M. Raja et A. Azzoni, Second-generation antipsychotics in the emergency care setting. A prospective naturalistic study, GEN HOSP PS, 22(2), 2000, pp. 107-114
The objective of this subject was to examine the impact of the replacement
of standard neuroleptics with atypical antipsychotic agents in an intensive
psychiatric care unit. A mirror-image study was conducted. Cases admitted
in the first semester of the year (when most of patients were treated with
standard neuroleptics) were compared to cases admitted in the second semest
er of the year, when atypical antipsychotic agents were routinely utilized
as first line treatment of patients with psychotic signs. Cases admitted in
the first semester received a significantly higher daily dosage of antipsy
chotic drugs and more frequently received anticholinergics. In the second s
emester, a significantly higher number of patients received anticonvulsants
, in particular valproate and gabapentin. There was no significant differen
ce between the two groups of cases in the number of patients treated with a
ntipsychotics, benzodiazepines, lithium, and carbamazepine and in the mean
daily dose of benzodiazepines, lithium, carbamazepine, or valproate on the
first day of hospitalization, the day of evaluation, and on discharge. On d
ischarge, similar percentages of patients went home, were transferred to ot
her Psychiatric Intensive Cave Units (PICUs) or to private clinics, or left
our PICU against medical advice. The length of hospitalization was similar
in the two groups. There was no significant difference in the rate of aggr
essive or violent behavior registered in the two groups of cases. The risk
of increasing violence rates, lengthening hospitalization, and facilitating
patients' noncompliance should not be major concerns for physicians prescr
ibing second-generation antipsychotics in the emergency cave setting. Since
these drugs have been shown to have at least similar efficacy (or greater
efficacy in the case of clozapine) in the treatment of psychotic disorders
as typical neuroleptics and to have a better side-effects profile, they sho
uld become first line treatment for patients with psychotic signs admitted
to emergency cave psychiatric facilities. (C) 2000 Elsevier Science Inc.