Intentional Drug Intoxication in Adolescents: Who, When, How and Why?

Background: Self-harm behavior in adolescents is a worrying reality. Understanding the patterns and risk factors underlying Intentional Drug Intoxication (IDI) may help prevent it.

Objective: To characterize IDI cases with prescription drugs in adolescents, managed in the emergency department (ED) of a level II hospital, between 2014 and 2018.

Methods: Retrospective study of IDI in adolescents, ages 12 to 17. Through consultation of medical records, we analyzed patient sociodemographic, time of ingestion, type, number and owner of medication used, management in ED and at discharge, and psychopathology history.

Results: There were 90 episodes of IDI in 85 individuals (71 female). Mean age at first episode was 15 years (similar to median value). Oral intake was the only intoxication route; in 45 cases, only one drug was taken. The most used group of substances were psychiatric drugs (50,4%). In 36.6%, the drug belonged to the patient and was a psychotropic medication. Most episodes occurred during the afternoon and at night, and during spring and winter. The main motivation for drugs intake was family conflict (42,2%), followed by problems in romantic relationships (28,9%). Seventy patients had a psychiatric evaluation before discharge; 4 were admitted to a psychiatric service due to structured suicidal intent. Sixty-three percent had a previous history of psychiatric/psychologic follow-up. Psychopathology or history of addiction was present in 35.3%. In 27,1%, parents were divorced. Seven had a history of institutionalization, and other 16 cases were under social services following.

Conclusion: Immaturity, misjudgment, impulsivity and lack of coping strategies are related to self-harm behavior, including IDI, in adolescents. Most times, there is no apparent structured suicidal intent. Emotional conflicts, social problems and a personal and family history of psychopathology are risk factors for this behavior. It is important to implement preventive measures, as follow-up of risk patients in a pediatric/psychiatric consultation.