Use of antipsychotics and benzodiazepines in connection to minimising coercion and mechanical restraint in a general psychiatric ward

• Published in: International journal of social psychiatry Vol. 64; no. 3; pp. 258 - 265
• Main Authors: Højlund, Mikkel, Høgh, Lene, Bojesen, Anders Bo, Munk-Jørgensen, Povl, Stenager, Elsebeth
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.05.2018; Sage Publications Ltd
• Subjects: Antipsychotics; Benzodiazepines; Coercion; Confidence intervals; Dosage; Drug dosages; Intervention; Involuntary; Life expectancy; Mental institutions; Patient admissions; Patients; Psychiatric units; Psychopharmacology; Psychotropic drugs; Safety measures; Side effects; Substance abuse; coercion; Antipsychotics; psychopharmacology; benzodiazepines; restraint
• ISSN: 0020-7640; 1741-2854
• DOI: 10.1177/0020764018760650

Background: Decrease in coercive measures can lead to increased exposure to antipsychotics and benzodiazepines. This is not desirable as these drugs are associated with harmful side effects and reduced life expectancy. Aim: To quantify and compare the use of antipsychotic and anxiolytic medications in connection with the implementation of a programme to reduce coercion and restraint. Methods: Observational study in a general psychiatric ward comparing psychopharmacological treatment after implementation of non-pharmacological interventions to reduce coercion and mechanical restraint with a historical reference cohort from the same ward. Results: Data from 101 admissions after implementation of interventions were compared with data from 85 admissions in a historical reference cohort. Mean defined daily doses of antipsychotics, benzodiazepines or the total amount of both showed no difference before and after implementation of the programme. Standardised regression coefficients (β) from a mixed effects linear regression model, adjusted for age, gender, length of admission, involuntary admission and history of substance abuse showed that neither total dose of antipsychotics (adjusted β: .05, 95% confidence interval (CI): −0.20 to 0.31), total dose of benzodiazepines (adjusted β: −.13, 95%CI: −.42 to 0.16) nor total amount of both drugs (adjusted β: .00, 95%CI: −.26 to 0.21) increased after implementation. Conclusion: Decrease in coercive measures from 2013 to 2016 has not lead to significant increases in the use of antipsychotic medication or benzodiazepines. The interventions are useful in establishing restraint-free wards, and careful monitoring of the psychopharmacological treatment is important for patient safety.