Acute poisoning and psychological trauma: Bridging emergency care to long-term mental health rehabilitation

Abstract

This review addresses the critical intersection between acute poisoning and the associated psychological trauma, highlighting the need to bridge the gap between emergency care and long-term mental health rehabilitation. The global incidence of acute poisoning varies, showing different demographic patterns in psychological trauma post-poisoning, with suicide attempts accounting for approximately 76% of cases in some cohorts. Additionally, an estimated 385 million unintentional pesticide poisonings occur annually worldwide. A comprehensive understanding of the biological and neurobiological mechanisms involved—along with accurate diagnostic strategies and treatment methods—is essential. Multidisciplinary and integrated care approaches associated with a reduction in all-cause mortality (odds ratio: 0.52) and significant symptom burden relief, along with technological and therapeutic innovations, are essential for improving patient outcomes. Finally, this review outlines policy and research recommendations to enhance integrated care systems for the better management of acute poisoning and its associated psychological trauma.

Key Words: Acute poisoning; Psychological trauma; Emergency care; Long-term rehabilitation; Integrated care

Core Tip: This review examines acute poisoning and linked psychological trauma, stressing the integration of emergency care with long-term mental health rehabilitation. It explores epidemiology, pathophysiology, diagnostics, treatments, and future research directions, aiming to enhance patient outcomes through multidisciplinary and innovative approaches.

INTRODUCTION

Overview of acute poisoning incidents

Acute poisoning remains a major global public health concern. A retrospective analysis of 859 hospitalized patients diagnosed with acute poisoning between 2017 and 2022 showed that suicide attempts/suicide were the leading cause, accounting for 75.9% of cases, and drug-related substances the most common. Among these, drug abuse was implicated in 53.2% of cases[1]. Another study of 493 acute poisoning cases in Nantong City, Jiangsu Province, China, conducted between May 2015 and December 2018, reported that oral exposure was the most common route (84.18%) and pesticide poisoning was responsible for 45.45% of poisoning-related deaths[2].

Neonicotinoid pesticides—among the most widely used insecticides worldwide—also pose considerable health risks. A review of 842 non-occupational human poisoning incidents involving neonicotinoids, recorded in the Incident Data System database of the United States Environmental Protection Agency from 2018 to 2022, revealed four human fatality reports, with moderate poisoning accounting for 88% of cases[3]. These incidents primarily stemmed from residential use. Although specific data on psychological effects of neonicotinoid poisoning are limited to this source, the high prevalence of moderate exposure underscores the potential for psychological distress and trauma among survivors. These findings were similar to trends observed with other toxic substances (see below). Overall, acute poisoning incidents vary widely in terms of causative agents, substances, and routes of exposure. Regardless of the specific agent or cause, the acute poisoning experience—characterized by fear, loss of control, and potential for severe health consequences—constitutes a major psychological stressor. This can result in long-lasting trauma[4,5], highlighting the complex and multifaceted impacts (both physical and psychological) of acute poisoning on public health.

Psychological trauma associated with acute poisoning

Acute poisoning can lead to substantial psychological trauma. A cross-sectional study of 300 smallholder farmers in Costa Rica found that 14% reported experiencing at least one episode of acute pesticide poisoning (APP) during their lifetime[4]. Self-reported APP was associated with neurological symptoms within the 12 months preceding the interview, including fainting [odds ratio (OR): 7.48; 95% confidence interval (95%CI): 1.83-30.74], hand tremors (OR: 3.50; 95%CI: 1.60-7.60), and increased irritability or anger (OR: 2.37; 95%CI: 1.23-4.55).

In another study examining 786 cases of acute carbon monoxide (CO) poisoning in Taiwan Province, China, patients with intentional CO exposure demonstrated a significantly higher risk of neurological sequelae[5]. Intentional CO poisoning was associated with factors such as tranquilizer use (OR: 3.89; 95%CI: 1.94-7.77), myocardial injury (OR: 1.70; 95%CI: 1.03-2.82), and a Glasgow Coma Scale score of less than 9 (OR: 4.05; 95%CI: 2.32-7.08). These findings indicate that acute poisoning can result in persistent neurological symptoms and long-term psychological effects on survivors.

