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Does prescribing psychiatric medication really make it less likely that alcohol is involved in a self-poisoning?

Published online by Cambridge University Press:  02 January 2018

Jonathan Chick
Affiliation:
Castle Craig Hospital, and School of Health and Social Care, Napier University, Edinburgh. Email: jonathan.chick@gmail.com
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Abstract

Type
Columns
Copyright
Copyright © The Royal College of Psychiatrists 2017 

Making causal assertions from complex cross-sectional data is risky and may lead to erroneous clinical advice. Although a negative association has been revealed between alcohol ingestion in self-poisoning and taking psychiatric medications (particularly a tricyclic or a typical antipsychotic), Reference Chitty, Dobbins, Dawson, Isbister and Buckley1 individuals who are prescribed these medications may be different from those who are not, even after adjusting in covariate analysis for a generic category of ‘psychiatric diagnosis’. This association even led Chitty et al to speculate that D2 antagonists might reduce the use of alcohol. However, there is evidence to the contrary: flupenthixol led to more drinking when tested in randomised controlled trials (RCTS), Reference Wiesbeck, Weijers, Lesch, Glaser, Toennes and Boening2 and olanzapine caused a similar trend. Reference Guardia, Segura, Gonzalvo, Iglesias, Roncero and Cardus3 In the remaining 10 of 13 RCTs found in a systematic review, antipsychotics did not reduce drinking. Reference Kishi, Sevy, Chekuri and Correll4

Clearly, there are various interpretations of the association that was found. For example, perhaps people who have access to highly sedating and potentially lethal drugs such as tricyclics and antipsychotics can self-poison seriously without recourse to added alcohol.

While Chitty et al raise some interesting questions, we are concerned that those reading the abstract alone might misperceive a role for antipsychotics in drinkers. Suicide rates in people who drink heavily might be best prevented by improving treatment and access to treatment for alcohol use disorders.

References

1 Chitty, KM, Dobbins, T, Dawson, AH, Isbister, GK, Buckley, NA. Relationship between prescribed psychotropic medications and co-ingested alcohol in intentional self-poisonings. Br J Psychiatry 2017; 210: 203–8.CrossRefGoogle ScholarPubMed
2 Wiesbeck, GA, Weijers, HG, Lesch, OM, Glaser, T, Toennes, PJ, Boening, J. Flupenthixol decanoate and relapse prevention in alcoholics: results from a placebo-controlled study. Alcohol Alcohol 2001; 36: 329–34.Google Scholar
3 Guardia, J, Segura, L, Gonzalvo, B, Iglesias, L, Roncero, C, Cardus, M, et al. A double-blind, placebo-controlled study of olanzapine in the treatment of alcohol-dependence disorder. Alcohol Clin Exp Res 2004; 28: 736–45.CrossRefGoogle ScholarPubMed
4 Kishi, T, Sevy, S, Chekuri, R, Correll, CU. Antipsychotics for primary alcohol dependence: a systematic review and meta-analysis of placebo-controlled trials. J Clin Psychiatry 2013; 74: 642–54.Google Scholar
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