الفهرس 
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Abstract
Suicidal attempts are considered one of the most common medical health problems in the world, as they are more frequent than suicide deaths. And they occur noticeably among women, young age groups and among those who suffer from psychological problems, chronic diseases, or difficult living conditions.
This study aims to throw light on the medicolegal aspects of suicide attempts through the assessment of socio-demographic, and the risk factors for suicide. In addition, it showed the most used type of drugs and the extent of their impact on all patients who were admitted to the poisoning control center at Ain Shams University Hospitals to receive medical care during the period from 1/9/2019 to 29/2/2020.
Patients were classified according to the type of the drugs taken by them in their suicidal attempts into the following groups:
group I: Patients who used central nervous system drugs.
group II: Patients who used chest preparations.
group III: Patients who used cardiovascular drugs.
group IV: Patients who used musculoskeletal drugs.
group V: Patients who used endocrine drugs.
group VI: Patients who used analgesics.
group VII: Patients who used a mixture of drugs or drugs with other poisons such as insecticides e.g., organophosphates and carbamates.
group VIII: Patients who used unknown drugs.
The data for all patients were recorded in a data sheet that addressed the following:
1-Sociodemographic data:
It included sex, age, residence, marital status, income level, occupation, educational level, and cause of attempted suicide.
2- Toxicological evaluation:
It included:
History taking:
• Past history of special habits: smoking, alcohol, and drug abuse.
• Past history of psychiatric and chronic illnesses.
• History of previous suicidal attempts if presented.
History of present illness which includes the drug’s name, category, amount, route of administration, location of poisoning, delay time, and the presented symptoms.
General physical examination includes vital signs, skin and mucous membranes and pupils size.
Local examination involved the nervous system, respiratory system, cardiovascular system, and abdominal assessment.
Laboratory investigations varied depending on the type of poison and drug used. Moreover, it included the examination of blood gases and electrolytes, electrocardiography, drug level in the blood, blood glucose level, liver, and kidney function tests.
Treatment of poisoning in the emergency department and the patient department included first aid, elimination by gastric lavage, activated charcoal and dialysis, antidotes that differ according to the type of drug used, and symptomatic treatment of poisoning.
Outcome after treatment included the site of admission and fate of the patients, whether it was a complete recovery, against medical advice (AMA), or death.
3- Medicolegal action against suicidal attempters had been done through psychiatric consultations and police notification in severe cases.
Analysis of the study results concluded that:
1. Socio-demographic assessment:
The number of attempted suicides was 580 cases that accounted for approximately one-third of the total number admitted to the center during the study period (29.44%), out of a total (1970) case. Most of the attempters by drugs were females (77.24%), 19–44-year-old (62.59%), from urban (70.69%), singles (69.31%), had low-income (62.07%), students (51.55%), at university-level (42.59%), and the most common causes of suicide attempts were psychiatric (55.18%) and familial problems (32.59%). There was a significant correlation between these causes and the sex of the patients.
2- Toxicological evaluation:
Most of the cases admitted to the center were those who took a mixture of drugs and poisons (27.24%), most of them had no special habits (87.76%), nor psychiatric diseases (90.52%). And (81.55%) of them did not suffer from chronic diseases nor dependence (97.76%), most of them had never attempted suicide before (86.55%). However, the study revealed an association between the sex and the age of the attempters with the history of special habits and psychiatric diseases. Also, it revealed correlation between history of psychiatric diseases and previous suicidal attempts and depression was the most psychiatric disease among attempters (56.36%).
The home was the most likely place to commit suicide (98.79%), (97.76%) of the tempters took it orally, delay time was 6 to 24 hours after taking the drug (30.69%), and (49.14%) of them suffered from gastrointestinal manifestations.
The clinical examination revealed that (50.17%) of the cases suffered from tachycardia, (59.31%) suffered from tachypnea, and most of the other vital signs and examination of the skin, mucous membranes, pupils, and body systems examination were normal.
For laboratory investigations, theophylline was the most commonly detected drug (30.84%).
Fifty-six-point seventy-two percent (56.72%) of cases were admitted to the inpatient department, while (43.28%) were admitted to the intensive care unit (ICU). (74.31%) of them had complete recovery, (24.14%) refused treatment, and two cases (0.34%) died; one case took cardiovascular drugs while the other took an unknown poison.
3. Medical-legal action:
Nearly (56.57%) of the cases admitted to the intensive care unit were notified by Police. One case was referred to the psychiatric health center for further follow-up.
from this study, we concluded that suicide attempt by drugs is a serious medical health problem affecting the entire community, as it accounts for the majority of cases of poisoning due to the availability of drugs (over-the-counter), which are inexpensive, and easier to obtain in comparison to other means of suicide. The most important risk factors for suicide attempts are the female gender, the young age group, urban residency, low-income, and students, or university level. There is also, a correlation between the sex and the age of the attempters with the history of special habits and psychiatric diseases. In addition, the most causes of suicide attempts are psychiatric and family problems that result from various lifestyle stress.