Use of antipsychotics and benzodiazepines in connection to minimising coercion and mechanical restraint in a general psychiatric ward

Mikkel Højlund, Lene Høgh, Anders Bo Bojesen, Povl Munk-Jørgensen, Elsebeth Stenager

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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Resumé

Background:
Decrease in coercive measures can lead to increased exposure to antipsychotics and benzodiazepines. This is not desirable as these drugs are associated with harmful side effects and reduced life expectancy.

Aim:
To quantify and compare the use of antipsychotic and anxiolytic medications in connection with the implementation of a programme to reduce coercion and restraint.

Methods:
Observational study in a general psychiatric ward comparing psychopharmacological treatment after implementation of non-pharmacological interventions to reduce coercion and mechanical restraint with a historical reference cohort from the same ward.

Results:
Data from 101 admissions after implementation of interventions were compared with data from 85 admissions in a historical reference cohort. Mean defined daily doses of antipsychotics, benzodiazepines or the total amount of both showed no difference before and after implementation of the programme. Standardised regression coefficients (β) from a mixed effects linear regression model, adjusted for age, gender, length of admission, involuntary admission and history of substance abuse showed that neither total dose of antipsychotics (adjusted β: .05, 95% confidence interval (CI): −0.20 to 0.31), total dose of benzodiazepines (adjusted β: −.13, 95%CI: −.42 to 0.16) nor total amount of both drugs (adjusted β: .00, 95%CI: −.26 to 0.21) increased after implementation.

Conclusion:
Decrease in coercive measures from 2013 to 2016 has not lead to significant increases in the use of antipsychotic medication or benzodiazepines. The interventions are useful in establishing restraint-free wards, and careful monitoring of the psychopharmacological treatment is important for patient safety.
OriginalsprogEngelsk
TidsskriftInternational Journal of Social Psychiatry
Vol/bind64
Udgave nummer3
Sider (fra-til)258-265
ISSN0020-7640
DOI
StatusUdgivet - maj 2018

Fingeraftryk

Coercion
Patients' Rooms
Confidence Intervals
Linear Models
Patient Safety
Life Expectancy
Pharmaceutical Preparations

Citer dette

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title = "Use of antipsychotics and benzodiazepines in connection to minimising coercion and mechanical restraint in a general psychiatric ward",
abstract = "Background:Decrease in coercive measures can lead to increased exposure to antipsychotics and benzodiazepines. This is not desirable as these drugs are associated with harmful side effects and reduced life expectancy.Aim:To quantify and compare the use of antipsychotic and anxiolytic medications in connection with the implementation of a programme to reduce coercion and restraint.Methods:Observational study in a general psychiatric ward comparing psychopharmacological treatment after implementation of non-pharmacological interventions to reduce coercion and mechanical restraint with a historical reference cohort from the same ward.Results:Data from 101 admissions after implementation of interventions were compared with data from 85 admissions in a historical reference cohort. Mean defined daily doses of antipsychotics, benzodiazepines or the total amount of both showed no difference before and after implementation of the programme. Standardised regression coefficients (β) from a mixed effects linear regression model, adjusted for age, gender, length of admission, involuntary admission and history of substance abuse showed that neither total dose of antipsychotics (adjusted β: .05, 95{\%} confidence interval (CI): −0.20 to 0.31), total dose of benzodiazepines (adjusted β: −.13, 95{\%}CI: −.42 to 0.16) nor total amount of both drugs (adjusted β: .00, 95{\%}CI: −.26 to 0.21) increased after implementation.Conclusion:Decrease in coercive measures from 2013 to 2016 has not lead to significant increases in the use of antipsychotic medication or benzodiazepines. The interventions are useful in establishing restraint-free wards, and careful monitoring of the psychopharmacological treatment is important for patient safety.",
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author = "Mikkel H{\o}jlund and Lene H{\o}gh and {Bo Bojesen}, Anders and Povl Munk-J{\o}rgensen and Elsebeth Stenager",
year = "2018",
month = "5",
doi = "10.1177/0020764018760650",
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pages = "258--265",
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Use of antipsychotics and benzodiazepines in connection to minimising coercion and mechanical restraint in a general psychiatric ward. / Højlund, Mikkel; Høgh, Lene; Bo Bojesen, Anders; Munk-Jørgensen, Povl; Stenager, Elsebeth.

