Predoziranje heroinom – suicid ili zadesno predoziranje?
Sažetak
Uvod/Cilj. Samoubistvo je značajan socijalno medicinski problem. Zbog čestih predoziranja među zavisnicima, postavlja se pitanje suicidnosti ove populacije. Cilj rada bio je utvrđivanje specifičnosti i distinktivnih faktora kod zavisnika od opijata koji su se predozirali sa namerom da počine suicid u odnosu na zavisnike kod kojih je predoziranje bilo zadesno. Metode. Istraživanjem je obuhvaćeno 150 ispitanika: 49 zavisnika od heroina na programu supstitucije koji su se predozirali sa jasnom suicidnom namerom i 101 zavisnik koji se predozirao bez suicidne namere. U istraživanju je korišćen socio-demografski upitnik i upitnik sa podacima o adikciji, Minnesota Multiphasic Personality Inventory (MMPI-2) i Manchester Short Assessment of Quality of Life (MANSA) upitnik kvaliteta života. Za statističku analizu su korišćeni Pirsonov χ2 test, Studentov t-test i univarijatna analiza varijanse. Rezultati. Zavisnici sa suicidnim pokušajem bili su mlađi (29,7 : 36,3 godine), ranije su počeli da uzimaju heroin (17,8 : 21,3 godine; p = 0,013), duže ga koriste (814,1 : 9,2 meseci; p = 0,00), i duže ga uzimaju intravenski (11,6 : 6,5 godine; p = 0,00). Suicidu je prethodio traumatski događaj (p = 0,015) i imali su više pokušaja suicida (p = 0,004). Kvalitet života su procenili kao manje kvalitetan (p = 0,03) u oblasti zadovoljstva smeštajem, prijateljima i organizacijom slobodnog vremena. Zaljučak. U skladu sa dobijenim podacima potrebno je koncipirati programe prevencije suicida među zavisnicima uopšte, a posebno programe koji bi bili usmereni ka zavisnicima mlađe životne dobi.
Reference
REFERENCES
Maloney E, Degenhardt L, Darke S, Mattick RP, Nelson E. Sui-cidal behaviour and associated risk factors among opioid-dependent individuals: A case-control study. Addiction 2007; 102(12): 1933‒41.
Kwon M, Yang S, Park K, Kim DJ. Factors that affect substance user's suicidal behavior: A view from the Addiction Severity Index in Korea. Ann Gen Psychiatry 2013; 12(1): 35.
Schneider B. Substance use disorders and risk for completed su-icide. Arch Suicide Res 2009; 13(4): 303‒16.
Darke S, Ross J, Lynskey M, Teesson M. Attempted suicide among entrants to three treatment modalities for heroin de-pendence in the Australian Treatment Outcome Study (ATOS): Prevalence and risk factors. Drug Alcohol Depend 2004; 73(1): 1‒10.
Borges G, Loera CR. Alcohol and drug use in suicidal behav-iour. Curr Opin Psychiatry 2010; 23(3): 195‒204.
Centers for Disease Control and Prevention. Injury prevention and control: Opioid overdose. Available from: www.cdc.gov/drugoverdose/opioids/heroin.html
National Institute on Drug Abuse. Heroin. 2015. [cited 2015 Sep 15]. Available from:
www.drugabuse.gov/drugs-abuse/heroin
International Classification of Diseases. Tenth Revision (ICD-10). Geneva: World Health Organization; 2010.
Priebe S, Huxley P, Knight S, Evans S. Application and Results of the Manchester Short Assessment of Quality of Life (Mansa). Int J Soc Psychiatry 1999; 45(1): 7‒12.
Butcher JN, Dahlstrom WG, Graham JR, Tellegen A, Kaemmer B. The Minnesota Multiphasic Personality Inventory-2 (MMPI-2): Manual for Administration and Scoring. Minneapolis, MN: University of Minnesota Press; 1989.
Wilcox HC, Conner KR, Caine ED. Association of alcohol and drug use disorders and completed suicide: An empirical review of cohort studies. Drug Alcohol Depend 2004; 76(Suppl): S11‒9.
Brooner RK, King VL, Kidorf M, Schmidt CW, Bigelow GE. Psy-chiatric and substance use comorbidity among treatment-seeking opioid abusers. Arch Gen Psychiatry 1997; 54(1): 71‒80.
