Patient emergency assessment following deliberate self-poisoning with benzodiazepines: Can cognitive markers predict recall of the psychiatric interview? A pilot study
Restricted accessResearch articleFirst published online October, 2017
Patient emergency assessment following deliberate self-poisoning with benzodiazepines: Can cognitive markers predict recall of the psychiatric interview? A pilot study
In cases of deliberate self-poisoning (DSP), patients often ingest benzodiazepines (BZDs), known to alter memory. Experts recommend recovery of the patient’s cognitive capacity before psychiatric assessment. Unfortunately, there is no validated tool in common practice to assess whether sufficient cognitive recovery has occurred after DSP with BZDs to ensure patient memory of the assessment.
Objective:
The aim of the study was to identify cognitive functions and markers which predict preserved memory of the mental health care plan proposed at the emergency department after DSP.
Methods:
We recruited patients admitted for DSP with BZDs and control patients. At the time of the psychiatric assessment, we performed cognitive tests and we studied the relationship between these tests and the scores of a memory test performed 24 h after.
Results:
In comparison with the control group, we found memory impairment in the BZD group. We found significant impairment on the Trail Making Test A (TMT A) in the BZD group in comparison with the control group, while TMT A and Wechsler Adult Intelligence Scale (WAIS) Coding test scores were significantly correlated with memory scores.
Conclusions:
Attentional functions tested by WAIS Coding test and TMT A were correlated with memory score. It could be profitable to assess it in clinical practice prior to a psychiatric interview.
BustoUKaplanHLSellersEM (1980) Benzodiazepine-associated emergencies in Toronto. Am J Psychiatry137: 224–227.
2.
CoulthardEJNachevPHusainM (2008) Control over conflict during movement preparation: Role of posterior parietal cortex. Neuron58: 144–157.
3.
CurranHVSchifanoFLaderM (1991) Models of memory dysfunction? A comparison of the effects of scopolamine and lorazepam on memory, psychomotor performance and mood. Psychopharmacology103: 83–90.
4.
CurranHVGardinerJMJavaRIet al. (1993) Effects of lorazepam upon recollective experience in recognition memory. Psychopharmacology110: 374–378.
5.
DassanayakeTLMichiePTJonesAet al. (2012) Cognitive impairment in patients clinically recovered from central nervous system depressant drug overdose. J Clin Psychopharmacol32: 503–510.
6.
DoshiABoudreauxEDWangNet al. (2005) National Study of US Emergency Department Visits for Attempted Suicide and Self-Inflicted Injury, 1997-2001. Ann Emerg Med46: 369–375.
7.
FedyszynIEErlangsenAHjorthøjCet al. (2016) Repeated suicide attempts and suicide among individuals with a first emergency department contact for attempted suicide: A prospective, nationwide, Danish register-based study. J Clin Psychiatry77: 832–840.
8.
ForcevilleEJMDekkerMJAAldenkampAPet al. (1992) Subtest profiles of the WISC-R and WAIS in mentally retarded patients with epilepsy. J Intellect Disabil Res36: 45–59.
9.
GentilVGorensteinCCamargoCHet al. (1989) Effects of flunitrazepam on memory and their reversal by two antagonists. J Clin Psychopharmacol9: 191–197.
10.
GuthrieEPattonGCKapurNet al. (2001) Randomised controlled trial of brief psychological intervention after deliberate self poisoning commentary: Another kind of talk that works?BMJ323: 135.
11.
HawtonKZahlDWeatherallR (2003) Suicide following deliberate self-harm: Long-term follow-up of patients who presented to a general hospital. Br J Psychiatry182: 537–542.
12.
HawtonKBergenHCaseyDet al. (2007) Self-harm in England: A tale of three cities. Multicentre study of self-harm. Soc Psychiatry Psychiatr Epidemiol42: 513–521.
13.
HickeyLHawtonKFaggJet al. (2001) Deliberate self-harm patients who leave the accident and emergency department without a psychiatric assessment: A neglected population at risk of suicide. J Psychosom Res50: 87–93.
14.
JatlowPDobularKBaileyD (1979) Serum diazepam concentrations in overdose. Their significance. Am J Clin Pathol72: 571–577.
15.
LuftTPereiraGSCammarotaMet al. (2004) Different time course for the memory facilitating effect of bicuculline in hippocampus, entorhinal cortex, and posterior parietal cortex of rats. Neurobiol Learn Mem82: 52–56.
16.
LukensTWWolfSJEdlowJAet al. (2006) Clinical policy: Critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department. Ann Emerg Med47(1): 79–99.
17.
McGaughJL (2002) Memory consolidation and the amygdala: A systems perspective. Trends Neurosci25: 456.
18.
MormontEJamartJRobayeL (2012) Validity of the five-word test for the evaluation of verbal episodic memory and dementia in a memory clinic setting. J Geriatr Psychiatry Neurol25: 78–84.
19.
MorrisRGAbrahamsSBaddeleyADet al. (1995) Doors and People: Visual and verbal memory after unilateral temporal lobectomy. Neuropsychology9: 464–469.
20.
MuzzioIAKentrosCKandelE (2009) What is remembered? Role of attention on the encoding and retrieval of hippocampal representations. J Physiol587(Pt 12): 2837–2854.
21.
PerryIJCorcoranPFitzgeraldAPet al. (2012) The incidence and repetition of hospital-treated deliberate self harm: Findings from the world’s first national registry. PloS One7: e31663.
22.
ReitanRM (1958) Validity of the trail making test as an indicator of organic brain damage. Perceptual and Motor Skills8: 271–276.
23.
RothschildAJ (1992) Disinhibition, amnestic reactions, and other adverse reactions secondary to triazolam: A review of the literature. J Clin Psychiatry53(Suppl. 12): 69–79.
24.
SchacterDL (1997) Searching For Memory: The Brain, The Mind, and The Past. Revised edition. New York, NY: Basic Books.
25.
ShihH-ILinM-CLinC-Cet al. (2013) Benzodiazepine therapy in psychiatric outpatients is associated with deliberate self-poisoning events at emergency departments—a population-based nested case–control study. Psychopharmacology229: 665–671.
26.
VaivaGPlanckeLDucrocqFet al. (2011) [Telephone calls for suicide attempt to the French emergency call center SAMU/Centre 15: A quantitative indicator of suicidal morbidity in a given health territory at a given period?]. Presse Médicale (Paris, France: 1983)40: 770–772.
27.
VasiliadisH-MNgamini-NguiALesageA (2014) Factorsassociated with suicide in the month following contact with different types of health services in Quebec. Psychiatr Serv66: 121–126.
28.
VerweyBMuntendamAEnsingKet al. (2005) Clinically relevant anterograde amnesia and its relationship with blood levels of benzodiazepines in suicide attempters who took an overdose. Prog Neuropsychopharmacol Biol Psychiatry29: 47–53.
29.
VerweyBvan WaardeJABozdağMAet al. (2010) Reassessment of suicide attempters at home, shortly after discharge from hospital. Crisis31: 303–310.