Importance of bridging emergency care and long-term mental health rehabilitation

Bridging emergency care with long-term mental health rehabilitation is essential for patients with acute poisoning. A nominal group study involving stakeholders from health, law enforcement, ambulance, and consumer agencies identified potential models of care for individuals with mental health concerns in acute healthcare settings[6]. These models emphasized the need for a skilled, collaborative approach, consumer-centered services, and enhanced mental health literacy.

In emergency-affected regions—particularly low- and middle-income countries—opportunities exist to improve mental health systems during emergencies[7]. Ten case studies from diverse settings, including Afghanistan, Burundi, and Indonesia, demonstrated that adopting a long-term perspective for mental health reform from the outset can result in substantial and sustainable improvements. For patients with acute poisoning, ensuring a seamless transition from emergency treatment to long-term mental health support can enhance overall recovery and quality of life.

EPIDEMIOLOGY OF ACUTE POISONING AND PSYCHOLOGICAL TRAUMA

Global incidence and prevalence of acute poisoning

The global incidence of acute poisoning varies according to the region and demographic group. A study in Qatar reported an incidence of 178 cases per 100000 individuals between 2015 and 2019, with females (56%) and children under the age of 14 years (44.3%) accounting for the largest proportion[8]. Most cases of exposure were accidental and involved therapeutic agents (64.2%).

In China, a retrospective analysis of 2867 patients treated at an emergency center between 2004 and 2009 showed that alcohol poisoning was the most prevalent cause (54.55%), followed by medication-related poisoning (25.95%)[9]. The incidence of acute poisoning peaked in January each year. An estimate based on a systematic review suggests that approximately 385 million cases of unintentional pesticide poisoning occur annually worldwide, including approximately 11000 fatalities[10]. These findings highlight the substantial global burden of acute poisoning and the need for targeted prevention and treatment strategies.

Demographic patterns in psychological trauma post-poisoning

Psychological trauma is a common and often underrecognized consequence of poisoning. In a Chinese study involving 6837 snakebite victims, 79.5% reported symptoms of post-traumatic stress disorder (PTSD), and 81.4% reported depressive symptoms—underscoring the widespread mental-health sequelae of snakebite[11]. Early substance use, including alcohol and tobacco, has been linked to an increased risk of PTSD. Research has shown that early exposure to these substances increases the likelihood of developing PTSD, possibly because early poisoning increases the chance of subsequent traumatic events or because self-medication with these substances raises vulnerability[12]. During the coronavirus disease 2019 pandemic, increased psychological stress has led to an increase in intentional poisoning incidents among children, further illustrating the complex bidirectional relationship between mental health problems and poisoning events[13]. Emerging cognitive screening and follow-up protocols, such as those developed for the Guangdong-Hong Kong-Macao Greater Bay Area[14], may offer valuable insights for assessing and managing post-poisoning psychological trauma.

Risk factors for long-term mental health issues

Multiple risk factors contribute to long-term mental health conditions following acute poisoning. A study of patients with severe psychiatric disorders found that victimization was common, and factors such as younger age, unemployment, single or divorced marital status, Indigenous ethnicity, and lower socioeconomic status were associated with the development of new mental health conditions after trauma.

A study conducted among female sex workers in Nairobi, Kenya, reported that recent hunger (OR: 1.99; 95%CI: 1.37-2.88) and recent violence from non-intimate partners (OR: 2.23; 95%CI: 1.55-3.19) were significantly associated with mental health problems[15]. These socioeconomic vulnerabilities are further supported by Mendelian randomization analyses, which demonstrated that lower educational attainment—a proxy for socioeconomic disadvantage—increases the risk of suicide attempts through mediating pathways, including depression (49%), smoking (47%), and chronic pain (36%)[16]. Understanding these risk factors is essential for early identification and intervention to prevent long-term mental health complications in patients with acute poisoning.

