Antipsychotic Selection for Acute Agitation and Time to Repeat Use in a Psychiatric Emergency Department

Gomez, Seth; Dopheide, Julie A.

doi:10.1097/pra.0000000000000186

Cited by 10 publications

(9 citation statements)

References 27 publications

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“…Patients requiring repeat doses of IM antipsychotics had a significantly longer LOS in the ED compared with non-repeat users of IM antipsychotics. However, patients who were initially administered oral, second-generation antipsychotics did not have longer stays in the ED even if a repeat dose was given 36. Given the association of many psychotropic medications with delirium and their sedating side effects it is plausible that medication choice in the ED may affect disposition or even cause a delay in discharge or admission 37.…”

Section: Discussionmentioning

confidence: 99%

A Research Agenda for the Assessment and Management of Acute Behavioral Changes in Elderly Emergency Department Patients

Shenvi¹,

Wilson²,

Aldai³

et al. 2019

WestJEM

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Introduction Agitation, mental illness, and delirium are common reasons for older adults to seek care in the emergency department (ED). There are significant knowledge gaps in understanding how to best screen older adults for these conditions and how to manage them. In addition, in areas where research has been performed, implementation has been slow. A working group convened to develop a set of high-priority research questions that would advance the understanding of optimal management of older adults with acute behavioral changes in the ED. This manuscript is the product of a breakout session on “Special Populations: Agitation in the Elderly” from the 2016 Coalition on Psychiatric Emergencies’ first Research Consensus Conference on Acute Mental Illness. Methods Participants were identified with expertise in emergency medicine (EM), geriatric EM, and psychiatry. Background literature reviews were performed prior to the in-person meeting in four key areas: delirium; dementia; substance abuse or withdrawal; and mental illness in older adults. Input was solicited from all participants during the meeting, and questions were iteratively focused and revised, voted on, and ranked by importance. Results Fourteen questions were identified by the group with high consensus for their importance related to the care of older adults with agitation in the ED. The questions were grouped into three topic areas: screening and identification; management strategies; and the approach to delirium. Conclusion It is important for emergency physicians to recognize the spectrum of underlying causes of behavioral changes, have the tools to screen older adults for those causes, and employ methods to treat the underlying causes and ameliorate their symptoms. Answers to the identified research questions have great potential to improve the care of older adults presenting with behavioral changes.

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Section: Discussionmentioning

confidence: 99%

A Research Agenda for the Assessment and Management of Acute Behavioral Changes in Elderly Emergency Department Patients

Shenvi¹,

Wilson²,

Aldai³

et al. 2019

WestJEM

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“…While many clinicians still rely on first generation antipsychotics such as haloperidol, fluphenazine, and chlorpromazine for acute agitation, the American Association of Emergency Psychiatry recommends the use of second generation antipsychotics (SGAs) as first-line agents 5,6. Second generation antipsychotics have been shown to cause less extrapyramidal side effects than first generation antipsychotics, and appear to be as effective at controlling agitation 7-9…”

Section: Introductionmentioning

confidence: 99%

Coadministration of intramuscular olanzapine and benzodiazepines in agitated patients with mental illness

Williams

2018

Mental Health Clinician

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Introduction:Intramuscular antipsychotics are commonly used to manage agitated patients. In 2005, Eli Lilly placed a warning on olanzapine's prescribing information following post-marketing reports of fatal drug reactions when intramuscular olanzapine was used in the setting of benzodiazepines. Data is lacking examining this drug combination.Methods:A medication use evaluation was conducted at a county psychiatric hospital surveying the usage of concomitant intramuscular olanzapine and lorazepam from October 1, 2016, to July 20, 2017. A literature search was conducted to review available evidence.Results:Ninety-one instances of the drug combination were discovered, with no serious adverse events following administration. Of these 91 patients, 41 received both medications within 60 minutes of each other. No instances of hypotension, bradycardia, bradypnea, or oxygen desaturation occurred following administration. The literature review yielded 1 randomized, placebo-controlled clinical trial, 3 retrospective chart reviews, and several case studies.Discussion:Data detailing a causal relationship between olanzapine/benzodiazepine combinations and serious adverse effects is lacking. Available evidence does not consistently support a strong cause and effect relationship. The results of this medication use evaluation are not consistent with the Food and Drug Administration warning. Further controlled research is needed to help define the actual risk of using concomitant intramuscular olanzapine and benzodiazepines.

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“…At present, literature regarding emergent psychosis intervention has predominantly focused on management of agitation 12–15. First- or second-generation antipsychotic medication interventions have measured outcomes such as achieving calm behavior16 or decreasing need for additional medications 15,17. These measures neglect the vast spectrum of distressing, patient-level experiences of psychosis such as delusional thought content, sensory hallucinations, and negative affective states.…”

Section: Discussionmentioning

confidence: 99%

A Research Agenda for Assessment and Management of Psychosis in Emergency Department Patients

Peltzer-Jones¹,

Nordstrom²,

Currier³

et al. 2019

WestJEM

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Introduction Emergency departments (ED) manage a wide variety of critical medical presentations. Traumatic, neurologic, and cardiac crises are among the most prevalent types of emergencies treated in an ED setting. The high volume of presentations has led to collaborative partnerships in research and process development between experts in emergency medicine (EM) and other disciplines. While psychosis is a medical emergency frequently treated in the ED, there remains a paucity of evidence-based literature highlighting best practices for management of psychotic presentations in the ED. In the absence of collaborative research, development of best practice guidelines cannot begin. A working group convened to develop a set of high-priority research questions to address the knowledge gaps in the care of psychotic patients in the ED. This article is the product of a subgroup considering “Special Populations: Psychotic Spectrum Disorders,” from the 2016 Coalition on Psychiatric Emergencies first Research Consensus Conference on Acute Mental Illness. Methods Participants were identified with expertise in psychosis from EM, emergency psychiatry, emergency psychology, clinical research, governmental agencies, and patient advocacy groups. Background literature reviews were performed prior to the in-person meeting. A nominal group technique was employed to develop group consensus on the highest priority research gaps. Following the nominal group technique, input was solicited from all participants during the meeting, questions were iteratively focused and revised, voted on, and then ranked by importance. Results The group developed 28 separate questions. After clarification and voting, the group identified six high-priority research areas. These questions signify the perceived gaps in psychosis research in emergency settings. Questions were further grouped into two topic areas: screening and identification; and intervention and management strategies. Conclusion While psychosis has become a more common presentation in the ED, standardized screening, intervention, and outcome measurement for psychosis has not moved beyond attention to agitation management. As improved outpatient-intervention protocols are developed for treatment of psychosis, it is imperative that parallel protocols are developed for delivery in the ED setting.

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Antipsychotic Selection for Acute Agitation and Time to Repeat Use in a Psychiatric Emergency Department

Cited by 10 publications

References 27 publications

A Research Agenda for the Assessment and Management of Acute Behavioral Changes in Elderly Emergency Department Patients

A Research Agenda for the Assessment and Management of Acute Behavioral Changes in Elderly Emergency Department Patients

Coadministration of intramuscular olanzapine and benzodiazepines in agitated patients with mental illness

A Research Agenda for Assessment and Management of Psychosis in Emergency Department Patients

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