Full Text

ORIGINAL RESEARCH / ORİJİNAL ARAŞTIRMA
2015
The Evaluation of Hospitalized Cases of Drug Intoxication
Hastanede Yatan İlaç İntoksikasyonu Olgularının Değerlendirilmesi
AUTHORS /
YAZARLAR
Özgür Erdem
Kayapınar Family Health
Centre Number 9,
Diyarbakır, Turkey
İsmail Hamdi Kara
Department of Family
Medicine, Düzce
University Medical
Faculty, Düzce, Turkey
Orhan Ayyıldız
Department of Internal
Medicine, Dicle
University Medical
Faculty, Diyarbakır,
Turkey
ABSTRACT
Aim: This study aims to determine the risk groups, socio demographic characteristics, and the drugs
which had been taken by the patients who are hospitalized and attempted suicide.
Methods: The documents and reports of the patients with the drug intoxication are obtained from
Dicle University Hospital between January 2006 and December 2006 and analyzed retrospectively.
Results: The average of age was 24.7±9.4. 74.5% (n=143) of them were females and 25.5% (n=49)
were males (p=0,023). 44% of the patients were under 20 years old, 80% were under 30 years old, and
96% were under 40 years old. Organic phosphor was the highest among the taken drug by the patients.
Most cases occurred in May, July and December, and most of the suicide attempts were in the spring.
With regard to the time of suicide, majority of the patients tried to attempt suicide in the afternoon and
evening times.
Conclusions: It is observed that most of the people who attempted suicide were housewives,
students and the girls who do not have schooling or job. It is thought that this is a behavior of people who
have not got an adequate social status in society and so, they try to draw attention by attempting suicide.
Keywords: organothiophosphorus compounds, social conditions, suicide, intoxication
ÖZET
Amaç: Bu çalışma intihar amaçlı ilaç alan ve hastanede yatan vakaların risk gruplarını,
sosyo-demografik özelliklerini ve hangi ilaçları aldıklarını belirlemek amacıyla yapıldı.
Yöntem: Dicle Üniversitesi Hastanesine 01/01/2006 ile 31/12/2006 tarihleri arasında ilaç
intoksikasyonu nedeni ile başvuran vakaların dosyaları retrospektif olarak incelendi.
Bulgular: Vakaların yaş ortalaması 24,7±9,4 idi. %74,5’i (n=143) kadın %25,5’i (n=49) erkekti
(p=0,023). Vakaların %44’ü ≤ 20 yaş, %80’ni ≤ 30 yaş ve %96’sı ≤ 40 yaş idi. Vakaların aldığı ilaç
grupları incelendiğinde; ilk sırayı organik fosfor oluşturmaktadır. Aylara göre incelendiğinde en çok vaka
sırasıyla Mayıs, Temmuz ve Aralık aylarında başvurmuştu. Mevsimlere göre incelendiğinde en fazla
intoksikasyon vakası ilkbaharda meydana gelmişti. Vakaların inihar girişiminde bulunma saatleri
incelendiğinde özellikle akşam saatleri ve öğle saatlerinde yoğunluk kazandığı tespit edildi.
Sonuç: İntihar girişiminde bulunanların çoğunlukla ev hanımı/kızı ve öğrenci olduğu saptandı. Bu
bize toplumda yeterli bir sosyal statüsü olmayan insanların dikkatleri üzerine çekmek için intihar
girişiminde bulunduğunu düşündürmektedir.
Anahtar kelimeler: organik tiyofosfor bileşikleri, sosyal durumlar, intihar, zehirlenme
Introduction
Drug intoxication takes place either with having the intention of suicide or taking
the drugs unintentionally. In general, intoxication of children occurs by accident, but
intoxication of adults take place intentionally to commit suicide. The death among the
people who take drugs for suicide has been observed more often all around the world.
In developed countries the victims who are exposed to intoxication both accidentally
and intentionally are between 0.2 and 9.3 among 1000 people in a year (1).
Moreover, in the United State of America (USA) suicide is the fourth reason for
Corresponding Author / İletişim için
Dr. Özgür Erdem, MD
Kayapınar 9 Nolu ASM, Peyas Mah. 455. Sok. No:5, 21070-Kayapınar, Diyarbakır, Turkey
E-posta: [email protected]
Date of submission: 17.03.2015 / Date of acceptance: 18.07.2015
71
Erdem O et al. The Evaluation of Hospitalized Cases of Drug Intoxication
deaths after accidents, cancer and murders of the
teenagers who are between 10-14 years old.
