Deliberate self-poisoning presenting at a rural hospital in Northern Ireland 1976-1996: relationship to prescribing

Purpose - This study reports on a project to monitor deliberate self-poison ing in a rural area of Northern Ireland over a 20-year period. Comparison i s made with reports from large urban centres. In addition, a local prescrib ing database allows assessment of any association between psychotropic drug prescription and use for deliberate self-poisoning. Materials and methods - Frequency of self-poisoning, demographic details and drugs used were reco rded for all episodes of deliberate self-poisoning occurring at Craigavon A rea Hospital for the years 1976, 1986, 1991 and 1996. It was possible to co mpare prescriptions of psychotropic drugs with their use for deliberate sel f-poisoning between the years 1991 and 1996 in the region served by the hos pital, using the Defined Daily Dose (DDD) system. Results - In this rural a rea the pattern of deliberate self-poisoning has changed, as in urban centr es, with a rise in frequency and the male/female ratio approaching unity. T he pattern of drug use has altered, with paracetamol overtaking benzodiazep ines as the most commonly used agent. More recently, antidepressants have b ecome the second most frequently used drug class for this purpose. Psychotr opic medications used for self-poisoning altered in proportion to their pre scription between the years 1991 and 1996. Conclusions - In the face of a c ontinuing rise in deliberate self-poisoning, which is effecting both urban and rural areas, care should be taken to prescribe the least toxic agent av ailable as this is associated with likely frequency of self-poisoning for m ost classes of psychotropic drug. (C) 2000 Editions scientifiques et medica les Elsevier SAS.