The Snow Phenomenon: Tranquilizing the Assaultive<sup>†</sup>

Appleton, William S.

doi:10.1080/00332747.1965.11023418

Cited by 17 publications

(4 citation statements)

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“…Subsequently, it was found that the efficacy of these medications appeared to correlate with their antagonist potency at dopamine receptors, and most particularly the type 2 dopamine receptor (D 2 ). In addition to relieving psychotic symptoms in a significant number of patients, antipsychotic drugs were soon found to reduce the agitation and aggression associated with other psychiatric conditions, such as acute mania, personality disorders and substance-induced behavioral disorders [ 23 , 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

Antipsychotics in the Management of Disruptive Behavior Disorders in Children and Adolescents: An Update and Critical Review

Rajkumar

2022

Biomedicines

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Disruptive behaviour disorders (DBDs) in childhood include conduct disorder (CD) and oppositional defiant disorder (ODD). Though psychological therapies are considered to be the first-line treatment for DBDs, many patients require adjunctive pharmacotherapy for the control of specific symptoms, such as aggression. Three prior systematic reviews have examined the evidence for the use of antipsychotics in DBDs and have concluded that their efficacy is marginal and limited by adverse effects. This paper has two objectives: (i) to summarize the findings of existing systematic reviews of antipsychotics for the management of DBDs in children and adolescents (2012–2017), and (ii) to provide an update to these reviews by examining recent clinical trials of antipsychotics in this population, published in the period from 2 January 2017 to 10 October 2022. The PubMed, Scopus and ScienceDirect databases were searched for relevant citations using the search terms “disruptive behaviour disorder”, “oppositional defiant disorder”, “conduct disorder” and their variants, along with “antipsychotic”, “atypical antipsychotic” and the generic names of all currently approved atypical antipsychotics. Six relevant trials were identified during this period, including five randomized controlled trials and one naturalistic open-label trial. These trials were critically evaluated in terms of outcome measures, efficacy and safety. Overall, the data from these trials suggests that of all available antipsychotics, risperidone appears to be effective in the short-term management of DBDs. All available antipsychotics are associated with significant metabolic adverse effects in this population. These results are discussed in the light of global trends towards increasing off-label prescription of antipsychotic medication in children and adolescents and of recent literature on the neuropharmacology of aggression in this patient population. The need for rational, short-term use of these drugs is highlighted, as well as the importance of post-marketing surveillance for long-term or severe adverse events.

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Section: Introductionmentioning

confidence: 99%

Antipsychotics in the Management of Disruptive Behavior Disorders in Children and Adolescents: An Update and Critical Review

Rajkumar

2022

Biomedicines

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show abstract

“…Subsequently, it was found that the efficacy of these medications appeared to correlate with their antagonist potency at dopamine receptors, and most particularly the type 2 dopamine receptor (D2). Besides relieving psychotic symptoms in a significant number of patients, antipsychotic drugs were soon found to reduce the agitation and aggression associated with other psychiatric conditions, such as acute mania, personality disorders, and substance-induced behavioral disorders [18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Antipsychotics in the Management of Disruptive Behavior Disorders in Children and Adolescents: An Update and Critical Review

Rajkumar¹

2022

Preprint

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Disruptive behaviour disorders (DBDs) in childhood, such as conduct disorder (CD) and oppositional defiant disorder (ODD) are characterized by high levels of irritability and aggression. Though psychological management is considered the first-line approach for these disorders, many children and adolescents require adjunctive pharmacotherapy for the control of specific symptoms. Several prior systematic reviews have examined the evidence for the use of antipsychotics in the symptomatic management of DBDs, but have concluded that their efficacy is marginal and limited by significant adverse effects. This paper updates existing reviews of this field by reviewing clinical trials of antipsychotics in children and adolescents with DBDs published in the period 2-1-2017 to 2-10-2022. The PubMed, Scopus and ScienceDirect databases were searched for relevant citations. Six relevant trials were identified during this period. These trials were critically evaluated in terms of outcome measures, efficacy and safety. Overall, the data from these trials suggests that certain atypical antipsychotics, such as risperidone and clozapine, are effective in the short-term management of aggression in DBDs. They have no apparent effect on cognition, but are associated with significant metabolic adverse effects. The results of these trials, and of the earlier systematic reviews, are discussed in the light of global trends towards increasing off-label prescription of antipsychotic medication in children and adolescents, and of recent literature on the neuropharmacology of aggression in this patient population. The need for rational, short-term use of these drugs is highlighted, as well as the importance of post-marketing surveillance for long-term or severe adverse events.

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Section: Introductionmentioning

confidence: 99%

“…Previous studies of aggression in psychiatry have suggested that new staff members may experience more anxiety in their first weeks and months working in psychiatry. This is the case, for instance, with junior doctors who appear to prescribe higher levels of sedating drugs to patients (Appleton 1965). Nursing students have also been reported to be particularly vulnerable to being assaulted by patients (Hodgkinson et al 1984), and their presence has been associated with more frequent incidents of aggression (Tam et al 1996, Owen et al 1998, although this has not been uniformly found, with one study even showing lower risks for students (Rix & Seymour 1988).…”

Section: Introductionmentioning

confidence: 99%

Junior staffing changes and the temporal ecology of adverse incidents in acute psychiatric wards

Bowers¹,

Jeffery²,

Simpson

et al. 2007

Journal of Advanced Nursing

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Aim. This paper reports an examination of the relationship between adverse incident rates, the arrival of new junior staff on wards, and days of the week on acute psychiatric wards. Background. Incidents of violence, absconding and self-harm in acute inpatient services pose risks to patients and staff. Previous research suggests that the arrival of inexperienced new staff may trigger more adverse incidents. Findings on the relationship between incidents and the weekly routine are inconsistent. Method. A retrospective analysis was conducted of formally reported incident rates, records of nursing student allocations and junior doctor rotation patterns, using Poisson Regression. Variance between days of the week was explored using contingency table analysis. The data covered 30 months on 17 psychiatric wards, and were collected in 2002-2004. Findings. The arrival of new and inexperienced staff on the wards was not associated with increases in adverse incident rates. Most types of incidents were less frequent at weekends and midweek. Incident rates were unchanged on ward-round days, but increased rates were found on the days before and after ward rounds. Conclusion. Increased patient tension is associated with raised incident rates. It may be possible to reduce incident rates by moderating stimulation in the environment and by mobilizing support for patients during critical periods. Permanent repository link

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The Snow Phenomenon: Tranquilizing the Assaultive^†

Cited by 17 publications

References 0 publications

Antipsychotics in the Management of Disruptive Behavior Disorders in Children and Adolescents: An Update and Critical Review

Antipsychotics in the Management of Disruptive Behavior Disorders in Children and Adolescents: An Update and Critical Review

Antipsychotics in the Management of Disruptive Behavior Disorders in Children and Adolescents: An Update and Critical Review

Junior staffing changes and the temporal ecology of adverse incidents in acute psychiatric wards

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The Snow Phenomenon: Tranquilizing the Assaultive†

Cited by 17 publications

References 0 publications

Antipsychotics in the Management of Disruptive Behavior Disorders in Children and Adolescents: An Update and Critical Review

Antipsychotics in the Management of Disruptive Behavior Disorders in Children and Adolescents: An Update and Critical Review

Antipsychotics in the Management of Disruptive Behavior Disorders in Children and Adolescents: An Update and Critical Review

Junior staffing changes and the temporal ecology of adverse incidents in acute psychiatric wards

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Product

Resources

About

The Snow Phenomenon: Tranquilizing the Assaultive^†