Introduction: Previous studies showed that aggression is an important reason to prescribe as-needed medication. The objective of this study was to compare the use of as-needed medication in aggressive and non-aggressive psychiatric patients and to explore patterns of administration of as-needed medication around aggressive incidents.
Methods: An observational study in three psychiatric wards was conducted. Incidence densities of as-needed medication were determined for aggressive and non-aggressive patients and expressed as incidence density ratios [IDRs]. Intensity of as-needed medication used before and following aggressive incidents were determined within a 48-hours time-window.
Results: Aggressive patients had an increased use of both psychotropic and somatic as-needed medication (IDR, 2.5; 95% CI, 2.2-2.7 and IDR, 2.1; 95% CI, 1.8-2.4, respectively). Of the psychotropic medication for aggressive patients, 15% was administered in a time-window of 48 hours around an aggressive incident; in this time-window more as-needed medication was administered following an aggressive incident compared to earlier treatments.
Conclusion: An increased use of both psychotropic and somatic as-needed medication is associated with aggressive behavior. Psychotropic as-needed medication is more frequently administered shortly after an aggressive incident than shortly before. However, more often as-needed medication is administered outside the 48 hours time-window around an aggressive incident.
References
1 Andersen PK, Borgan O. et al .Statistical models based on counting processes. New York: Springer 1997
4
Goedhard LE, Stolker JJ. et al .
Pharmacotherapy for the treatment of aggressive behavior in general adult psychiatry: A systematic review.
J Clin Psychiatry.
2006;
67
((7))
1013-1024
8
Nijman HL, Palmstierna T. et al .
Fifteen years of research with the Staff Observation Aggression Scale: a review.
Acta Psychiatr Scand.
2005;
111
((1))
12-21
10
Stolker JJ, Heerdink ER. et al .
Determinants of multiple psychotropic drug use in patients with mild intellectual disabilities or borderline intellectual functioning and psychiatric or behavioral disorders.
Gen Hosp Psychiatry.
2001;
23
((6))
345-349
11
Thapa PB, Palmer SL. et al .
P. R.N. (As-needed) orders and exposure of psychiatric inpatients to unnecessary psychotropic medications.
Psychiatr Serv.
2003;
54
((9))
1282-1286
12
Whicher E, Morrison M. et al .
As required' medication regimens for seriously mentally ill people in hospital.
Cochrane Database Syst Rev(2).
2002;
CD003441