Suicidal contingent in the overall structure of poisonings in Russia

Individuals who commit deliberate self-poisoning for suicidal reasons make up at least a quarter of the contingent of toxicology centers in Russia, which indicates the scale of the problem. The suicidal contingent differs from unintentional victims in a number of key indicators. Women predominate among those who commit suicide (up to 73%), with the mean age of 32.5 years. There is a high proportion of unmarried - 31-45%, divorced - 6.3% people, a significant proportion are unemployed (39.5%). Upon admission to hospital, 70.2% are diagnosed with neurotic and stress-related disorders (F40-F48). Often, victims are examined by a psychiatrist or clinical psychologist not on the first day, when the most complete picture is needed to make a correct diagnosis. It is assumed that many are not diagnosed with depression. Alcohol is detected in a third of suicide attempters. The motives are predominantly interpersonal conflicts, less often they report the loss of a loved one, somatic disease, in isolated cases productive psychopathological symptoms can be found. Often the motives cannot be established. In 80-87% of attempts, medication is used. Psychotropic drugs (21.6-55.4%), cardiotropic drugs (22.5%), analgesics and antispasmodics (up to 12.5%) predominate. At least a third of suicide victims (36%) use combined medication, which usually entails increased toxic effects. For a number of territories of the country, the use of acids and alkalis (mainly acetic acid) remains relevant - up to 6-7%, poisoning with which determines high mortality. Intentional poisonings with inhalants (carbon monoxide, helium, etc.) are isolated cases. Mortality is on average 1.7-3.1%. The diagnosis of poisoning, especially committed for suicidal reasons, is not always obvious and simple. At the time of the initial examination, 61.5% of patients do not have pronounced clinical manifestations of acute poisoning. Often, victims deny what they did, which requires a more thorough questioning, examination, involvement of other people and objective data. Therefore, when making a diagnosis, it is recommended to use the principle of the "toxicological diagnostic triad": 1) the presence of a toxicological anamnesis; 2) toxicological situation and 3) a characteristic clinical picture, in combination with the fourth (4) task - identifying suicidal history and motives.