Self-poisoning with paracetamol is the most frequently used overdose method in the UK. Psychosocial assessments were conducted by mental health clinicians with 127 consecutive individuals who presented with pure paracetamol overdoses to a large general hospital over 8 months, including asking about the source of the tablets and scoring the patients’ acts on the Beck Suicide Intent scale (BSI). Patients were predominantly female (86%) and young (79% aged 12–24 years). Most had used paracetamol which was available in the home (77%). Those who purchased paracetamol for the act took double the number of tablets compared with those who used paracetamol available in the home (37 v. 18), had higher suicidal intent (mean BSI: 11 v. 7) and more often required treatment with N-acetyl cysteine (71% v. 43%). These results highlight the need for safer home storage of paracetamol and consideration of reducing pack size limits on paracetamol that can be purchased.

Purpose – This study reports on a project to monitor deliberate self-poisoning in a rural area of Northern Ireland over a 20-year period. Comparison is made with reports from large urban centres. In addition, a local prescribing database allows assessment of any association between psychotropic drug prescription and use for deliberate self-poisoning. Materials and methods – Frequency of self-poisoning, demographic details and drugs used were recorded for all episodes of deliberate self-poisoning occurring at Craigavon Area Hospital for the years 1976, 1986, 1991 and 1996. It was possible to compare prescriptions of psychotropic drugs with their use for deliberate self-poisoning between the years 1991 and 1996 in the region served by the hospital, using the Defined Daily Dose (DDD) system. Results – In this rural area the pattern of deliberate self-poisoning has changed, as in urban centres, with a rise in frequency and the male/female ratio approaching unity. The pattern of drug use has altered, with paracetamol overtaking benzodiazepines as the most commonly used agent. More recently, antidepressants have become the second most frequently used drug class for this purpose. Psychotropic medications used for self-poisoning altered in proportion to their prescription between the years 1991 and 1996. Conclusions – In the face of a continuing rise in deliberate self-poisoning, which is effecting both urban and rural areas, care should be taken to prescribe the least toxic agent available as this is associated with likely frequency of self-poisoning for most classes of psychotropic drug.

The optimisation of nutritional support for the growing number of older individuals does not usually take into account medication. Paracetamol (acetaminophen; APAP) is the first intention treatment of chronic pain that is highly prevalent and persistent in the elderly. Detoxification of APAP occurs in the liver and utilises sulfate and glutathione (GSH), both of which are issued from cysteine (Cys), a conditionally indispensable amino acid. The detoxification-induced siphoning of Cys could reduce the availability of Cys for skeletal muscle. Consequently, APAP could worsen sarcopenia, an important component of the frailty syndrome leading to dependency. The present review provides the rationale for the potential pro-sarcopenic effect of APAP then recent results concerning the effect of chronic APAP treatment on muscle mass and metabolism are discussed. The principal findings are that chronic treatments with doses of APAP comparable with the maximum posology for humans can increase the requirement for sulfur amino acids (SAA), reduce Cys availability for muscle, reduce muscle protein synthesis and aggravate sarcopenia in animals. One clinical study is in favour of an enhanced SAA requirement in the older individual under chronic treatment with APAP. Few clinical studies investigated the effect of chronic treatment with APAP combined with exercise, in nutritional conditions that probably did not affect Cys and GSH homeostasis. Whether APAP can aggravate sarcopenia in older individuals with low protein intake remains to be tested. If true, nutritional strategies based on enhancing Cys supply could be of prime interest to cut down the pro-sarcopenic effect of chronic treatment with APAP.

Ireland’s suicide rate is falling, but suicide and self-harm remain substantial societal problems. It is not possible to predict suicide at the level of the individual but good primary care, good mental health care and good social care all likely reduce risk. In terms of targeted interventions, public health measures, such as paracetamol pack size regulations, have the best evidence base to support them. Despite increased public and professional discussion, much remains to be done to provide effective, coordinated support to those at risk of suicide and those bereaved. In 2016, there were up to 300 different groups providing support. Clearly, a coordinated, effective and compassionate approach is needed, linking community and state resources meaningfully with each other. Approaches rooted outside of core mental health services will be vital: addressing alcohol problems and other addictions, reducing homelessness, reforming the criminal justice system and improving social care.

