Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-22T17:06:25.979Z Has data issue: false hasContentIssue false
  • English
  • Français

A prospective, observational study of the safety and effectiveness of intramuscular psychotropic treatment in acutely agitated patients with schizophrenia and bipolar mania

Published online by Cambridge University Press:  15 April 2020

E. Perrin ,
E. Anand ,
Y. Dyachkova ,
T. Wagner ,
S. Frediani ,
A. Ballerini  and
the OBS-IM investigators group
E. Perrin
Affiliation:
Eli Lilly and Company, France
E. Anand*
Affiliation:
Lilly Neuroscience Research Center, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey, GU20 6PH United Kingdom
Y. Dyachkova
Affiliation:
Eli Lilly and Company, Austria
T. Wagner
Affiliation:
Lilly Deutschland GmbH, Werner Reimers Street 2-4, 61350Bad Homburg, Germany
S. Frediani
Affiliation:
National Mental Health Service, Psychiatric Department of Venice, Venice, Italy
A. Ballerini
Affiliation:
Servizio Psichiatrico Diagnosi e Cura, Santa Maria Nuova Hospital, Firenze, Italy
*
*Corresponding author. Tel.: +44 7831 850 080; fax: +44 1442 241 445. E-mail address: [email protected]
Get access

Abstract

This naturalistic, observational pan-European study assessed the safety and early effectiveness of intramuscular (IM) psychotropic treatments in patients with acute agitation suffering from schizophrenia or bipolar mania. One thousand nine hundred and forty of 1945 patients completed the 24-hour observation period after initial IM treatment. Patients from 12 European countries were included (mean age 39 years; 58% male, 66% schizophrenia). IM treatment was at the physician's discretion. The primary objective was to describe the acute tolerability of IM psychotropic therapies in clinical practice, with particular emphasis on EPS. At baseline, 68% of the patients received IM monotherapy, with IM olanzapine most commonly prescribed (36%). During the first 24hours, 190 (9.8%) patients experienced EPS. The occurrence of EPS was statistically significantly lower in patients treated with IM olanzapine compared to those treated with other IM psychotropic medications (mainly typical antipsychotics and benzodiazepines): acute dystonia: 1.1%, 95% CI 0.5–2.3 and 2.9%, CI 2.0–4.0; akathisia: 2.3%, CI 1.3–3.7 and 5.5%, CI 4.3–6.9; Parkinsonism: 2.9%, CI 1.8–4.4 and 7.8%, CI 6.4–9.4, respectively. Anticholinergic treatment was given to 12% IM olanzapine versus 31% non-olanzapine treated patients. Acute agitation after 24hours was reduced by 1.68 (95% CI 1.46–1.91) points on the Clinical Global Impression of Severity (CGI-S) in IM olanzapine patients and 1.51 (95% CI 1.30–1.73) points in non-olanzapine patients. Additional psychotropic medication was required for 90% of the patients during the first 24hours of treatment. Results provide naturalistic evidence for low EPS rates and improvement of agitation with IM psychotropic medications during acute states of patients suffering from acute mania or schizophrenia.

