Acutely disturbed behaviour in psychiatry: A survey of current practice

Abstract

Background:Acute behavioural disturbance in psychiatric patients often requires urgent treatment. National guidelines in England indicate that olanzapine is a suitable alternative to older antipsychotics due to a beneficial side effect profile.Method:A retrospective study that looked at the case notes of 32 patients on an acute adult and psychogeriatric ward. Information was gathered on patient gender, diagnosis, incidence of acute behavioural disturbance in the preceding 3 months and the type of medication and route of administration chosen.Results:Of the patients assessed 56.2% (18/32) were male and 43,8% (14/32) were female.62.5% (20/32) were aged between 18-65 years and 37.5% (12/32) were aged over 65yrs.43.8% (14/32) had a diagnosis of schizophrenia and 21.9% (7/32) had a diagnosis of bipolar affective disorder.Pharmacological intervention for acutely disturbed behaviour was necessary in 46.9%(15/32) of patients. In 86.6% (13/15) of these cases the oral route of administration was chosen. Haloperidol was used in 46.6%(7/15) of cases while the other cases necessitated the use of lorazepam only. Although oral and im preparations of olanzapine were available neither were chosen in any of the above cases. Vital signs were monitored in only 6.6% (1/15).Conclusions:Surprisingly haloperidol, an older antipsychotic, is still preferred over olanzapine which has fewer extrapyramidal side effects and is widely acknowledged to be effective in the acute setting.