Prescribing preferences in rapid tranquillisation: a survey in Belgian psychiatrists and emergency physicians

Abstract

BackgroundThe pharmacotherapeutic management of agitation is a common clinical challenge. Pharmacotherapy is frequently used, the use of published guidelines is not known. The purpose of this study was twofold; to describe the prescribing patterns of psychiatrists and emergency physicians and to evaluate to which extent guidelines are used.MethodsA cross-sectional survey in the Dutch-speaking part of Belgium is carried out in 39 psychiatric hospitals, 11 psychiatric wards of a general hospital and 61 emergency departments. All physicians are asked for demographic information, their prescribing preferences, their use of guidelines and the type of monitoring (effectiveness, safety). For the basic demographic data and prescription preferences descriptive statistics are given. For comparing prescribing preferences of the drug between groups Chi square tests (or in case of low numbers Fisher’s exact test) were performed. Mc Nemar test for binomial proportions for matched-pair data was performed to see if the prescription preferences of the participants differ between secluded and non-secluded patients.Results550 psychiatrist and emergency physicians were invited. The overall response rate was 20% (n = 108). The number 1 preferred medication classes were antipsychotics (59.3%) and benzodiazepines (40.7%). In non-secluded patients, olanzapine (22.2%), lorazepam (21.3%) and clotiapine (19.4%) were most frequently picked as number 1 choice drug. In secluded patients, clotiapine (21.3%), olanzapine (21.3%) and droperidol (14.8%) were the three most frequently chosen number 1 preferred drugs. Between-group comparisons show that emergency physicians prefer benzodiazepines significantly more than psychiatrists do. Zuclopenthixol and olanzapine show a particular profile in both groups of physicians. Polypharmacy is more frequently used in secluded patients. Published guidelines and safety or outcome monitoring are rarely used.ConclusionsOur results show that prescription practice in Flanders (Belgium) in acute agitation shows a complex relationship with published guidelines. Prescription preferences differ accordingly to medical specialty. These findings should be taken into account in future research.

Atendimentos De Natureza Psiquiátrica Realizados Pelo Serviço Pré-Hospitalar Móvel De Urgência

“…It was also identified that the pharmacological management was performed in only 1.3% of the cases, and its main objective was to reduce the symptoms of agitation and aggressiveness. A Belgian study having 108 physicians working in the psychiatric emergency services found that antipsychotics are the most widely used drugs in clinical practice in situations of acute agitation, 34 which corroborates the findings of this study.…”

Management of behavioural emergencies: a prospective observational study in Australian emergency departments

“…This study demonstrates that droperidol is the most common monotherapy prescribed for the management of acute agitation in Australia. This differs from other countries, where haloperidol is the first choice for sedation of acutely agitated patients in the US, the UK, Europe and Hong Kong . This difference may be related to the limited availability of droperidol in these countries.…”

Clotiapine in schizophrenia: a guide to its use

“…For example, in a recent survey, 108 psychiatrists and emergency physicians in Belgium were asked to rank their first choice drug for rapid tranquillisation of agitated patients in secluded and non-secluded settings from a list of 80 drugs [41]. In the secluded setting, clotiapine was the first drug of choice of 21.3 % of respondents, with olanzapine and droperidol being the first drug of choice of 21.3 and 14.8 % of respondents, respectively.…”

“…In the secluded setting, clotiapine was the first drug of choice of 21.3 % of respondents, with olanzapine and droperidol being the first drug of choice of 21.3 and 14.8 % of respondents, respectively. In the non-secluded setting, olanzapine, lorazepam and clotiapine were the first drug of choice of 22.2, 21.3 and 19.4 % of respondents, respectively [41].…”