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'As required' medication regimens for seriously mentally ill people in hospitalChakrabarti A, Whicher EV, Morrison M, Douglas-Hall P
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Summary'As required' medication regimes for seriously mentally ill people in hospitalPrescribing drugs to be given 'as required' by clinical staff is a widespread interim method of treating acute psychotic symptoms or behavioural disturbance thought to be secondary to psychotic illness. We searched for randomised trials that compared this method of administering medication to regular regimens of the same drug. Despite the extensive use of 'as required' regimens in psychiatric patients, we found no relevant studies. Consequently standard prescribing and current practice for patients who need 'calming' could be far more helpful or harmful than is currently perceived.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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April 22. 2002 AbstractBackgroundDrugs used to treat psychotic illnesses may take weeks to be effective. In the interim, additional 'as required' doses of medication can be used to calm patients in psychiatric wards. The practice is widespread with 20% - 50% of people on acute psychiatric wards receiving at least one 'as required' dose of psychotropic medication during their admission. ObjectivesTo compare the effects of 'as required' medication regimens with regular regimens of medication for the treatment of psychotic symptoms or behavioural disturbance, thought to be secondary to psychotic illness. Search strategyFor this 2006 update, we searched The Cochrane Schizophrenia Group's register of trials (March 2006). Selection criteriaWe included all relevant randomised control trials involving hospital inpatients with schizophrenia or schizophrenia-like illnesses, comparing any regimen of medication administered for the short term relief of behavioural disturbance, or psychotic symptoms, to be given at the discretion of ward staff ('as required', 'prn') with fixed non-discretionary patterns of drug administration of the same drug(s). This was in addition to regular psychotropic medication for the long-term treatment of schizophrenia or schizophrenia-like illnesses where prescribed. Data collection and analysisWe independently inspected abstracts, extracted data from the papers and quality assessed the data. For dichotomous data we would have calculated the relative risks (RR), with the 95% confidence intervals (CI) and the number needed to treat statistic (NNT). Analyses would have been conducted on an intention-to-treat basis. Main resultsWe didnt identify any randomised trials comparing 'as required' medication regimens to regular regimens of the same drug. Authors' conclusionsThere is no evidence from within randomised trials to support this common current practices. Current practice is based on clinical experience and habit rather than high quality evidence. |