The use ofprnmedication in a child and adolescent mental health inpatient service in France

Abstract

Objective. The aim of this study was to investigate the use of "as needed" (pro re nata or prn) psychotropic medication in a child and adolescent psychiatric inpatient population. The study was carried out on the psychiatry ward of a paediatric teaching hospital in Paris, France. Methods. A prospective analysis of prn psychotropic drug prescriptions and administrations was conducted for all patients hospitalised over a period of 4 months. The study group consisted of 187 patients. Results. In total, 93 prn prescriptions were written, for 27% of the patients (51) but only 14% (26) received a total of 76 administrations. Antipsychotic drugs accounted for 54% of the prescriptions, anxiolytics for 33%, antiepileptic drugs for 8%, antiparkinsonian drugs for 4% and hypnotic drugs for 1%. Anxiety was the reason given for 67% of the prn administrations, with hydroxyzine used in 69% of these cases. Disruptive behaviour accounted for 22% of prn administrations, with antipsychotic drugs accounting for 88% of these administrations. Insomnia accounted for 8% of prn administrations, and antipsychotic drug-induced dystonia accounted for 3% of such administrations. Conclusion. Controlled studies are required to assess the efficacy and safety of prn medication and the conditions in which its use is indicated.

The use and effectiveness of pro re nata psychotropic medications in children and adolescents: A systematic review

“…The target group consisted children and adolescents in child and adolescent mental care facilities. Of the studies included for review, there was only one controlled study,[ 6 ] nine retrospective studies,[ 1 4 5 7 9 10 12 13 14 ] two cross-sectional studies,[ 2 8 ] and two prospective studies[ 3 11 ] were reviewed.…”

“…Frequently prescribed PRN psychotropic medications include antipsychotics, benzodiazepines, and antihistamines. [ 2 4 5 7 8 11 14 ] Chlorpromazine and haloperidol being the most commonly prescribed typical antipsychotic medication, with increasing interest in atypical antipsychotics. [ 3 10 13 ] Use of non–benzodiazepines sedatives, and anticholinergic as pro re nata medications were documented in six studies.…”

“…[ 3 10 13 ] Use of non–benzodiazepines sedatives, and anticholinergic as pro re nata medications were documented in six studies. [ 2 3 7 8 9 12 ] In two studies,[ 6 13 ] only one medication was used as PRN while intramuscular ziprasidone, lorazepam, and haloperidol were used to control agitation during the period of hospitalization. [ 14 ]…”

“…[ 1 2 3 4 ] Other reasons may include hallucinations and destructiveness, for which etiology would include attention-deficit hyperactivity disorder (ADHD), mood disorder, psychosis, intellectual disability, autism spectrum disorders, insomnia, and anxiety. [ 5 6 7 8 9 10 11 12 13 14 ]…”

“…Benzodiazepines are very popular in this category, in addition, antipsychotics are well known. [ 8 9 10 11 12 15 ] In some units, nurses are responsible for decision-making in the administration of PRN psychotropic medications; and in other situations, physicians are responsible. [ 16 17 18 19 20 21 ] PRN psychotropic medications have been used to reduce mechanical restraint and other forms of management for these patients.…”