Antipsychotics linked to decreased assault risk for emergency personnel

Use of antipsychotic medication in psychiatric patients led to decreases in assault risk against personnel within emergency settings, according to a longitudinal study published in the Journal of Clinical Psychiatry.

“Physical assaults are a persistent problem in hospital psychiatry, causing physical injuries, psychological distress and increased costs. Although these events are rare on a per-person basis, larger facilities still have many events,” Y. Nina Gao, MD, PhD, department of psychiatry, New York State Psychiatric Institute, and colleagues wrote.

“The widespread adoption of electronic health records, which capture the sequence of clinical events in granular detail, has created new opportunities to study the relationship between medication administration and subsequent violence risk in emergency settings,” they said.

Researchers sought to determine and evaluate any relationship between the various intramuscular medications (IMs) used to mollify an agitated patient (antipsychotics, mood stabilizers and benzodiazepines) along with incidence and severity of assaults within psychiatric emergency departments.

Previous research clarified certain demographic risk factors for episodes of hospital-based violence but did not strictly examine a relationship between administration of intramuscular drugs and violent behavior, they wrote.

Orders for medication as well as assault incident reports were culled from electronic health records based on 17,056 total visits by 9,870 individual patients to urban psychiatric emergency locations over more than 1.3 million hours during a 5-year period from January 2014 to December 2019. Determination of assault risk was modeled longitudinally using Poisson mixed-effects regression.

Results showed that assaults were reported during just 0.5% of all visits, and IMs were used during 23.3% of visits overall, most of which were given before 4 hours elapsed during a particular visit. Forty-one percent of assaults occurred within 1 hour of a medication order. IM orders were predominantly correlated with incidents of assault because they were most often ordered immediately after reports of violent behavior.

Conversely, data revealed IMs did not hold a significant association with assault reductions over time. While use of antipsychotic medication showed a correlation with decreased assault risk over the period of the study, use of neither benzodiazepines nor mood stabilizers produced any significant change to the probability of assault risk.

“Administration of IM medications can increase safety in some respects but – particularly when IM medications are given involuntarily – patients may experience a loss of autonomy, they may experience the intervention as unnecessarily invasive, and the experience may disrupt their relationships with health care providers,” Gao and colleagues wrote. “Administration of IM medications may also temporarily escalate the situation and place the patient and staff members at increased risk of injury.”