Keywords

AgitationSchizophreniaBipolar maniaIM psychotropic drugsAcute dystoniaAkathisiaParkinsonism
Type
Original article
Information
European Psychiatry , Volume 27 , Issue 4 , May 2012 , pp. 234 - 239
Copyright
Copyright © Elsevier Masson SAS 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Addonizio, G., Alexopoulos, G.S.Drug-induced dystonia in young and elderly patients. Am J Psychiatry. 1988; 145: 869–871.Google Scholar
Ballerini, A., Boccalon, R., Boncompagni, G.et al.An observational study in psychiatric acute patients admitted to general hospital psychiatric wards in Italy. Ann Gen Psychiatry. 2007; 6: 2.CrossRefGoogle ScholarPubMed
Ballerini, A., Boccalon, R.M., Boncompagni, G.et al.Clinical features and therapeutic management of patients admitted to Italian acute hospital psychiatric units: the PERSEO (psychiatric emergency study and epidemiology) survey. Ann Gen Psychiatry. 2007; 6: 29.CrossRefGoogle ScholarPubMed
Ballerini, A., Boccalon, R.M., Boncompagni, G.et al.Main clinical features in patients at their first psychiatric admission to Italian acute hospital psychiatric wards: the PERSEO study. BMC Psychiatry. 2007; 7: 3.CrossRefGoogle ScholarPubMed
Battaglia, J.Pharmacological management of acute agitation. Drugs. 2005; 65: 1207–1222.CrossRefGoogle ScholarPubMed
Castle, D.J., Udristoiu, T., Kim, C.Y., Sarosi, A., Pidrman, V., Omar, A.N.et al.Intramuscular olanzapine versus short-acting typical intramuscular antipsychotics: comparison of real-life effectiveness in the treatment of agitation. World J Biol Psychiatry. 2009; 9: 45–53.Google Scholar
Chandrasena, R., Dvorakova, D., Lee, S.I.et al.Intramuscular olanzapine vs. intramuscular short-acting antipsychotics: safety, tolerability and the switch to oral antipsychotic medication in patients with schizophrenia or acute mania. Int J Clin Pract. 2009; 63: 1249–1258.CrossRefGoogle ScholarPubMed
Citrome, L.Comparison of intramuscular ziprasidone, olanzapine, or aripiprazole for agitation: a quantitative review of efficacy and safety. J Clin Psychiatry. 2007; 68: 1876–1885.CrossRefGoogle ScholarPubMed
Currier, G.W., Medori, R.Orally versus intramuscularly administered antipsychotic drugs in psychiatric emergencies. J Psychiatr Pract. 2006; 12: 30–40.CrossRefGoogle ScholarPubMed
Haro, J.M., Suarez, D., Novick, D., Brown, J., Usall, J., Naber, D.et al.Three-year antipsychotic effectiveness in the outpatient care of schizophrenia: observational versus randomized studies results. Eur Neuropsychopharmacol. 2007; 17: 235–244.CrossRefGoogle ScholarPubMed
Hartnell, N.R., Wilson, J.P., Patel, N.C., Crismon, M.L.Adverse event reporting with selective serotonin-reuptake inhibitors. Ann Pharmacother. 2003; 37: 1387–1391.CrossRefGoogle ScholarPubMed
Meehan, K., Zhang, F., David, S.et al.A double-blind, randomized comparison of the efficacy and safety of intramuscular injections of olanzapine, lorazepam, or placebo in treating acutely agitated patients diagnosed with bipolar mania. J Clin Psychopharmacol. 2001; 21: 389–397.CrossRefGoogle ScholarPubMed
Mohr, P., Pecenak, J., Svestka, J.et al.Treatment of acute agitation in psychotic disorders. Neuro Endocrinol Lett. 2005; 26: 327–335.Google ScholarPubMed
San, L., Arranz, B., Querejeta, I., Barrio, S., De la Gandara, J., Perez, V.A naturalistic multicentre study of intramuscular olanzapine in the treatment of acutely agitated manic or schizophrenic patients. Eur Psychiatry. 2006; 21: 539–543.CrossRefGoogle ScholarPubMed
Tarsy, D., Baldessarini, R.J., Tarazi, F.I.Effects of newer antipsychotics on exptrapyramidal function. CNS Drugs. 2002; 16: 23–45.CrossRefGoogle Scholar
Taylor, D.Antipsychotic prescribing — time to review practice. Psychiatr Bull. 2002; 26: 401–402.CrossRefGoogle Scholar
Taylor, D., Paton, C., Kerwin, R.The Maudsley prescribing guidelines. 2009 Informa Healthcare London (9th Ed).CrossRefGoogle Scholar
Thomas, P., Alptekin, K., Gheorghe, M., Mauri, M., Olivares, J.M., Riedel, M.Management of patients presenting with acute psychotic episodes of schizophrenia. CNS Drugs. 2009; 23: 193–212.CrossRefGoogle ScholarPubMed
Tollefson, G.D., Beasley, C.M. Jr.Tran, P.V.et al.Olanzapine versus haloperidol in the treatment of schizophrenia and schizoaffective and schizophreniform disorders: results of an international collaborative trial. Am J Psychiatry. 1997; 154: 457–465.Google ScholarPubMed
Wagstaff, A.J., Easton, J., Scott, L.J.Intramuscular olanzapine: a review of its use in the management of acute agitation. CNS Drugs. 2005; 19: 147–164.CrossRefGoogle ScholarPubMed
Weiden, P.J.EPS profiles: the atypical antipsychotics are not all the same. J Psychiatr Pract. 2007; 13: 13–24.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.