{
  "abstract": "Background: Z-drugs are alternatives to benzodiazepines (BZDs) for insomnia, but overdose safety remains uncertain. We compared acute and post-discharge outcomes after intentional Z-drug and BZD overdose.\n\nMethods: This retrospective cohort included 239 adults (110 Z-drug; 129 BZD) treated at two emergency departments without flumazenil (2018–2024). Models adjusted for age, sex, dose category, intent, and center.\n\nResults: Compared with BZD overdose, Z-drug overdose was associated with more recorded physical restraint use (adjusted odds ratio [aOR], 6.974; 95% confidence interval [CI], 3.358–14.483), more recorded patient-behavior-related medical interruption events (PB-MIEs; aOR, 5.955; 95% CI, 2.732–12.980), and a longer emergency-department stay (adjusted median difference, 2.516 h; 95% CI, 2.056–2.845), but fewer intensive care unit (ICU) admissions (aOR, 0.092; 95% CI, 0.031–0.272). Among admitted patients, total stay was longer after Z-drug overdose (228 vs 146 h, P < 0.001). The hazard of a first documented anxiety and/or depressive diagnosis was higher after Z-drug overdose (adjusted hazard ratio [aHR], 2.918; 95% CI, 1.928–4.416). Recurrence proportions were similar (25.5% vs 23.3%; log-rank P = 0.426), but timing differed. The recurrence Cox model violated the proportional-hazards assumption; the adjusted HR of 1.266 is descriptive, not a constant relative risk. Among 58 recurrent cases, standard single-dose (SSD) multiples declined and documented intent shifted toward sleep-related dose escalation; this pattern may partly reflect assessment or documentation differences.\n\nConclusion: Z-drug overdose was associated with more recorded behavioral-management events and a higher hazard of first documented psychiatric diagnosis, whereas BZD overdose was associated with more severe supportive-care outcomes. Initial care should integrate mental-status and respiratory monitoring with behavioral and self-harm assessment. Follow-up should address insomnia, medication safety, and mental health. Recurrence timing and intent shifts were documented associations, not causal effects.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Rehabilitation, the Affiliated Suqian Hospital of Xuzhou Medical University",
    "Department of Emergency Medicine, Specialty Center for Poisoning Diagnosis and Treatment, the Affiliated Suqian Hospital of Xuzhou Medical University",
    "Department of Emergency Medicine, Specialty Center for Poisoning Diagnosis and Treatment, Suqian Clinical Medical College of Yangzhou University",
    "Department of Emergency Medicine, Specialty Center for Poisoning Diagnosis and Treatment, Nanjing Drum Tower Hospital Group Suqian Hospital",
    "Suqian Scientific Research Institute of Nanjing University Medical School",
    "Department of Emergency Medicine, the Affiliated Brain Hospital of Nanjing Medical University",
    "Department of Neurology, the Affiliated Brain Hospital of Nanjing Medical University"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0,
        1,
        2,
        3,
        4
      ],
      "name": "Qinqin Liu"
    },
    {
      "affs": [
        1,
        2,
        3,
        4
      ],
      "name": "Chao Wu"
    },
    {
      "affs": [
        1,
        2,
        3,
        4
      ],
      "name": "Liang Gu"
    },
    {
      "affs": [
        5
      ],
      "name": "Beibei Huang"
    },
    {
      "affs": [
        6
      ],
      "name": "Jie Lu"
    },
    {
      "affs": [
        5
      ],
      "name": "Yao Tan"
    },
    {
      "affs": [
        6
      ],
      "name": "Donglin Zhu"
    },
    {
      "affs": [
        1,
        2,
        3,
        4
      ],
      "name": "Ming Sun"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/2033453qw0nyp.bib",
  "cited_by": 0,
  "doi": "10.3389/fpsyt.2026.1991713",
  "fulltext_url": null,
  "id": "2033453qw0nyp",
  "issns": [
    "1664-0640"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1991713/full",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-09",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/2033453qw0nyp.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:23:40Z",
      "native_id": "10.3389/fpsyt.2026.1991713",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1991713/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:1664-0640",
      "subfield": "psychiatry"
    }
  ],
  "title": "From acute presentation to post-discharge outcomes: intentional Z-drug versus benzodiazepine overdose in a retrospective cohort",
  "title_text": "From acute presentation to post-discharge outcomes: intentional Z-drug versus benzodiazepine overdose in a retrospective cohort",
  "type": "peer-reviewed",
  "updated_at": "2026-11-10T00:21:44Z",
  "url": "https://research.draconitic.com/paper/2033453qw0nyp",
  "venue": "Frontiers in Psychiatry",
  "versions": []
}