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

Mikkel Højlund, Lene Høgh, Povl Munk-Jørgensen, Elsebeth Stenager

Publikation: Bidrag til bog/antologi/rapport/konference-proceedingKonferenceabstrakt i proceedingsForskningpeer review

Resumé

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).
265
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.
OriginalsprogEngelsk
TitelViolence in Clinical Psychiatry : Proceedings of the 10th European Congress on Violence in Clinical Psychiatry
Udgivelses stedThe Netherlands
ForlagOud Consultancy
Publikationsdato2017
Sider264-265
Kapitel8
ISBN (Elektronisk)978-90-827096-0-5
StatusUdgivet - 2017
Begivenhed10th European Congress on Violence in Clinical Psychiatry - Dublin, Irland
Varighed: 26. okt. 201728. okt. 2017
http://www.oudconsultancy.nl/dublin_10_ECVCP_2017/index.html

Konference

Konference10th European Congress on Violence in Clinical Psychiatry
LandIrland
ByDublin
Periode26/10/201728/10/2017
Internetadresse

Citer dette

Højlund, M., Høgh, L., Munk-Jørgensen, P., & Stenager, E. (2017). Does the use of antipsychotics increase when coercion decreases in a general psychiatric ward? I Violence in Clinical Psychiatry: Proceedings of the 10th European Congress on Violence in Clinical Psychiatry (s. 264-265). The Netherlands: Oud Consultancy.
Højlund, Mikkel ; Høgh, Lene ; Munk-Jørgensen, Povl ; Stenager, Elsebeth. / Does the use of antipsychotics increase when coercion decreases in a general psychiatric ward?. Violence in Clinical Psychiatry: Proceedings of the 10th European Congress on Violence in Clinical Psychiatry. The Netherlands : Oud Consultancy, 2017. s. 264-265
@inbook{12bedae2a49e4a0c999fa0bb3db1bae8,
title = "Does the use of antipsychotics increase when coercion decreases in a general psychiatric ward?",
abstract = "BackgroundAntipsychotic 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.AimsTo evaluate type and doses of psychotropic prescriptions during intervention to reduce coercion in a general psychiatric ward.MethodsCohort 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.ResultsIn 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).265 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{\%}).ConclusionsReduction 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.",
author = "Mikkel H{\o}jlund and Lene H{\o}gh and Povl Munk-J{\o}rgensen and Elsebeth Stenager",
year = "2017",
language = "English",
pages = "264--265",
booktitle = "Violence in Clinical Psychiatry",
publisher = "Oud Consultancy",

}

Højlund, M, Høgh, L, Munk-Jørgensen, P & Stenager, E 2017, Does the use of antipsychotics increase when coercion decreases in a general psychiatric ward? i Violence in Clinical Psychiatry: Proceedings of the 10th European Congress on Violence in Clinical Psychiatry. Oud Consultancy, The Netherlands, s. 264-265, 10th European Congress on Violence in Clinical Psychiatry, Dublin, Irland, 26/10/2017.

Does the use of antipsychotics increase when coercion decreases in a general psychiatric ward? / Højlund, Mikkel; Høgh, Lene; Munk-Jørgensen, Povl; Stenager, Elsebeth.

Violence in Clinical Psychiatry: Proceedings of the 10th European Congress on Violence in Clinical Psychiatry. The Netherlands : Oud Consultancy, 2017. s. 264-265.

Publikation: Bidrag til bog/antologi/rapport/konference-proceedingKonferenceabstrakt i proceedingsForskningpeer review

TY - ABST

T1 - Does the use of antipsychotics increase when coercion decreases in a general psychiatric ward?

AU - Højlund, Mikkel

AU - Høgh, Lene

AU - Munk-Jørgensen, Povl

AU - Stenager, Elsebeth

PY - 2017

Y1 - 2017

N2 - BackgroundAntipsychotic 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.AimsTo evaluate type and doses of psychotropic prescriptions during intervention to reduce coercion in a general psychiatric ward.MethodsCohort 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.ResultsIn 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).265 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%).ConclusionsReduction 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.

AB - BackgroundAntipsychotic 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.AimsTo evaluate type and doses of psychotropic prescriptions during intervention to reduce coercion in a general psychiatric ward.MethodsCohort 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.ResultsIn 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).265 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%).ConclusionsReduction 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.

M3 - Conference abstract in proceedings

SP - 264

EP - 265

BT - Violence in Clinical Psychiatry

PB - Oud Consultancy

CY - The Netherlands

ER -

Højlund M, Høgh L, Munk-Jørgensen P, Stenager E. Does the use of antipsychotics increase when coercion decreases in a general psychiatric ward? I Violence in Clinical Psychiatry: Proceedings of the 10th European Congress on Violence in Clinical Psychiatry. The Netherlands: Oud Consultancy. 2017. s. 264-265