However, it is the third death reason after accidents
and murders of the teenagers who are between 15-24
years old. Additionally, it is stated that suicide rates
of the teenagers between 15-19 years old have
increased 350% since 1950. 70% of the people who
attempted suicide took drugs excessively and 63% of
these people preferred guns to suicide (2).
The ratio of the people who attempted suicide in
Turkey is less than European countries. Moreover,
most of the people attempting suicide are teenagers
between 15 and 19 similar to European countries (3).
However, it is mentioned that there are not any
systematic and reliable data about the attempts of
suicide in Turkey (4). In a study conducted in Turkey,
94.73% of the teenager attempted to suicide killed
themselves by taking drugs (5).
This study aims to describe the sociodemographic features and groups of medicine of the
patients who were accepted to Dicle University
Hospital because of drugs intoxication. All of the
cases were analyzed retrospectively.
Methods
The data of patients who attempted suicide by
taking drugs, who were treated in Internal Diseases
Department of Dicle University Medical Faculty in
Diyarbakır between the first of January and thirtyfirst of December in 2006 were analyzed retrospectively.
The patients were from eleven cities of South
East and East Anatolian regions (Diyarbakır, Mardin,
Batman, Bingöl, Hakkari, Van, Muş, Bitlis, Şanlıurfa,
Şırnak and Siirt). However, the children who were
under 12 were not included in this study, as they were
followed by pediatricians. The patients were firstly
evaluated in the emergency service and then they
were taken to the Internal Diseases Department after
their first treatment. In this study, parameters were
evaluated according to age, gender, marital status,
occupation, the sort of medicine, type of intoxication
(suicide-accident), the time of the arrival to hospital,
dispersion according to the months, evaluating
complications, and biochemical parameters. The
results were categorized according to gender, season
72 and kind of drugs.
Statistical Package for Social Sciences (SPSS)
11.5 program was used for analysis. The independent
groups were compared by student test, chi-square test
or Fisher’s exact test. The valve of p<0,05 was
accepted as statistically significant.
Results
The average age of the patients was 24.7±9.4.
74.5% of them were females (n=143) and 25.5%
were males (n=49) (p=0,023). 44% of the patients
were younger than the age of 20, 80% were younger
than 30, while 96% of them were younger than 40
years old. Socio-demographic characteristics of the
patients and their occupations are given in Table 1
and Table 2.
Table 1. Socio-Demographic Characteristics of Patients
Women Men
Total
Parameter
n
n
n
p
(%)
(%)
(%)
Married
75
17
92
(39.1) (8.9) (47.9)
Marital status
0.023
Single
68
32
100
(35.4) (16.7) (52.1)
Present
32
12
44
Psychiatric
(16.7) (6.3) (22.9)
treatment
0.451
Absent
111
37
148
background
(57.8) (19.3) (77.1)
First
141
48
189
(73.4) (25.0) (98.5)
Number of
Second
1
0
1
suicide
0.614
(0.5)
(0)
(0.5)
attempt
Third
1 (0.5) 1 (0.5) 2 (1)
One
99
34
133
Number of
(51.6) (17.7) (69.3)
0.494
drug(s) taken Multiple 44
15
59
(22.9) (7.8) (30.7)
Table 3 shows the clinical characteristics of the
patients during the first evaluation.
Table 2. Job distribution of patients
Women
Men
Job
n (%)
n (%)
Total
n (%)
Housewife
72 (37.5)
0 (0)
72 (37.5)
Student
36 (18.8)
19 (9.9)
55 (28.6)
House girl
31 (16.1)
0 (0)
31 (16.1)
Artisan
1 (0.5)
8 (4.2)
9 (4.7)
Worker
0 (0)
9 (4.7)
9 (4.7)
Officer
3 (1.6)
5 (2.6)
8 (4.2)
0 (0)
8 (4.2)
8 (4.2)
Unemployed
Total
143 (74.5) 49 (25.5)
192 (100)
p
<0.0001
Euras J Fam Med 2015;4(2):71-77
Table 3. Clinical characteristics of patients
Women
Men
P
Clinic Characteristics
n (%)
n (%)
Open
1.08 (56.3) 33 (17.2)
Conscious Close
22 (11.5) 6 (3.1) 0.106
ECG*
Confused
13 (6.8)
Normal
69 (35.9) 28 (14.6)
compounds (OP) 28.1% (n=54), antidepressants 24%
(n=46), and non-categorized group of 20.3% (n=39)
(Table 5). There were two patients ended up death;
one of them was 50 years old and married, and the
other was 22 years old single woman. Both of the
patients who died had taken OP for suicide.
