Treatment of acutely aggressive psychiatric inpatients with olanzapine and other antipsychotics

This prospective, comparative observational study documents antipsychotic treatment in patients with an indication for aggression control. Documented were the first 5 days of treatment following initiation of an antipsychotic (AP) medication.

Overall, 558 patients were documented, 390 (69.9%) treated with olanzapine (OLZ) and 168 (30.1%) with other APs. The median age was 38 years and 204 (36.6%) patients were females.

Most common diagnoses were schizophrenia and related disorders in 59.1% of the patients followed by disorders due to psychoactive substance abuse (17.6%), mood disorders (15.8%), and personality disorders (15.1%). Common patient characteristics were psychomotor agitation (73.1%), third-party endangering (70.4%), self-endangering (47.3%), and compulsory admission (42.7%).

Antipsychotic mono-therapy was given to 46.4% of the OLZ patients (mean daily dose 16.5±9.6mg) but only to 26.3% of those treated with other APs. Most commonly given concomitant medications were the benzodiazepines lorazepam (44.4%) and diazepam (31.4%). The proportion of patients who received benzodiazepines throughout the 5 days observation was 60.0% in the OLZ and 71.4% in the other APs cohort.

After 5 days, the mean PANSS-EC score was reduced from 24.9 at baseline to 12.5 for OLZ and from 25.6 to 13.0 for other APs.

The present study provides for the first time a naturalistic observation of antipsychotic treatment of acutely aggressive patients at psychiatric hospitals in Germany.