Treatment of agitation in the acute psychiatric setting. An observational study of the effectiveness of intramuscular psychotropic medication.
BACKGROUND
Agitation is frequent in the acute psychiatric setting. The observation and treatment of agitation is important to avoid harm to patients or staff, to reduce distress of the patient, and to reduce the risk of coercion, especially physical restraint.


AIM
To evaluate the effect of intramuscular treatment with psychotropics on agitation in a non-selected acute psychiatric population.


METHODS
The Positive and Negative Syndrome Scale Excitement Component (PANSS-EC) was implemented in the acute psychiatric ward at Psychiatric Center Copenhagen to improve assessment and treatment of agitation. During a period of almost ~2 years the staff was requested to assess agitation before and after administration of intramuscular injections.


RESULTS
PANSS-EC was obtained at baseline and within 2 hours after injection for 135 injections with antipsychotics or benzodiazepines administered to 101 acute, non-selected psychiatric patients with high occurrence of co-morbid substance abuse. Mean PANSS-EC at baseline was 26.53 ± 4.87, and mean reduction in PANSS-EC was 14.99 ± 8.48 (p < 0.001). For 73% of injections PANSS-EC decreased with ≥40% (generally accepted definition of response). In 49% of cases patients were subjected to physical restraint. Patients subjected to restraint had a significantly higher PANSS-EC score. Patients who received a subsequent injection had a significantly lower decline in PANSS-EC score. Besides two cases of acute dystonia following haloperidol injections, no serious side-effects were observed.


CONCLUSIONS
Treatment of agitation with intramuscular injections of psychotropics was in general effective in this non-selected, highly agitated psychiatric population, and injections were well tolerated.
['Bauer|Jeanett Østerby|JØ|', 'Stenborg|Dina|D|', 'Lodahl|Tue|T|', 'Mønsted|Mik Mathias|MM|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D014150:Antipsychotic Agents D005260:Female D006220:Haloperidol D006801:Humans D007273:Injections, Intramuscular D008297:Male D008875:Middle Aged D011567:Psychiatric Department, Hospital D011569:Psychiatric Status Rating Scales D011595:Psychomotor Agitation D012559:Schizophrenia D016896:Treatment Outcome D055815:Young Adult
Agitation PANSS-EC antipsychotics benzodiazepines IM