Tachycardia
72 (37.5) 17 (8.9) 0.020
Table 5. Distribution of taken drug groups
Bradycardia
Reason
Suicide
4 (2.1)
130 (67.7) 42 (21.9)
Mistakenly
Healthy
Outcome
2 (1.0)
10 (5.2)
13 (6.8)
7 (3.6)
0.050
141 (73.4) 48 (25.0)
Exitus
Transfer to another hospital
1 (0.5)
1 (0.5)
1 (0.5) 0.614
0 (0)
When the patients were examined based on the
time of the year, most of them occurred in May, June
and December. When it was examined according to
the seasons, most of the intoxication cases occurred
in spring (p>0.05) (Table 4).
Winter
Paraceta
mol
Antiepileptic
NSAİD*
Amitraz
Antibiotic
P
Other
January
8 (4.2)
2 (1.0)
10 (5.2)
Total
February
11 (5.7)
2 (1.0)
13 (6.8)
p
† OP:Organic Phosphor, ‡AD:Anti-Depressant, *NSAID:Non
Steroid Anti Inflammation Drug
March
12 (6.3)
7 (3.6)
19 (9.9)
April
10 (5.2)
5 (2.6)
15 (7.8)
May
18 (9.4)
5 (2.6) 23 (12.0)
June
9 (4.7)
4 (2.1)
Summer July
16 (8.3)
5 (2.6) 21 (10.9)
13 (6.8)
3 (1.6)
16 (8.3)
September 12 (6.3)
9 (4.7)
Autumn October
November 10 (5.2)
2 (1.0)
14 (7.3)
5 (2.6)
14 (7.3)
4 (2.1)
14 (7.3)
Spring
OP†
AD‡
*ECG : Electrocardiography
Table 4. Distribution of cases according to seasons
Woman Man
Total
Seasons Months
N (%) N (%)
N (%)
December 15 (7.8) 5 (2.6) 20 (10.4)
Drugs
Woman
Man
Total
Married Single Married Single
n
p
n
n
n
n
(%)
(%)
(%)
(%)
(%)
28
9
8
9
54 0.040
(14.6) (4.7)
(4.2) (4.7) (28.1)
16
21
4
5
46 0.617
(8.3) (10.9) (2.1) (2.6) (24.0)
7
6
1
2
16 0.500
(3.6)
(3.1)
(0.5) (1.0) (8.3)
4
6
2
2
14 0.594
(2.1)
(3.1)
(1.0) (1.0) (7.3)
5
3
0
2
10 0.222
(2.6)
(1.6)
(0)
(1.0) (5.2)
2
3
0
4
9
0.278
(1.0)
(1.6)
(0)
(2.1) (4.7)
2
2
0
0
4
(1.0)
(1.0)
(0)
(0)
(2.1)
11
18
2
8
39 0.264
(5.7)
(9.4)
(1.0) (4.2) (20.3)
75
68
17
32
192 0.023
(39.1) (35.4) (8.9) (16.7) (100)
August
13 (6.8)
0.490
According to the laboratory results, 3% of the
patients had urea rising, 1.6% had creatine rising,
3.7% had aspartate aminotransferase (AST) rising,
and 2.1% had alanine aminotransferase (ALT) rising.
In the blood count values, it was stated that white
blood cells (WBC) were found higher in 36.5% of the
patients. While hemoglobin was below 12.3 gr/dl in
49% patients, hematocrit was below 37.7% in 62.5%
of the patients.
When the patients were examined, the groups of
drugs were as follows: organothiophosphorus
0.072
0.414
<0.0001
The average age of the patients who took OP was
29.5±12.6 (Figure 1). Laboratory reports showed that
the kind of drugs which made the WBC (Figure 2)
and Lactate dehydrogenase (LDH) (Figure 3) higher
was OP.
