Trends in pharmacological emergency treatment of patients suffering from schizophrenia over a 16-year observation period

Abstract

Patients suffering from schizophrenia are often treated in locked psychiatric units because of psychomotor agitation, hostility and aggressive behavior, or suicidality. Because of legal conditions, investigations on these acutely ill patients are difficult, and many studies do not represent 'real-life psychiatry'. This retrospective survey was conducted at the Department of Psychiatry, Psychotherapy and Psychosomatics of the Medical University, Innsbruck, Austria. Data were collected from the records of all adult inpatients suffering from a schizophrenia spectrum disorder according to the International Classification of Diseases, 10th ed. (ICD-10) (F2x) who had been admitted to a locked unit in 1997, 2002, 2007, and 2012. In addition to demographic data, diagnoses at the time of admission, length of stay at the locked unit, and psychopharmacological treatment (3 h before and following admission) were recorded. The mean length of stay at a locked unit decreased significantly from 11.8±4.43 days (mean±SD) in 1997 to 8.5±12.96 days (mean±SD) in 2012. The use of antipsychotics decreased nonsignificantly from 1997 to 2012. Despite an increasing use of second compared with first-generation antipsychotic drugs over the course of time, haloperidol was the most frequently used single compound in all investigated years except 2012. The majority of medications were administered orally. The use of benzodiazepines did not change substantially over the course of time. All in all, pharmacological emergency treatment of patients suffering from schizophrenia spectrum disorders in locked units was in line with current treatment guidelines, which recommend the use of second-generation antipsychotic drugs, monotherapy, oral application, and cautious dosing.

Efecto de la amigdalotomía e hipotalamotomía unilateral en pacientes con agresividad refractaria

“…Este síntoma se acompaña con cierta frecuencia en algunas enfermedades neurológicas y/o psiquiátricas. De acuerdo con Yudofsky la conducta agresiva patológica es estereotipada y se puede manifestar emitiendo ruidos o lenguaje soez, produciendo daño a objetos o animales, infringiendo lesiones físicas a otras personas (heteroagresividad) o contra ellos mismos (autoagresividad) 3 . Yudofsky considera que la conducta agresiva en pacientes está relacionada con daño neurológico o psiquiátrico, por lo que debe ser considerado como un «trastorno neuroagresivo».…”

No gender differences in the pharmacological emergency treatment of schizophrenia: results of a 21-year observation

“…We have previously shown that two-thirds of patients suffering from schizophrenia spectrum disorders who had involuntarily been admitted to a locked unit of our clinic received pharmacological treatment in an emergency situation. Most of them were treated with BZD monotherapy, while the remaining patients received either antipsychotic monotherapy or a combined treatment (Edlinger et al ., 2018). This management was in line with current guidelines (Lehmann et al ., 2004; DGPPN, 2019; NICE Guidance, 2015; Garriga et al ., 2016).…”

Surgical Treatment for Refractory Aggression after Bacterial Meningitis Complicated by Stroke: Case Report

“…5,6 Aggressiveness becomes pathological when its manifestation becomes exaggerated in response to a stimulus that would normally not cause danger or even in the absence of a stimulus. 7 Unfortunately, for patients with affective disorders resistant to treatment and their families, pathological aggressiveness represents an extreme emotional and psychological burden, in addition to an increased risk of suicide. 8 Among the brain nuclei used as targets in stereotactic neurosurgeries for psychiatric disorders (NPDs) to control pathological aggressiveness, the following are considered the most important ones: the amygdala, the posteromedial hypothalamus, the ventral part of the internal capsule and the striatum, the cingulate, the substance innominate, and the nucleus accumbens (NAcc).…”

“…5 6 Aggressiveness becomes pathological when its manifestation becomes exaggerated in response to a stimulus that would normally not cause danger or even in the absence of a stimulus. 7 Unfortunately, for patients with affective disorders resistant to treatment and their families, pathological aggressiveness represents an extreme emotional and psychological burden, in addition to an increased risk of suicide. 8…”