PATHOPHYSIOLOGY OF ACUTE POISONING AND PSYCHOLOGICAL TRAUMA

Biological mechanisms of acute poisoning

Biological mechanisms underlying acute poisoning are complex and vary depending on the toxicant involved. Lipid peroxidation plays an important role in the development of acute methanol poisoning[17]. Two years after discharge, the concentrations of lipid peroxidation markers—such as trans-4-hydroxy-2-hexenal, 4-hydroxynonenal (HNE), and malondialdehyde—remained higher in previously intoxicated patients compared to survivors. The maximum acute serum concentrations of HNE were 71.7 ± 8.0 ng/mL vs 35.4 ± 2.3 ng/mL at the follow-up (P < 0.001).

In cases of acute diquat poisoning, metabolomic analysis of rat brain tissue identified key pathways involved in toxin-induced brain injury[18]. In the high-dose group, 24 metabolites showed significant differences compared to the controls, particularly in two key pathways: Phenylalanine, tyrosine, and tryptophan biosynthesis, and the pentose phosphate pathway, both of which are implicated in brain injury. These findings provide insights into the biological processes underlying acute poisoning.

Neurobiological impact of psychological trauma

Psychological trauma has profound neurobiological effects. Early exposure to traumatic stressors, such as early life trauma (ELT), impairs emotional brain circuitry[19]. In a study of 352 healthy adolescents, greater exposure to ELT was significantly associated with smaller amygdala volume and reduced cortical thickness in the rostral anterior cingulate cortex.

Childhood trauma can also affect autobiographical memory deficits, mediated by changes in basal cortisol and prefrontal-extrastriate functional connectivity[20]. In a study of 100 healthy individuals, childhood trauma, assessed using the Childhood Trauma Questionnaire (CTQ), was associated with lower basal cortisol levels and increased functional connectivity between the lateral and anteromedial prefrontal and extrastriate cortex. This increased connectivity mediated the relationship between CTQ and semantic-associated memory—a retrieval tendency toward semantic content without specific contextual details of an experienced event. Recent research further supports the long-term neurobiological effects of adverse childhood experiences, highlighting their association with dementia risk among individuals with long-term abnormal body mass index trajectories[21].

Bidirectional interactions: poisoning, psychological stress responses, and exacerbated outcomes

The interplay between acute poisoning and psychological stress is both bidirectional and synergistic, forming a vicious cycle that significantly worsens patient outcomes. Poisoning acts as a severe physiological and psychological stressor, potently activating the body's stress response systems, particularly the hypothalamic-pituitary-adrenal (HPA) axis. Conversely, pre-existing or concurrent psychological stress can dysregulate the HPA axis, amplify inflammatory pathways, impair detoxification and repair mechanisms, and increase vulnerability to toxic insults.

Research has shown that this interaction is strong. Muneer et al[22] showed that a combination of mild traumatic brain injury (a physical insult) and alcohol (a toxin) synergistically induced profound psychological symptoms, including depression and anxiety. This stress response exacerbated core pathological processes, including oxidative stress, amyloidogenesis, tau pathology, neuroinflammation, neurodegeneration, glial activation, and blood-brain barrier damage. Biochemical markers of stress dysregulation were evident, including reduced 5-HT1AR receptor, neuropeptide-Y, and norepinephrine, alongside increased monoamine oxidase-A, directly linking the psychological stress to worsened neuropathology. Similarly, Huang et al[23] provided human-based evidence that acute psychological stress disrupts immune function by altering LPS-stimulated TNF-α and IL-6 mRNA expression. These findings are highly relevant to poisoning, suggesting that the psychological stress resulting from the poisoning event may similarly dysregulate the immune responses to the toxin, potentially amplifying organ damage.

