antispasmodics, steroids, cough suppressants, fungicides, PPD, air injection and corrosives. Organophophates and aluminum phosphide represented 11.4% of all cases.
A statistically significant difference between males and females regarding the use of rodenticides, CVS drugs and pesticides as a method of attempting suicide.
A statistically significant relation was noted between the use of rodenticides and pesticides in deliberate self-poisoning and educational level. A statistically significant difference was revealed in the use of CNS depressants, rodenticides and pesticides among patients from rural and urban regions.
More than two thirds of the admitted cases took a toxic dose of the substance used in self-poisoning. A significant relation was noted between the dose of substance used and previous suicidal attempts.
Time elapsed between the intake of the poisonous substance and presenting to APC ranged from 1 to 24 hours with mean 5.28 ± 4.28 hours, with more than half of the cases (63.7%) of the cases presented to APC within 6 hours of time of exposure. As regard time of admission, about half of the cases (50.2%) were admitted during the night shift.
The presenting complaints of the suicidal patients were most commonly gastrointestinal manifestations, followed by CNS symptoms. Glasgow Coma Scale (GCS) for the cases ranged from 9 to 15 with mean 14.77 ± 0.99.
Regarding the treatment of admitted patients, only (2%) of cases required Endotracheal intubation, 2.5% of cases needed Noradrenaline. Gastric lavage was done for (21.9%) of the cases, nearly three quarters of the cases (74.6%) received activated charcoal, and more than quarter (25.4%) of the cases were given paraffin oil. 15.9% of the admitted cases required antidotal therapy, almost all cases (99.5%) received proton pump inhibitors.
Duration of hospital stay was one day or more in more than three quarters of the cases (79.1%), while the rest (20.9%) stayed for less than one day.
Linehan Risk Assessment and Management Protocol (LRAMP):
Regarding acute suicide risk factors, about three quarters of the admitted cases said that they had recent stressful life events. In addition, a considerable number of cases attempting suicide had access to lethal means and current severe hopelessness or pessimism (45.8% and 48.3% respectively). Nearly equal distribution of cases who believe that they have diminished concentration or impaired decision making and those who did not believe. Moreover, a considerable number of cases admitted to APC with deliberate self-poisoning had perceived burdensomeness to others, and had severe loss of interest or pleasure (anhedonia).
A statistically significant difference was noted between patients with and without previous suicidal attempts regarding most of the suicide risk factors, including current suicidal intent, access to lethal means, perceived burdensomeness to others, current severe hopelessness or pessimism, diminished concentration and impaired decision making, severe loss of interest or pleasure (anhedonia), and recent discharge from psychiatric hospital.
In the youth population of the admitted patients More than two thirds of the cases deny their exposure to recent suicide in media or community.
Regarding suicide protective factors, the highest percentage of the cases who attempted suicide (86.1%) were not attached to therapist, followed by 77.1% of admitted cases did not attend religious services frequently. Yet, a considerable number of cases believe that suicide is immoral and had hope for the future. A high percentage of the admitted cases (62.2%) said they did not have responsibility to children, family, or others, in addition more than half the cases (55.7%) did not have fear of social disproval of suicide. More than half of the suicide cases reported their attachment to life and having social support or connectedness (54.7% and 55.2% respectively). Confidence in ability to solve or cope with problems was not reported in the highest percentage of admitted cases (41.3%). Fear of suicide was not present in the highest number of cases (39.3%).
A statistically significant difference was noted between patients with and without previous suicidal attempts regarding most of the suicide protective factors, including confidence in ability to solve or cope with problems, attachment to life, social support or connectedness, attachment to a therapist or counsellor, fear of suicide, death and dying, fear of social disproval of suicide, and belief that suicide is immoral.
A statistically significant difference was noted in the mean score of suicide risk and protective factors between different marital statuses and having previous suicidal attempts or not. There was a significant positive correlation between mean score of suicide risk and protective factors with age (r=0.238 and p=0.001).
Using a multivariate regression model to assess risk of suicidal attempt showed that, the significant factors for assessment of risk of suicidal attempts were the mean score of suicide risk and protective factors, and past history of psychiatric disease.
ROC curve was used for evaluation of diagnostic accuracy of the regression model to assess risk of suicidal attempts and it was significant (AUC=0.84 and P<0.001).
The outcome of self-poisoning cases was complete recovery for nearly three quarters (74.1%) of the admitted cases, 23.9% of the cases had incomplete treatment, and 2% of cases only have been discharged with complications (heart failure and muscle weakness). No deaths were observed in the current study. 3.5% of the cases attempting suicide were admitted to the ICU for either mechanical ventilation or close observation