Introduction: Haemodynamically significant patent ductus arteriosus is a significant cause of morbidity and mortality in pre-term infants. This retrospective study was conducted to investigate the usefulness of lower-dose paracetamol for the treatment of patent ductus arteriosus in pre-term infants. Materials and Methods: A total of 13 pre-term infants who received intravenous paracetamol because of contrindications or side effects to oral ibuprofen were retrospectively enrolled. In the first patient, the dose regimen was 15 mg/kg/dose, every 6 hours. As the patient developed significant elevation in transaminase levels, the dose was decreased to 10 mg/kg/dose, every 8 hours in the following 12 patients. Echocardiographic examination was conducted daily. In case of closure, it was repeated after 2 days and when needed thereafter in terms of reopening. Results: A total of 13 patients received intravenous paracetamol. Median gestational age was 29 weeks ranging from 24 to 31 weeks and birth weight was 950 g ranging from 470 to 1390 g. The median postnatal age at the first intravenous paracetamol dose was 3 days ranging from 2 to 9 days. In 10 of the 13 patients (76.9%), patent ductus arteriosus was closed at the median 2nd day of intravenous paracetamol ranging from 1 to 4 days. When the patient who developed hepatotoxicity was eliminated, the closure rate was found to be 83.3% (10/12). Conclusion: Intravenous paracetamol may be a useful treatment option for the treatment of patent ductus arteriosus in pre-term infants with contrindication to ibuprofen. In our experience, lower-dose paracetamol is effective in closing the patent ductus arteriosus in 83.3% of the cases.

The objective was to explore the feasibility of prospective recruitment of general practice patients to a future trial on the effects of paracetamol on the symptoms of the common cold. In October 2000, recruitment letters were sent by a general practitioner to 276 patients aged between 18 and 75. 65 patients returned signed consent forms. Postal packs were sent to the first 60 of these patients to reply. They contained a daily diary, symptom score questionnaires, an EQ-5D questionnaire, a pack of paracetamol tablets, and detailed instructions. When a cold developed and symptoms reached a specified level, one gram of paracetamol was taken four times daily for two days and questionnaires were completed for four days. Telephone interviews and crosschecking of data were used to identify difficulties in completing the study. The overall recruitment rate was 24% (65/276) with 95% confidence interval 19% to 29%. Recruitment was significantly higher (p < 0.001) amongst patients registered with the main researcher (43% (29/68)) than with other doctors in the practice. The response rate, i.e., those who returned completed study packs, was 77% (46/60). Thirty participants experienced a cold and returned their data during the six months of the study, representing 50% (30/60, 95% Cl 37% to 63%) of participants and 11% (30/276, 95% Cl 7% to 15%) of those initially approached. The mean cumulative four-day symptom score was 34.6, standard deviation 14.7. The EQ-5D health status on day four was 0.89. We conclude that a prospective postal recruitment method in general practice is a potentially useful method of conducting research on the common cold. A better response is obtained when the initial letter is signed by the patient's own doctor.

In a randomized double-blind study, 60 children, aged 4–7 years, undergoing dental extractions of six or more teeth under day-case general anaesthesia, were assigned to receive either tramadol drops 1.5 mg kg−1 (n=31), or placebo (normal saline) (n=29), 30 min before surgery. In addition, all received anxiolytic premedication of oral midazolam 0.5 mg kg−1 (max7.5 mg) at the same time. No differences were seen in behaviour, respiratory or cardiovascular assessments. In both groups, 93% were drowsy preanaesthetic, 3% were asleep but rousable and less than 4% exhibited minor distress. At induction, mild weeping occurred in 9.7% of the tramadol group and 6.9% of the placebo group (p>0.05). Active awake recovery took 48.8 min, SD 32.6 in the tramadol group and 36.4 min, SD 29.6 in the placebo group (p>0.05). Post-operative analgesia (paracetamol 120 mg) was given to 19.4% of the tramadol group compared with 82.8% of the placebo group (p>0.05), after which the Hannalah objective pain scale scores were comparable. Analysis of the Oucher six faces pain scale showed significantly better analgesia in the tramadol group at all time points, the pain score being half that of the placebo group at 60 min and one third from 60 to 120 min (p>0.05). No adverse respiratory or cardiovascular effects were seen. For children undergoing multiple extractions, 10.7, SD 3.0, effective postextraction analgesia was provided.

Dopamine decreases gastric tone and may therefore influence gastrointestinal motility. The aim of this investigation was to study the effects of a continuous infusion of dopamine on gastric emptying and orocaecal transit time. Nine healthy male volunteers were studied on two occasions in a randomized order. All volunteers received on separate days a continuous infusion of dopamine 5 μg kg−1 min−1 on one occasion and normal saline on the other occasion. Gastric emptying was measured by the paracetamol absorption test and orocaecal transit time by the hydrogen breath test. During the dopamine infusion the area under the paracetamol concentration curve was significantly smaller than during control conditions (P=0.02). Orocaecal transit time was prolonged during the dopamine infusion (P=0.02). Dopamine delays gastric emptying and prolongs orocaecal transit time.