Central to this interaction is dysregulation of the HPA axis. Toxins can disrupt the HPA axis directly via neurotoxicity. Simultaneously, the psychological trauma of the event potently activates the HPA axis, leading to cortisol release. Chronic or severe stress may result in HPA dysfunction, either excessive or prolonged cortisol secretion or blunted responsiveness (as seen in some trauma profiles[20]). Both states promote systemic inflammation, metabolic dysregulation, and neuronal vulnerability, which in turn predispose individuals to long-term neuropsychiatric outcomes, such as depression, PTSD, and cognitive decline[24]. Furthermore, psychological stress may impair hepatic detoxification pathways and cellular repair mechanisms, thereby delaying recovery from the initial toxic insult. Individuals with pre-existing vulnerabilities outlined in Section 2.3—such as low socioeconomic status, prior trauma, and mental health conditions[15]—likely exhibit heightened susceptibility to this deleterious cycle due to baseline HPA or immune dysregulation or reduced resilience. Understanding and interrupting this bidirectional poisoning-stress interaction is, therefore, critical for promoting acute recovery and preventing chronic complications.

DIAGNOSTIC APPROACHES IN ACUTE POISONING AND PSYCHOLOGICAL TRAUMA

Emergency diagnostic techniques for acute poisoning

Accurate and timely diagnostic techniques are crucial in the emergency management of acute poisoning. A study conducted at a hospital in Taiwan demonstrated that systematic toxicological analysis (STA) could alter the diagnosis of poisoning cases[25]. Of the 588 patients assessed following the initiation of the Intoxication Analysis Service, STA or hospital-based toxicological tests confirmed the diagnosis in 84.4% of cases. Among the patients diagnosed with toxin poisoning based on clinical history, only 83.6% matched the STA results.

The development of multi-analyte approaches can also help assess the severity of acute poisoning. A multi-analyte liquid chromatography-tandem mass spectrometry (LC-MS/MS) method with a 5-minute gradient was developed and validated to detect 45 drugs and their active metabolites[26]. The determination ranges were defined by quality control samples, and one-point calibration was used to shorten the turnaround time. This approach, in combination with gas chromatography-mass spectrometry, can provide sufficient support for clinical evaluation of poisoning severity.

Psychological assessment tools for post-poisoning trauma

Several psychological assessment tools are available for post-poisoning trauma patients. The New York PTSD Risk Score is a multifactor prediction tool that includes a Primary Care PTSD Screen, depression symptoms, access to care, sleep disturbance, trauma history, and demographic variables[27]. It is effective in predicting PTSD among patients seen in healthcare settings, with an area under the receiver operating characteristic curve of 0.943 when care status, sleep disturbance, depression, and trauma exposure are added to the primary-care PTSD screen.

Psychosocial screening instruments for physical trauma patients (PSIT) have also been developed and psychometrically examined[28]. In a study of 1448 adult patients with trauma, the PSIT showed good test-retest reliability (intraclass correlation coefficient: 0.86) and identified three subscales: Negative effects, anxiety and post-traumatic stress symptoms, and social and self-image. These tools can aid in early identification and appropriate management of psychological trauma following acute poisoning.

Integrative diagnostic models for combined care

Integrative diagnostic models for combined care aim to provide comprehensive assessments. In Singapore, an integrated, collaborative healthcare model for the early diagnosis and management of dementia involves a multidisciplinary memory clinic[29]. The majority of patients (93.5%) had their memory-related problems managed within the memory clinic, without requiring escalation to other specialist services. This model integrates family medicine-based services with geriatric psychiatric expertise and community-based partnerships.

Another approach is the person-centered integrative diagnosis model, which evaluates health status, health experiences, and contributory factors[30]. Each domain is assessed using standardized categories, multiple dimensions, and narrative inputs. This model emphasizes the role of evaluators and the interactive nature of the diagnostic process. Such models can improve the diagnosis and management of patients experiencing acute poisoning along with associated psychological trauma.

