Psychopathology and psychosocial causes in adult deliberate self-poisoning in Plovdiv region, Bulgaria

INTRODUCTION: The percentage of deliberate self-poisoning among acute intoxications continues to be high in the medical practice worldwide; in Plovdiv region it reaches 64% of all acute poisoning cases. MATERIAL AND METHODS: A representative retrospective study of 311 acute deliberate self-poisoning cases over 14 years of age, treated in the Regional toxicological center of Plovdiv region between 01.01.1990 and 31.12.1998 was carried out. The following factors were studied: gender, age, type of poisoning, psychiatric diagnosis and psychosocial stressors. The classification criteria of Diagnostic and Statistical Manual--4th edition (DSM-IV) of the American Psychiatric Association were applied. RESULTS: We identified a first attempt of deliberate self-poisoning in 237 patients (71.6%) and a second consecutive attempt in 62 patients (18.7%). Thirty two (9.7%) of the attempts were committed in a state of alcohol intoxication. The percentage of women was statistically significantly higher. The age group of 14-19 years represented the highest percentage (27%). In 168 patients (50.8%) a psychiatric disorder was diagnosed. Adjustment disorder (53.57%) and depressive and schizophrenic disorders (26.79%) were the leading diagnoses among adults committing deliberate self-poisoning. The problems with primary support group (in 61.8% as a single stressor and in 13.71% in combination with other stressors) were the most common psychosocial factors for deliberate self-poisoning. CONCLUSIONS: To reduce the number of adult deliberate self-poisonings, measures including harmonization of the relationships in the primary support group and active treatment of patients with depressive and schizophrenic disorders are needed.