I: International Journal of Social Psychiatry, Bind 64, Nr. 3, 05.2018, s. 258-265.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Use of antipsychotics and benzodiazepines in connection to minimising coercion and mechanical restraint in a general psychiatric ward

AU - Højlund, Mikkel

AU - Høgh, Lene

AU - Bo Bojesen, Anders

AU - Munk-Jørgensen, Povl

AU - Stenager, Elsebeth

PY - 2018/5

Y1 - 2018/5

N2 - Background:Decrease in coercive measures can lead to increased exposure to antipsychotics and benzodiazepines. This is not desirable as these drugs are associated with harmful side effects and reduced life expectancy.Aim:To quantify and compare the use of antipsychotic and anxiolytic medications in connection with the implementation of a programme to reduce coercion and restraint.Methods:Observational study in a general psychiatric ward comparing psychopharmacological treatment after implementation of non-pharmacological interventions to reduce coercion and mechanical restraint with a historical reference cohort from the same ward.Results:Data from 101 admissions after implementation of interventions were compared with data from 85 admissions in a historical reference cohort. Mean defined daily doses of antipsychotics, benzodiazepines or the total amount of both showed no difference before and after implementation of the programme. Standardised regression coefficients (β) from a mixed effects linear regression model, adjusted for age, gender, length of admission, involuntary admission and history of substance abuse showed that neither total dose of antipsychotics (adjusted β: .05, 95% confidence interval (CI): −0.20 to 0.31), total dose of benzodiazepines (adjusted β: −.13, 95%CI: −.42 to 0.16) nor total amount of both drugs (adjusted β: .00, 95%CI: −.26 to 0.21) increased after implementation.Conclusion:Decrease in coercive measures from 2013 to 2016 has not lead to significant increases in the use of antipsychotic medication or benzodiazepines. The interventions are useful in establishing restraint-free wards, and careful monitoring of the psychopharmacological treatment is important for patient safety.

AB - Background:Decrease in coercive measures can lead to increased exposure to antipsychotics and benzodiazepines. This is not desirable as these drugs are associated with harmful side effects and reduced life expectancy.Aim:To quantify and compare the use of antipsychotic and anxiolytic medications in connection with the implementation of a programme to reduce coercion and restraint.Methods:Observational study in a general psychiatric ward comparing psychopharmacological treatment after implementation of non-pharmacological interventions to reduce coercion and mechanical restraint with a historical reference cohort from the same ward.Results:Data from 101 admissions after implementation of interventions were compared with data from 85 admissions in a historical reference cohort. Mean defined daily doses of antipsychotics, benzodiazepines or the total amount of both showed no difference before and after implementation of the programme. Standardised regression coefficients (β) from a mixed effects linear regression model, adjusted for age, gender, length of admission, involuntary admission and history of substance abuse showed that neither total dose of antipsychotics (adjusted β: .05, 95% confidence interval (CI): −0.20 to 0.31), total dose of benzodiazepines (adjusted β: −.13, 95%CI: −.42 to 0.16) nor total amount of both drugs (adjusted β: .00, 95%CI: −.26 to 0.21) increased after implementation.Conclusion:Decrease in coercive measures from 2013 to 2016 has not lead to significant increases in the use of antipsychotic medication or benzodiazepines. The interventions are useful in establishing restraint-free wards, and careful monitoring of the psychopharmacological treatment is important for patient safety.

KW - Antipsychotics

KW - benzodiazepines

KW - coercion

KW - psychopharmacology

KW - restraint

KW - Humans

KW - Middle Aged

KW - Restraint, Physical/statistics & numerical data

KW - Psychiatric Department, Hospital/organization & administration

KW - Linear Models

KW - Male

KW - Mental Disorders/therapy

KW - Coercion

KW - Young Adult

KW - Benzodiazepines/administration & dosage

KW - Adolescent

KW - Denmark

KW - Adult

KW - Female

KW - Hospitalization/statistics & numerical data

KW - Aged

KW - Antipsychotic Agents/administration & dosage

KW - Retrospective Studies

KW - Controlled Before-After Studies

U2 - 10.1177/0020764018760650

DO - 10.1177/0020764018760650

M3 - Journal article

C2 - 29480051

VL - 64

SP - 258

EP - 265

JO - International Journal of Social Psychiatry

JF - International Journal of Social Psychiatry

SN - 0020-7640

IS - 3

ER -