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THE ANALYSIS OF ADMINISTERING MULTIPLE ANTIPSYCHOTICS TO PATIENTS RECEIVING TYPICAL OR ATYPICAL ANTIPSYCHOTICS THERAPY
Source publication
The selection of antipsychotics as medications used primarily for treating schizophrenia and disorders similar to schizophrenia is an important aspect of the treatment of forensic patients. This study examines the effect of antipsychotics selection (typical or atipycal) on the level of aggressiveness, side effects and the hospitalisation length. Th...
Context in source publication
Context 1
... analysis of simultaneous application of multiple antipsychotics (Table 2) in patients receiving typical or atypical antipsychotics showed that prescription of mul- tiple drugs is more common when typical antipsychotics were prescribed. A higher percentage of patients treated with a combination of two or more antipsychotics be- longed to the group receiving typical neuroleptic therapy. ...
Citations
... Ruzic et al 22 analyzed if patients with schizophrenia (n = 98) on forensic psychiatric wards who received SGAs were less violent, measured on the Aggressiveness Questionnaire (AG-87) than those treated with FGAs. Contrary to their hypothesis, the authors found no significant effect of antipsychotic type on violence scores as measured by patient self-ratings on the AG-87. ...
... Contrary to their hypothesis, the authors found no significant effect of antipsychotic type on violence scores as measured by patient self-ratings on the AG-87. 22 The main limitation of this study was its observational non-randomized nature. There was also no information on blinding of either the subjects or assessors to the treatment regimens administered ( Table 2). ...
Background
The purpose was to systematically investigate which pharmacological strategies are effective to reduce the risk of violence among patients with Schizophrenia Spectrum Disorders (SSD) in forensic settings.
Methods
For this systematic review six electronic data bases were searched. Two researchers independently screened the 6,003 abstracts resulting in 143 potential papers. These were then analyzed in detail by two independent researchers. Of these, 133 were excluded for various reasons leaving 10 articles in the present review.
Results
Of the 10 articles included, five were merely observational, and three were pre-post studies without controls. One study applied a matched case-control design and one was a non-randomized controlled trial. Clozapine was investigated most frequently, followed by olanzapine and risperidone. Often, outcome measures were specific to the study and sample sizes were small. Frequently, relevant methodological information was missing. Due to heterogeneous study designs and outcomes meta-analytic methods could not be applied.
Conclusion
Due to substantial methodological limitations it is difficult to draw any firm conclusions about the most effective pharmacological strategies to reduce the risk of violence in patents with SSD in forensic psychiatry settings. Studies applying more rigorous methods regarding case-definition, outcome measures, sample sizes, and study designs are urgently needed.
... The medication safety category included 17 publications (5%). Five studies focused on adverse events, and examined: antipsychotics side effects, 340 how best to manage the effect of psychotropics on long QT segments, 341 antidepressants 342 and medication error reporting. 343 344 Three studies investigated errors occurring in broader medication management processes [345][346][347] and a further five studies focused on medication administration specifically. ...
Objectives
Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology.
Design
Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to ‘mental health’, ‘patient safety’, ‘inpatient setting’ and ‘research’. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model.
Results
Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control.
Conclusions
Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice.
PROSPERO registration number
CRD42016034057.
