Aggression of Psychiatric Patients Associated with the Use of As-needed Medication

Abstract

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
• 2 Craig TJ, Bracken J. An epidemiological study of prn/stat medication use in a state psychiatric hospital.  Ann Clin Psychiatry. 1995;  7 ((2)) 57-64
• 3 Craven JL, Voore PM. et al . PRN medication for psychiatric inpatients.  Can J Psychiatry. 1987;  32 ((3)) 199-203
• 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
• 5 Hunter M, Carmel H. The cost of staff injuries from inpatient violence.  Hosp Community Psychiatry. 1992;  43 586-588
• 6 McLaren S, Browne FW. et al . A study of psychotropic medication given ‘as required’ in a regional secure unit.  Br J Psychiatry. 1990;  156 732-735
• 7 Nijman H, Muris P. et al . The staff observation aggression scale-Revised (SOAS-R).  Aggress Behav. 1999;  25 197-209
• 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
• 9 Soliman AE, Reza H. Risk factors and correlates of violence among acutely ill adult psychiatric inpatients.  Psychiatr Serv. 2001;  52 ((1)) 75-80
• 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

Correspondence