TREATMENT STRATEGIES FOR ACUTE POISONING AND PSYCHOLOGICAL TRAUMA

Immediate medical interventions for acute poisoning

Immediate medical intervention is crucial in the management of acute poisoning. A case study of acute 1, 2, 3-trichloropropane poisoning demonstrated that hemoperfusion and plasma exchange contributed to clinical improvement[31]. After receiving these treatments, the clinical condition and laboratory values of the patients gradually improved.

Activated charcoal (AC) is commonly used to treat acute oral poisoning. However, a Cochrane review revealed that the evidence for its effectiveness in prehospital settings was mostly of low to very low certainty[32]. In some studies, uncertainty remained regarding whether a single-dose AC significantly affected the incidence of adverse events, intensive care unit admission, or clinical deterioration when compared with no intervention, particularly in participants with mixed-type or paracetamol poisoning. These findings underscore the need for further research to clarify optimal immediate medical interventions for acute poisoning.

Psychological interventions for trauma management

Psychological interventions in trauma management can help patients recover from the psychological effects of acute poisoning. A systematic review and meta-analysis of multiple-session early psychological interventions for the prevention of PTSD reported that some interventions may be more effective than usual care is in reducing PTSD diagnosis at 3-6 months follow-up [relative risk (RR): 0.62; 95%CI: 0.41-0.93; I²: 34%; studies: 5; participants: 758]. However, the certainty of the evidence was low due to a high risk of bias in the included trials[33].

In a study of children and adolescents exposed to trauma, psychological therapies—particularly cognitive behavioral therapy—were effective in reducing the likelihood of PTSD diagnosis and alleviating its symptoms in the short term[34]. The OR for being diagnosed with PTSD was 0.51 (95%CI: 0.34-0.77) for those who had received psychological therapy compared with the controls, and the standardized mean difference for PTSD symptoms was -0.42 (95%CI: -0.61 to 0.24) up to one month after therapy.

Mitincu-Caramfil et al[35] conducted a three-year (2021-2023) quasi-experimental study in a Romanian psychiatric ward involving 147 inpatients with alcohol dependence comorbid with depression or anxiety. The study systematically compared the procedures and outcomes of short- and long-term psychological intervention protocols. Both groups demonstrated significant reductions in alcohol use and depressive and anxiety scores at discharge and 3-6 months post-discharge (P < 0.001). The long-term group showed a significantly greater reduction in GAD-7 scores at 3 months compared to the short-term group (Δ = -6.4 vs -4.1, P = 0.018), with 87% completing all outpatient follow-ups and no serious adverse events reported. (1) Short-term protocol (2-3 weeks, intensive inpatient care): Within the first two weeks of admission, patients received a two-step package combining motivational interviewing (MI) and “mini” cognitive-behavioral therapy (CBT). A clinical psychologist first delivers a 60-minute bedside MI session to address ambivalence regarding quitting alcohol consumption and collaboratively setting feasible goals. Subsequently, four 45-min acute-phase CBT sessions were held on alternate days. These CBT sessions targeted high-risk situations, cognitive restructuring, coping strategies, and drink-refusal rehearsals to rapidly reduce cravings and emotional instability. A 30-minute family meeting was also conducted to develop a post-discharge crisis plan. The entire sequence was replicated in the standard psychiatric ward; and (2) Long-term protocol (3-6 months, extended care): This approach Built upon the short-term content, and extended care for 3-6 months. During the inpatient phase, four additional in-depth CBT sessions (addressing post-trauma drinking beliefs and emotion regulation) and two multifamily group sessions were added. After discharge, patients received weekly 50-min individual CBT (deliverable online) and monthly group therapy (8-10 participants) supplemented with naltrexone or acamprosate, as prescribed. Daily completion of a “mood-drinking diary”, use of progressive muscle relaxation audio, and implementation of a traffic-light (“red-yellow-green”) relapse-prevention plan were required. The 3-month follow-up indicated a significantly greater reduction in anxiety symptoms compared to the short-term group, making this protocol suitable for individuals at high risk of relapse or with severe comorbidities (Table 1).