Figure 1. The correlation of the drugs and the average age
of the patients
73
Erdem O et al. The Evaluation of Hospitalized Cases of Drug Intoxication
Figure 2. The correlation of the drugs which make the
WBC higher
Figure 3. The correlation of the drugs which make the
LDH higher
The times of suicide attempts were especially
during evening and noon periods (Figure 4).
Figure 4. The time of drugs taking
Discussion
It was stated that one million people attempt to
suicide every year in the 2001 (6). Taking the drugs
excessively to suicide is one of the common
techniques of attempting suicide (7). Intoxications
74 which were among adult groups are mostly taking
drugs for suicide. Furthermore, it is commonly used
among the female population rather than males (8,9).
The studies which were conducted in different
periods and in different regions of Turkey such as
Istanbul, Ankara, Bursa, Diyarbakır, and Elazığ, the
average age of the patients attempting suicide was
between 22.1 and 29.4. According the these studies,
the ratio of female patients who attempted to suicide
was between 67.5% and 82.5% (7,9-15).
According to the results from the National Centre
for Health Statistics in USA, the ratio of completed
suicide of boy teenager is higher five times more than
girl teenagers, at the age of 15 and 19 (16). On the
other hand it is seen that, the girls thinking, planning
and attempts to suicide are more often than boys (2).
In this study, the average age of the people who
attempted to suicide was 24.7±9.4 and 74.5% were
females. The valves were compatible with the
average of Turkey ratio and the data around the
world. As it was shown in many studies, it was found
out that age and gender are important variables which
have clues for the probability of attempting suicide. It
is assumed that the higher suicide rate among females
is due to their sensitive and fragile natures, which
make attempt suicide more often.
Since the individuals whose ages were between
20 and 30 have little hope and sense about the future,
they did not have ethical or religious values. Thus,
the ratio of suicide among these individuals can be
more often. The teenagers among these ages expose
to university entry exams and unemployment after
graduation due to Turkey standards (17). The studies
about the attempt to suicide patients show that lower
education level is an important factor in these cases.
For example, in another study in Batman, it was
shown that most of the individuals attempting to
suicide were illiterate or primary school graduates
(15,18,19).
Competed with these results, it is indicated that
36% and 46% of the individuals who attempted
suicide were housewives and the girls who do not
have schooling or job and 38% of this ratio were
students (19,20). However, in this study the 53.6% of
the ratio were housewives and the girls who did not
have schooling or job, and 28.6% were students.
Euras J Fam Med 2015;4(2):71-77
Moreover this study showed that 82.2% of the
individuals were among unemployed. These results
showed that lower education level and inadequacy in
the economical resources caused suicides more often.
The mostly used technique to attempt suicide is
by taking drugs (21). When the techniques for suicide
are examined carefully, 55% and 75% of patients take
drugs excessively since this technique is easier and
cheaper. Generally the amount of the taken drug is
very little and it is not a risky for life. Agriculture
medicine, chemical materials and jumping from a
high place are other following often suicide
techniques (13-15).
In some studies, it was reported that 2/3 of the
patients take one drug; 1/3 of them take more than
one drug (11,13). In our study, 69.3% of the patients
attempted to suicide by one drug, while 30.7% of the
patients attempted to suicide with more than one
drug. This shows us that people can sometimes abuse
the drugs which they prescribed from doctors.
The results from several studies show that among
the drugs which were taken for suicide were
analgesics, antidepressants and psychoactive drugs.
In other studies, it is reported that pesticides are also
used (11,13,15,22). In our study, when the types of
drugs are examined, in the first place there was OP
28.1% (n=54), the second place was antidepressants
24% (n=46) and the third place was non-categorized
group as 20.3% (n=39). The average age of the
victims who take OP was 29,5±12,6. The laboratory
results indicate that OP is responsible for making
WBC and LDH higher.
Our results of taking antidepressants was
compatible with literature. However, analgesics were
used less than it is in literature. Also, OP takes the
first place and that is different from the literature.
East and South East regions of Turkey, where the
study takes place, are poor places in terms of
industrialization and the people here are busy with
agriculture and growing animals. As they are busy
with agriculture, it is easier to get the agriculture
drugs and pesticides. OP, being among these drugs
consists of the majority of these drugs. That is why,
the pesticides which consist of OP, should be
controlled densely and should be sold in a controlled
way. The farmers should be more informed and thus,
the suicide risks can be decreased when the easy
reach is prevented.
