Impact of risperidone on seclusion and restraint at a state psychiatric hospital

Objective: To evaluate the impact of risperidone on seclusion and restraint in patients at a state psychiatric facility, shortly after risperidone's r elease. Methods: Patients who were in the hospital for at least 3 months prior to r eceiving risperidone and subsequently received risperidone for at least 3 m onths formed the cohort. A mirror-image design was used with duration to a maximum of 1 year before and 1 year after initiation of risperidone. The ho spital population that did not receive either risperidone or clozapine duri ng the same time period was used for comparison of trends of seclusion and restraint. Results: Seventy-four patients (most with schizophrenia) met the inclusion criteria of the risperidone group. There were statistically significant dec reases in the number of seclusion hours (2.2 [SD 5.5] to 0.26 [SD 0.06]) an d of events (0.23 [SD 0.59] to 0.05 [SD 0.14]) per person per month during risperidone treatment, compared with the prerisperidone treatment period (P = 0.01). The comparison group also evidenced decreases on these measures d uring the same time period, but the risperidone-treated cohort achieved a p roportionally greater reduction. There were similar trends toward reduction in the restraint measures during risperidone treatment compared with preri speridone, but these did not achieve statistical significance. The comparis on group also showed slightly decreased use of restraints over the study pe riod. Conclusions: Risperidone appears to have had a positive impact on seclusion in this state-hospital psychiatric population. These data support the posi tive impact of risperidone on violence found in other studies. Violence and aggression are major factors that affect morale among psychiatric patients and staff. So, any benefit in this regard as a result of antipsychotic dru g treatment is salutary for patients, families, and health care providers.