Schuckit MA, Hesselbrock V. Alcohol dependence and anxiety disorders: What is the relationship? Am J Psychiatry 1994; 151(12): 1723‒34.
Kranzler HR, Liebowitz NR. Anxiety and depression in sub-stance abuse. Med Clin North Am 1998; 72(4): 867‒85.
Charney DA, Paraherakis AM, Negrete JC, Gill KJ. The impact of depression on the outcome of addictions treatment. J Subst Abuse Treat 1998; 15(2): 123‒30.
Montoya AD, Svikis D, Marcus SC, Suarez A, Tanielian T, Pincus HA. Psychiatric care of patients with depression and comor-bid substance use disorders. J Clin Psychiatry 2000; 61(9): 698‒705; quiz 706.
Galanter M, Castaneda R, Ferman J. Substance abuse among general psychiatric patients: Place of presentation, diagnosis and treatment. Am J Drug Alcohol Abuse 1998; 14(2): 211‒35.
Sundin M, Spak F, Spak L, Sundh V, Waern M. Substance use/abuse and suicidal behavior in young adult women: A population-based study. Subst Use Misuse 2011; 46(13): 1690‒9.
Haw CM, Hawton K. Problem drug use, drug misuse and delib-erate self-harm: Trends and patient characteristics, with a fo-cus on young people, Oxford, 1993-2006. Soc Psychiatry Psy-chiatr Epidemiol 2011; 46(2): 85‒93.
Srdanović-Maraš J, Kolundžija K, Dukić O, Šobot V, Marković J. Suicidal behavior in adolescent psychiatric population. Curr Top Neurol Psychiatr Relat Discip 2010; 3(18): 60‒4.
Bansal P, Gupta A, Kumar R. The Psychopathology and the So-cio-demographic Determinants of Attempted Suicide Patients. J Clin Diagn Res 2011; 5(5): 917‒20.
Nagendra Gouda MR, Rao SM. Factors related to attempted su-icide in Davanagere. Indian J Community Med 2008; 33(1): 15‒8.
Centers for Disease Control and Prevention. National Vital Statistics System. 2010. Multiple Cause of Death File. Hy-attsville, MD: US Department of Health and Human Services; 2012.
Bohnert AS, Roeder K, Ilgen MA. Unintentional overdose and suicide among substance users: A review of overlap and risk factors. Drug Alcohol Depend 2010; 110(3): 183‒92.
Ilgen MA, Burnette ML, Conner KR, Czyz E, Murray R, Cher-mack S. The association between violence and lifetime suicidal thoughts and behaviors in individuals treated for substance use disorders. Addict Behav 2010; 35(2): 111‒5.
Black DW, Blum N, Pfohl B, Hale N. Suicidal behavior in bor-derline personality disorder: Prevalence, risk factors, predic-tion, and prevention. J Pers Disord 2004; 18(3): 226‒39.
Darke S, Degenhardt L, Mattick R. Mortality among illicit drug users: epidemiology, causes and intervention. Cambridge: CambridgeUniversity Press; 2006.
Maloney E, Degenhardt L, Darke S, Nelson EC. Impulsivity and borderline personality as risk factors for suicide attempts among opioid-dependent individuals. Psychiatry Res 2009; 169(1): 16‒21.
Steil RI, Hinckers A, Bohus M. Comorbidity of personality dis-orders and posttraumatic stress disorder. Eur Psychiatry 2007; 22: S17.
Verona E, Patrick CJ, Joiner TE. Psychopathy, antisocial per-sonality, and suicide risk. J Abnorm Psychol 2001; 110(3): 462‒70.
Negredo L, Melis F, Herrero O. Psychopathy and suicidal behav-iour in a sample of mentally disordered offenders. Rev Esp Sanid Penit 2013; 15(1): 3‒7. (Spanish)
Dawson DA, Li TK, Chou SP, Grant BF. Transitions in and out of alcohol use disorders: Their associations with conditional changes in quality of life over a 3-year follow-up interval. Al-cohol Alcohol 2009; 44(1): 84‒92.
Donovan D, Mattson ME, Cisler RA, Longabaugh R, Zweben A. Quality of life as an outcome measure in alcoholism treatment research. J Stud Alcohol Suppl 2005; (15): 119‒39; discussion 92‒3.
Smith KW, Larson MJ. Quality of life assessments by adult sub-stance abusers receiving publicly funded treatment in Massa-chusetts. Am J Drug Alcohol Abuse 2003; 29(2): 323‒35.