2019 Research Forum

History of Drug Abuse and the Use of Pro re nata (PRN) Medication on an Inpatient Psychiatric Unit

Nazila Sharbaf Shoar MS IV, Mantavya Punj MS IV, Frederick Venter MS IV, Sara Abdijadid DO MS

UCLA-Kern Psychiatry Residency Program

Conclusions Previous studies suggested that psychiatric patients with a history of illicit drug abuse required more frequent PRN medications when compared to nonusers. Our independent research found differently, that there was no statistically significant difference in PRN anxiolytic medication use in hospitalized psychiatric patients with a history of previous illicit drug use compared to nonusers. Patients with a history of substance abuse did not require more PRN anxiolytic medications when compared to non-drug abusers. This changes the way that the general physician population views the medication needs of drug abusers possibly leading to lower medication use, better cost-effectiveness, decreased length of stay, better patient communication, and understanding of illicit drug abusers medication requirements. References 1. Bauer, J. Ø., Stenborg, D., Lodahl, T., & Mønsted, M. M. (2016). Treatment of agitation in the acute psychiatric setting. An observational study of the effectiveness of intramuscular psychotropic medication. Nordic journal of psychiatry, 70(8), 599- 605. 2. Cheong, J., (2004). An Evidence-Based Approach to the Management of Agitation in the Geriatric Patient. 3. D’Mello, D. A., Lyon, D. E., Colenda, C. C., & Fernandes, C. L. (2000). Substance dependence and the use of pro re nata anxiolytic/hypnotic drugs in a hospital setting. Addictive behaviors, 25(3), 441-443. 4. Donlon, PT., Hopkin, J., Tupin, JP., (1979) Overview: safety and efficacy of rapid neuroleptization method with injectable haloperidol. Am J Psychiatry 5. Feifel, D., (2001).Psychopharmacology in Acute Setting: Review and Proposed Guidelines. Psychiatric Times 6. Lehman, A. F., Myers, C. P., & Corty, E. (2000). Assessment and classification of patients with psychiatric and substance abuse syndromes. Psychiatric Services, 51(9), 1119-1125. 7. Mohr, P. Pecenak, J. (2005). Treatment of acute agitation in psychotic disorders. Neuroendocrinology Letters 8. Osher, F. C., & Kofoed, L. L. (1989). Treatment of patients with psychiatric and psychoactive substance abuse disorders. Psychiatric Services, 40(10), 1025-1030. 9. Schumacher, L., Dobrinas, M., Tagan, D., Sautebin, A., Blanc, A. L., & Widmer, N. (2017). Prescription of Sedative Drugs During Hospital Stay: A Swiss Prospective Study. Drugs - real world outcomes, 4(4), 225–234. doi:10.1007/s40801-017-0117-6. Acknowledgements Thank you to the UCLA-Kern Psychiatry Program , and all those who have supported us furthering our research experience through feedback and providing valuable comments at various stages of this research.

This research is a retrospective cohort study, which reviewed a randomly selected 75 patients who were hospitalized on the psychiatric unit. Full history and physical examination was done for every patient. Special attention was paid to history of illicit drug use. Following substances were considered as illicit drug in this study: alcohol, cocaine, cannabis, LSD, and stimulants. Patients were divided into two groups of substance users and nonusers. The data was entered and analyzed by a statistical software program. t-test was used to assess the relationship between utilization of the p.r.n anxiolytic in substance users and nonusers. Methods

Clinicians are increasingly facing the diagnostic and treatment challenges in patients with dual diagnosis of mental illness and substance use disorders. Existing literature support the idea that the dual diagnosis is not a co-occurrence. It is believed that patients with mental illness are at high risk for substance abuse and substance abuse increase the risk of mental illness (Lehman A. F., 2000) Agitation is commonly encountered in inpatient psychiatric settings. Agitation is a feeling of aggravation, annoyance, or restlessness brought on by provocation or, in some cases, little to no provocation. It maybe a manifestation of psychotic disorder, mood disorder, or panic attack and requires immediate attention (Cheong J, 2004). Agitation maybe a manifestation of psychotic disorder, mood disorder, or panic attack , which is managed in the inpatient psychiatric unit by administration of tranquilizing psychotropic medications. Tranquilizing psychotropic medications are the antipsychotic and benzodiazepine classes, which can be prescribed either in combination or as single agents (Feifel D, 2001). There are two classes of tranquilizers, minor and major. Minor tranquilizers are known as anxiolytics, which are commonly used in the management of anxiety, fear and tension. Major tranquilizers, are known as antipsychotic agents, as they are prescribed to treat major states of mental disturbances like delusions, hallucinations and disorganized behavior (Mohr, 2005). The antipsychotics can be divided into two groups of high potency/low sedation and low potency/high sedation. Haloperidol and risperidone are some of the good examples of high potency with low sedation, which are used in the setting of behavioral disturbances to reduce agitation (Donlon PT, 1979). The other group is the Low potency/high sedation agents that are used in cases of affective dysregulation and anxiety. Some of the commonly used agents are thioridazine, olanzapine and quetiapine, which can be administered either orally or parenterally. Introduction Objectives Patients with psychiatric illness hospitalized in an acute psychiatric unit receive pro re nata (p.r.n.) antianxiety and hypnotic agents for the treatment of the acute agitation. The relationship between illicit drug use and p.r.n. anti-anxiety/hypnotic drug use in hospitalized psychiatric patients has not been extensively examined. Previous researches support the idea that substance abusers experience more anxiety and insomnia when hospitalized compared to the non- abusers and they substitute prescription preparations for illicit substances (D’Mello D. A., 2000). Consequently they receive more PRN anxiolytic medications compared to the non-abusers. The purpose of this study was to assess the correlation between utilization of PRN anxiolytic medications and recreational drug abuse.

No statistical significant was found when utilized p.r.n. anxiolytic were compared between substance users and nonusers (t = 0.9946, df =40.508, p-value = 0.3258, 95%, CI -0.5184708 1.5239870). Results

 Welch Two Sample t-test t = 0.9946, df = 40.508, p-value = 0.3258 alternative hypothesis: true difference in means is not equal to 0 95 percent confidence interval: -0.5184708 1.5239870 sample estimates:

mean in group No: 1.4814815 mean in group Yes: 0.9787234

What this means: The average # of PRN medications given in the illicit drug user group is 1.48 The average # of PRN medications given in the nonuser group is 0.98 These results are not statistically different, p-Value = 0.3258

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