Intentional Overdose in a Young Male Patient: Limitations of Current Mental Health Models at the Initial Point of Care for High-Risk Patient Cohorts

<h3><strong>Abstract</strong></h3>\n<p>A male in his early 20‘s presented to the ED of a district hospital within the West Midlands following an intentional mixed overdose of prescribed medications; Citalopram, Chlorpromazine, and Diazepam. Following ingestion of an unknown quantity of these medications at around 2 PM, he was found an hour later in an unresponsive state by family members. The patient reported a separation from their partner preceding the event and had a history of PTSD and extreme anxiety. Post overdose the patient reported significant muscle aches and pains. This combination of drugs placed the patient at an increased for developing Neuroleptic malignant syndrome (NMS). NMS is a life-threatening idiosyncratic reaction associated with exposure to dopamine antagonists, commonly antipsychotics<strong> [1]</strong>  characterized by fever, altered mental status, muscle rigidity, and autonomic dysfunction<strong> [2]</strong>. NMS has been associated with virtually every neuroleptic agent but is more commonly reported with typical antipsychotics <strong>[3]</strong>. There is also a concurrent increase in the risk of developing rhabdomyolysis secondary to the overdose of antipsychotic drugs. Rhabdomyolysis (lysis of skeletal muscle cells) is a potentially lethal syndrome with a broad spectrum of clinical and biochemical findings<strong> [4]</strong>. Antipsychotic use is a risk factor for rhabdomyolysis and seems to be more common in those taking multiple agents<strong> [5]</strong>. This case highlights the potential risk of developing both NMS and rhabdomyolysis in the context of a mixed antipsychotic drug overdose. It highlights the challenges with the assessment of these high-risk patients presenting with self-harm that are assessed by liaison psychiatry teams or models in the United Kingdom.</p>