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J Korean Soc Emerg Med > Volume 27(1); 2016 > Article
Journal of The Korean Society of Emergency Medicine 2016;27(1): 75-81.
정신과 치료 거부 중독 자살 시도 환자의 특성과 중재 치료로서 응급의학과 입원의 효과
임용균, 정회환, 박은정, 민영기, 최상천
아주대학교 의과대학 응급의학교실
Characteristics of Suicidal Attempters with Acute Poisoning Who Discharged Against Psychiatric Medical Advice and Emergency Department Admission as an Acute Intervention
Yong Gyun Lim, Hoe Hwan Jeong, Eun Jung Park, Young Gi Min, Sang Chun Choi
Department of Emergency Medicine, Ajou University Medical Center, 164 Worldcup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, Korea
Correspondence  Sang Chun Choi ,Tel: 031) 219-7754, Fax: 031) 216-7760, Email: avenue59@ajou.ac.kr,
Received: November 3, 2015; Revised: November 4, 2015   Accepted: January 13, 2016.  Published online: February 29, 2016.
ABSTRACT
Purpose:
Discharge against medical advice (DAMA) carries a risk of increased mortality and readmissions in the emergency department (ED). The aim of the current study was to examine characteristics of suicidal attempters with acute poisoning who were discharged against psychiatric medical advice and other clinical department admission as acute intervention.
Method:
We retrospectively selected a consecutive series of suicidal attempters with acute poisoning who were admitted to the emergency department between 2011 and 2012. Sex, age, admission time, psychiatric DAMA, impressions by the Psychiatrist-in-charge, and psychiatry follow-up after discharge were reviewed in the medical records. DAMA was defined as an unplanned discharge for which the psychiatrist-in-charge documented in the medical record that the patient or one’s legally authorized representatives decided to refuse hospitalization against the psychiatrist’s medical advice including closed ward admission.
Results:
A total of 883 patients who had attempted suicide who visited the emergency department were included. Of these, 155 patients were suicidal attempters with acute poisoning for ED ward admission. Among these patients, the rate of psychiatric DAMA was 66.5% (n=103). Psychiatric impressions were 1) adjustment disorder 51.5% (n=53), 2) major depressive disorder 28.2% (29%). The rate of DAMA was higher in the adjustment disorder group than in the major depressive disorder group (82.8% vs 58.7%, p <0.001). The rate of follow-up after hospital discharge to the psychiatric outpatient department was 26.5% (n=27).
Conclusion:
Admission to the emergency department may improve psychiatric outpatient department referral in suicidal attempters with acute poisoning. In addition, customized plans according to psychiatric diagnosis will be considered for effective acute intervention and continuous psychiatric referral.
Key words: Suicide, Poisoning, Treatment refusal, Patient discharge
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