الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
The word ”overdose” implies that there is unsafe dosage and usage for the drug; therefore, the term is commonly only applied to drugs, not poison. Toxicity is dose related and reflects an extension of the drug effects on neurotransmitter systems and other biological processes.
Sometimes drug overdoses are caused intentionally to commit suicide, but many drug overdoses are accidental and are usually the result of either irresponsible behavior or the misreading of product labels.
However, idiosyncratic adverse reactions also can occur in the context of routine therapeutic use. This toxicity result from individual susceptibility, usually is pharmacognetic in nature and generally un related to antipsychotic dose.
Toxicological exposures and fatalities associated with neuroleptic agents continue to increase in the world in past ten years. Consequently, it is important for the practicing clinician to be familiar with the pharmacology and toxicology of these medications.
This study was carried out because of the increasing rate of antipsychotic poisoning cases arrived at Menoufia poison and dependence control center.
The aim of this work was to study all patients arrived at Menoufia Poison Control Center (MPCC) complaining of antipsychotic drug overdose over one year; sociodemographic factors (age, sex, residence….etc); clinical manifestations (symptoms and signs); and the relation between antipsychotic drug overdose and each of ABG changes, electrolytes changes and severity grades of the studied cases according to PSS.As well as outcome of the studied cases.
The study was conducted on patients arrived at MPCC with antipsychotic poisoning seeking for medical advice throughout one year (from 1-10-2012 to 30-9-2013).
The data were collected from a previously designed clinical admission sheet (including the patient’s age, gender, history and clinical assessment data) and from investigations results.
from the current study, the following can be concluded:
According to sex, it was found that females over numbered males cases. The most affected age group was 20-<40 years, the least affected one was 5 – < 10 years. Cases living in urban areas were more frequent than those in rural areas. The most affected categories were singles, with secondary education, not working, with family troubles and with no special habits of medical importance.
The relation between sex and different age groups was significant. Predominance of males in age below< 10 years, while The percent of females in age 20 – < 40 years consider the highest value between all age groups in both sexes.
The suicidal mode of poisoning comprised the highest frequency. There was only one homicidal case.
Age had highly significant effect on mode of poisoning (suicidal and accidental, homicidal) where all of cases under 10 years old had taken the overdose accidentally represented (84.1%). The highest percent for patients to commit suicide was cases (20 <- 40) years represented 42.5%.
Regarding gender, there was a significant relation between mode of exposure and gender where females had the highest percent in suicidal mode represented 77.5%. While males had the highest
percent in homicidal and accidental mode represented (100%) and (73.3%) respectively.
On studying poison history, it was found that atypical antipsychotics were used more frequent in overdose, with more than half of cases had co ingestion of other types of drugs. Oral route was the highest. Cases that were on psychic therapy represented 25% of the total number. More than half of them had no previous attempts to take overdose.
Regarding the patient complaint, the most studied cases sought medical advice complaining of abnormal movements 46.7%. Patients who complain of vomiting 43.3% followed by a symptomatic coming only for reassurance (31.7%) then those with convulsions and loss of consciousness (23.3%) for each. Less common was dizziness represented (16.7%). The least were abdominal pain and abnormal behavior represented (13.3%) for each.
The clinical signs found upon examining the cases. As regard blood pressure 13.3% of cases had hypotension.16.7% had tachycardia and only 1.7% had bradycardia. Only 5% of patients had irregular rhythm. Concerning temperature 15% had hyperthermia and (1.7%) had hypothermia.
Concerning respiratory rate, apnea was found in 5% of cases. Pupils were dilated in 13.3% of cases and 10% had constricted pupils. On skin examination, 18% of cases presented with sweating followed by flushed skin (16.7%) followed by pale skin (15%) then cyanosed skin (5%). Finally dry skin represented 3.3%.Upon chest examination wheezy chest, crepitations represented 3.3% for each.
On central nervous system examination, cases that had coma represented 18.4 % of cases followed by patient who had hallucinations represented 8.3% and patient with convulsions and tremors represented 6.7% and fasiculations represented 1.7%.
Regarding coma , grade I coma represented 6.7% followed by grade II coma represented 8.3% and then coma grade III and coma grade IV represented 1.7% for each.
Concerning extra pyramidal movements represented 26.7% this include: dystonia represented 16.7% followed by akathesia represented 5% then tardive dyskinesia 3.3% then parkinsonism 1.7%.
Regarding dystonia the most prominent manifestation was occulogyric crisis (90%) followed by tongue protrusion or deviation (60%) then torticollis (40%) then opisthotonuss (30%) and gait disorders (20%). Taking in consideration that many of the cases were complaining of more than one complain as occulogyric crisis and tongue deviation, opisthotonus position and torticollis …etc
Upon examining severity grades of the studied cases according to PSS, it revealed that 41.7% of the cases were of moderate grade, followed by cases of ”None” grade (30%). Minor grade cases of severity score represented (25%) and the least was cases of severe and fatal grade represented (1.7%) for each one.
On studying acid base disorders in the present study, revealed a significant relation between metabolic acidosis and ECG changes. 63.6% of cases that had sinus tachycardia, had metabolic acidosis while cases of Wide QRS and Depressed ST segment had metabolic acidosis represented (9.1%).
Summary and Conclusion
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Regarding relation between PSS and place of admission, it was highly significant where most of cases admitted to ICU were of the severe and fatal grades (100%) and (32%) of moderate grades. All of none” grade and minor grade cases didn’t need admission to ICU.
Concerning the need for emergency stabilization, the study illustrated that a significant relation between severity grades according to PSS and need for emergency stabilization. All of moderate severe and fatal cases needed emergency stabilization and 40% of moderate grade and (6.6 %) of minor grades. All of ”none” grade cases (100%) didn’t need it.
There was highly significant relation between temperature and CPK level as 100% of cases with increased CPK level had hyperthermia.
The current study shows that there was highly significant relation between severity grades and outcome of the patients as the case with fatal severity score had been died while severe case improved. No deaths in none, minor, moderate or severe cases.
Regarding number of days of hospital admission and severity grades of the studied cases, significant relation was found as no cases of none grade admitted for more than one day and severe case admitted for more than one day and the fatal case admitted for less than one day as the case died.