In some studies, it is reported that the time of
suicide was in the afternoon and evening densely
(20,23). In this study, they were during noon and
evening. This was compatible with literature.
When the season of suicide is examined, the
results show that suicides were committed in summer
time more often (13,24). In this study most cases
occurred in May, July and December. However,
analysis based on the seasons indicated that
intoxication occurred more often in spring. In this
regard, our study contrasts with the literature.
In the literature, the ratio of death as a result of
suicide is reported as males being higher than
females. Otherwise the ratio of attempt to suicide is
reported as females being higher than males
(13,15,25-27). In several studies, the ratio of death
due to intoxication has been found between 0% and
3.9% (12,13,15,28). In this study, both of the victims
who died took OP in order for suicide. Even though,
the ratio of death among males and elderly is higher
than teenagers, suicidal intoxication among teenagers
and females is higher than males and elderly
(25,26,29,30).
Conclusion
As a result, the patients who attempted to suicide
have been especially among teenagers and females.
Their aims are to be focused on and to tackle with the
daily problems and to call a S.O.S. message.
However, older aged-people and male ones attempted
to suicide to make an end of their lives mostly. In this
way, age, gender and technique of suicide can help us
to understand the patients mood.
This study was presented at the second congress
of Association of General Practice family Medicine of
South East Europe Congress, 22-25 April 2010,
Antalya, Turkey. It received “The Best Poster
Presentation” award.
75
Erdem O et al. The Evaluation of Hospitalized Cases of Drug Intoxication
References
1. Hanssens Y, Deleu D, Taqi A.
Etiologic and demographic
characteristics of poisoning: a
prospective hospital-based
study in Oman. J Toxicol
Clin Toxicol
2001;39(4):371-80.
2. Davis JM, Brock SE. Suicide.
In: J Sandoval (Ed.).
Handbook of in crisis
counseling, intervention,
prevention in the schools.
2nd ed. London: Lawrence
Erlbaum Associates
Publishers; 2002:273-301.
3. Özgüven-Devrimci H, Sayıl
I. Suicide attempts in Turkey:
Results of the WHO / EURO
multicentre study of suicidal
behavior. Can J Psychiatry
2003;48(5):324-9.
4. Korkut F. School-based,
preventive and psychological
counseling. Ankara: Anı
Publishing, 2004:217-53.
5. Tezcan AE, Oğuzhanoğlu
NK, Ülkeroğlu F. Suicide
attempts of children and
young’s [in Turkish]. Kriz
Dergisi 1995;3(1-2):70-4.
6. World Health Organization
[Internet]. The world mental
health report, 2001 [cited
2015 Jan 12]. Available from:
http://www.who.int/whr/2001
/en/whr01_en.pdf?ua=1
7. Keles A, Demircan A,
Aygencel G, Karamercan A,
Turanli S. The retrospective
analyze of intoxication cases
that are presenting to Gazi
University hospital
emergency department.
JAEM 2003;1(2):39-42.
8. Schapira K, Linsley KR,
76 9.
10.
11.
12.
13.
14.
Linsley A, Kelly TP, Kay
DWK. Relationship of
suicide rates to social factors
and availability of lethal
methods: comparison of
suicide in Newcastle upon
Tyne 1961-1965 and
1985-1994. Br J Psychiatry
2001;178:458-64. doi:
10.1192/bjp.178.5.458
Akkose S, Fedakar R, Bulut
M, Cebicci H.Epidemiology
of poisoning in adults: a 5
year study [in Turkish]. Turk
J Emerg Med 2003;3(1):8-10.
Yesil O, Akoglu H, Onur O,
Guneysel O. Retrospective
evaluation of poisoning
patients in the emergency
department [in Turkish].
Marmara Medical Journal
2008;21(1);26-32.
Uyanıkoğlu A, Zeybek E,
Cordan İ, Avcı S, Tükek T.
Evaluation of intoxication
cases [in Turkish]. Nobel
Med 2007;3(2):18-22.
Çetin NG, Beydilli H,
Tomruk Ö. Retrospective
evaluation poisoning patients
in emergency department [in
Turkish]. S.D.Ü. Tıp Fak
Derg 2004;11(4):7-9.
Seydaoglu G, Satar S,
Alparslan N. Frequency and
mortality risk factors of acute
adult poisoning in Adana,
Turkey, 1997–2002. Mt Sinai
J Med 2005;72(6):393-401.