Table 1 Comparison of short-term vs long-term psychological intervention protocols for in-patients with alcohol dependence and comorbid depression/anxiety.

Dimension	Long-term protocol	Short-term protocol
Total duration	2-3 weeks (entirely within hospital)	3-6 months (in-hospital + post-discharge extension)
Target population	Mild-to-moderate symptoms, first admission, good social support	Severe/complex comorbidity, high relapse risk
Core modules & frequency	Motivational interviewing 1 × 60 minutes within 48 hours of admission; acute-phase CBT 4 × 45 minutes (every other day); single 30-minute family crisis-planning session	All short-term components; Additional in-depth CBT 4 × 50 minutes (late hospital phase); multi-family group therapy 2 × 90 minutes; post-discharge: Weekly 50 minutes individual CBT (can be online); monthly 90-minute group therapy
Technical focus	Explore ambivalence, goal-setting, high-risk situation identification, coping cards, drink-refusal rehearsal	Reconstruct post-trauma drinking beliefs, emotion regulation, family-system interventions, relapse-chain analysis
Pharmacological adjunct	Short-course benzodiazepines if necessary	Naltrexone or acamprosate maintenance
Homework/tools	Discharge crisis plan	Daily “mood-drinking” diary, progressive muscle-relaxation audio, traffic-light relapse-prevention plan (red-yellow-green)
Follow-up points	At discharge + one telephone call	1 week, 1-, 3-, and 6-month post-discharge
Key outcome indicators	Reduced craving, emotional stabilization, safe discharge	Additional significant GAD-7 reduction (Δ -6.4 vs -4.1, P = 0.018), 87% complete follow-up, no serious adverse events

CBT: Cognitive-behavioral therapy.

Multidisciplinary approaches to integrated care

Multidisciplinary approaches to integrated care are increasingly recognized for their effectiveness. A systematic review and meta-analysis examining multidisciplinary integrated care for patients with atrial fibrillation demonstrated that it was associated with a decrease in all-cause mortality (OR: 0.52; 95%CI: 0.36-0.74; P = 0.0003) and cardiovascular hospitalizations (OR: 0.66; 95%CI: 0.49-0.89; P = 0.007)[36].

In the management of functional gastrointestinal disorders, a matched cohort study showed that a multidisciplinary integrated treatment approach delivered through a dedicated integrated care clinic (ICC) was superior to the standard model of care[37]. Patients in the ICC had a greater reduction in gastrointestinal symptom burden, with a mean reduction in the Structured Assessment of Gastrointestinal Symptoms Scale total score of -9.7 (95%CI: -13.6 to 5.8; P < 0.0001) compared to a -1.7 reduction (95%CI: -4.0 to 0.6; P = 0.15) in the controls.

FUTURE DIRECTIONS IN ACUTE POISONING AND PSYCHOLOGICAL TRAUMA CARE

Innovations in emergency medical technologies

Innovations in emergency medical technologies are emerging to improve the management of acute poisoning and trauma. In low- and middle-income countries, emergency medical dispatch (EMD) systems, which utilize telecommunications technologies, are crucial for coordinating emergency responses[38]. After training and equipping layperson-first responders, EMD can enhance the coverage and effectiveness of emergency care.

Technologies for interoperable Internet of Medical Things platforms are also being developed to support prehospital and home-based care[39]. Commonly used technologies in these systems include cloud computing (63%), representational state transfer application programming interfaces (57%), and Wi-Fi (57%). However, lower levels of interoperability were focused on, and technologies that support higher interoperability levels, such as blockchain (7%), are less frequently reported.

