Does the use of antipsychotics increase when coercion decreases in a general psychiatric ward?

Background
Antipsychotic medication is known to contribute to cardio-vascular disease and reduced life expectancy in patients with severe mental disorders. Our hypothesis is that reduction of coercion might lead to unwanted increase in doses of psychotropic medication.
Aims
To evaluate type and doses of psychotropic prescriptions during intervention to reduce coercion in a general psychiatric ward.
Methods
Cohort study of patients in risk of agitation and coercion admitted to a general psychiatric ward during rst half of 2013 (baseline) and of 2016 (intervention). Eligible patients were diagnosed as having organic mental disorders, substance abuse, psychotic disorders, mania, bipolar affective disorder or personality disorders (ICD-10: F0x, F1x, F2x, F30-31, F60). Primary outcome is exposure to antipsychotic medication measured and summarized in WHO de ned daily doses. Cohorts are compared by Wilcoxon Rank sum test.
Results
In total 304 admissions with relevant diagnoses were screened for eligibility (174 from 2013 and 134 from 2016). Hereof 192 were included in the further analyses (89 respectively 103 admissions). Exclusions were due to insuf cient prescription history (12 resp. 11), or one-day admissions for electroshock treatment (73 resp. 20). Among the included patients psychotic disorders (F2x) was the most common primary diagnosis (57 resp. 46%), followed by personality disorders (15 resp. 20%), bipolar affective disorder (11 resp. 16%), substance abuse (17 resp. 16%) og organic mental disorders (0 resp. 3%).
Number of coercive measures during the intervention period were: 2 episodes of mechanical restraint (Difference from baseline -80%), and 3 episodes of forcibly given medication (-50%).
During the intervention period (2016) mean total dose of antipsychotics across all diagnoses was 1.51DDD (Interquartile range (IQR) 0.68-2.72).
Comparison between cohorts 2013 and 2016 did not reveal any signi cant difference in mean total dose of antipsychotics (Diff -0.23 DDD, p=0.44).
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Quetiapine was the most frequently used antipsychotic drug in xed dosing (38%), followed by olanzapine (22%), risperidone (18%) and clozapine (15%). In exible dosing the most frequently used antipsychotic drug was also quetiapine (50%) followed by olanzapine (27%) and chlorprothixene (17%).
Conclusions
Reduction in coercive measures at the Department of Psychiatry in Aabenraa has not lead to an increase in antipsychotic medication. The majority of prescribed drugs and doses were within recommendations.