Sır A, Özkan M, Altındağ A,
Özen Ş, Oto R. Suicide and
suicide attempts in
Diyarbakir: examination of
court files [in Turkish]. Türk
Psikiyatri Dergisi
15.
16.
17.
18.
19.
20.
21.
1999;10(1):50-7.
Kara IH, Güloğlu C,
Karabulut A, Orak M.
Sociodemographic, clinical,
and laboratory features of
cases of organic phosphorus
intoxication who attended the
emergency department in the
Southeast Anatolian region of
Turkey. Environ Res
2002;88(2):82-8.
Gould MS, Kramer RA.
Youth suicide prevention.
Suicide and Life-Threatening
Behavior 2001;31(suppl
1):6-32.
Durak Batigün A. Suicide
probability: An assessment
term of reasons for living,
hopelessness and loneliness
[in Turkish]. Turk Psikiyatri
Derg 2005;16(1):29-39.
Deniz İ, Ersöz AG, İldeş N,
Türkaslan N. A study on
suicides and suicide attempts
in the official records of the
province of Batman during
the period 1995-2000 [in
Turkish]. Aile ve Toplum
2001;1(4):27-48.
Deveci A, Taskın OE, Erbay
Dündar P, Demet MM, Kaya
E, Özmen E, et al. The
prevalence of suicide ideation
and suicide attempts in
Manisa city centre [in
Turkish]. Turk Psikiyatri
Derg 2005;16(3):170-8.
Sayar K, Acar B. Risk factors
in suicide attempts victims
with the use of psychotropic
drugs [in Turkish]. Klinik
Psikofarmakoloji Bülteni
1999;9(4):208-12.
McClure GM. Changes in
Euras J Fam Med 2015;4(2):71-77
suicide in England and
Wales, 1960-1997. Br J
Psychiatry 2000;176:64-67.
doi: 10.1192/bjp.176.1.64
22. Andersen UA, Andersen M,
Rosholm JU, Gram LF.
Psychopharmacological
treatment and psychiatric
morbidity in 390 cases of
suicide with special focus on
affective disorders. Acta
Psychiatr Scand
2001;104(6):458-65.
23. Özen Ş, Oto R, Tıraşcı Y,
Ayna YE. Offense
behaviours, awareness, and
sociodemographic features of
the juvenile delinquents [in
Turkish]. Psikiyatri Psikoloji
Psikofarmakoloji Dergisi
2002;10(2):155-64.
24. Doganay Z, Sunter AT, Guz
H, Ozkan, A, Altintop L, Kati
C, et al. Climatic and diurnal
variation in suicide attempts
in the ED. Am J Emerg Med
2003;21(4):271-5.
25. Camidge DR, Wood RJ,
Bateman DN. The
epidemiology of
self-poisoning in the UK. Br
J Clin Pharmacol
2003;56(6):613-9.
26. Le Pont F, Letrilliart L,
Massari V, Dorleans Y,
Thomas G, Flahault A.
Suicide and attempted suicide
in France: results of a general
practice sentinel network,
1999-2001. Br J Gen Pract
2004;54(501):282-4.
27. Sahin HA, Sahin I, Arabaci F.
Sociodemographic factors in
organophosphate poisonings:
a prospective study. Hum
Exp Toxicol
2003;22(7):349-53.
28. Hatzitolios AI, Sion ML,
Eleftheriadis NP, Toulis E,
Efstratiadis G, Vartzopoulos
D, et al. Parasuicidal
poisoning treated in a Greek
medical ward: epidemiology
and clinical experience. Hum
Exp Toxicol
2001;20(12):611-7.
29. Townsend E, Hawton K,
Harriss L, Bale E, Bond A.
Substances used in deliberate
self-poisoning 1985-1997:
trends and associations with
age, gender, repetition and
suicide intent. Soc Psychiatry
Psychiatr Epidemiol
2001;36(5):228-34.
30. Backman J, Ekman CJ, Alsen
M, Ekedahl A,
Traskman-Bendz L. Use of
antidepressants in deliberate
self-poisoning: psychiatric
diagnoses and drugs used
between 1987 and 1997 in
Lund, Sweden. Soc
Psychiatry Psychiatr
Epidemiol
2003;38(12):684-9.
77