Advances in psychological therapies for trauma

Significant advances have been made in psychological therapy for trauma. Internet-based cognitive and behavioral therapies (I-C/BT) for adults with PTSD are currently being explored[40]. A systematic review reported that, compared with a wait list, I-C/BT may be associated with a clinically meaningful reduction in PTSD post-treatment (SMD: -0.61; 95%CI: -0.93 to 0.29; studies: 10; participants: 608). However, the certainty of the evidence remains low due to the limited number of trials.

Digital interventions based on cognitive sciences are also gaining traction. For example, digital games are being evaluated for their potential to reduce intrusive memories of trauma. Novel cognitive techniques targeting worry and digitally supported mental imagery aimed at enhancing motivation for functional behavioral change are also under investigation[41].

Dialectical behavior therapy has also shown promise in treating trauma-related symptoms in adolescents, with studies demonstrating its efficacy in reducing self-injurious behaviors and improving emotion regulation in inpatient settings[42]. These emerging therapies have the potential to complement the existing face-to-face interventions.

Policy and research recommendations for integrated care systems

Policy and research recommendations for integrated care systems aim to improve the management of acute poisoning and associated psychological trauma. A Delphi consensus study conducted in the United Kingdom proposed a multidisciplinary team-based model to deliver integrated care for individuals with complex multisystem conditions, such as long coronavirus disease and complex multiple chronic conditions[43]. Key recommendations included resources allocation to support integrated care, providing access to care and treatment, and enabling structured consultations between primary and specialist care settings.

In the context of integrated care research, there is a need for more emergent, patient-centered approaches[44]. Current research methodologies require enhancement to better understand the complex nature of integrated care and its impact on patients. This includes conducting more in-depth studies on the experiences and needs of patients as well as evaluating the long-term effectiveness of integrated care models.

CONCLUSION

Acute poisoning represents a major global public health burden, often resulting from intentional acts such as suicide attempts (approximately 76% in key cohorts)[1] and involving a wide range of toxic agents. Unintentional pesticide poisoning alone is estimated to account for 385 million cases annually[10]. Critically, this review demonstrates that acute poisoning is not limited to transient physical crises but also profoundly interconnects with substantial psychological trauma[4,5]. Pathophysiological evidence reveals bidirectional interactions between toxic injury and stress responses, mediated by neuroendocrine dysregulation (e.g., of the HPA axis) and neuroinflammation[22,23]. These mechanisms contribute to a malignant cycle that exacerbates complications and increases the risk of long-term sequelae. Addressing this dual burden requires integrated strategies such as the concurrent application of poisoning diagnostics (e.g., STA[25]) and trauma assessments (e.g., New York PTSD Risk Score[27]) within continuous care pathways. Treatment must combine antidotal interventions with timely psychological support (e.g., CBT[32]) to prevent PTSD and mitigate stress responses. Multidisciplinary models have proven effective in related contexts[36,37]. Future advancements require: (1) Policy action: Implement emergency department-based psychological screening and seamless referral pathways for rehabilitation and fund integrated care infrastructure[43]; and (2) Research priorities: Clarify toxin-specific psychotrauma mechanisms, validate the long-term outcomes of integrated care, and develop acute-phase stress resilience protocols[33]. Current research on the management of acute poisoning and associated psychological trauma remains limited in several key ways: Most evidence comes from small, single-center retrospective cohorts with poor generalizability; incomplete case registration and loss to follow-up systematically underestimate true prevalence and long-term psychological outcomes; the reliability and validity of commonly used severity scores such as the Poisoning Severity Score continue to be questioned; there is no standardized protocol for treating PTSD, anxiety or depression after acute poisoning, and the efficacy and safety of psychological or pharmacological interventions await confirmation by high-quality RCTs; data on special populations—children, older adults and those with comorbid psychiatric disorders—are particularly scarce. Bridging acute care and mental health rehabilitation is indispensable for mitigating interconnected harm. A holistic integrated approach underpinned by targeted research and policy reform is the key to transforming survival outcomes.