The Prescription of Psychotropic Medications for Patients Discharged From a Psychiatric Emergency Service
J Clin Psychiatry 2006;67:720-726
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: Considerable debate exists
about the value and wisdom of initiating
"definitive" pharmacotherapies, particularly
antidepressants, in the psychiatric emergency setting. We
evaluated the nature and prevalence of medication
prescriptions for patients discharged from an
urban psychiatric emergency service and the extent
to which pharmacotherapy initiation was predictive of follow-through with aftercare.
Method: Records were reviewed for 675
consecutive individuals evaluated and discharged from a community-based psychiatric
emergency service over a 3-month period (January
2003-March 2003). Information was obtained
regarding diagnoses, past and current treatments, and
demographic and clinical features, as well as
outcomes for the subgroup of patients who received
aftercare appointments within the institutional system.
Results: Fifty-five percent of
psychiatric emergency service visits resulted in
discharge, with psychotropic drug prescriptions given
to about 30% of this group. Prescriptions most
often included antidepressants (64%),
benzodiazepines (25%), nonbenzodiazepine sedatives (20%),
antipsychotics (18%), and mood stabilizers (10%). After controlling for potential confounders,
the decision to prescribe was significantly
associated with a clinical diagnosis of major depressive
disorder or bipolar disorder and the preexisting
use of psychotropic medications. Nonprescribing occurred most often in discharged patients who
had suicidal ideation, substance abuse or
dependence, and an existing outpatient psychiatrist.
Follow-up emergency service and new outpatient
appointments were more often given to patients discharged with a prescription, but
follow-through with aftercare was not more likely in this group.
Conclusions: Psychiatrists in an
emergency service prescribe antidepressants or other
major psychotropics for about one third of
discharged patients, rarely in the presence of suicidality
or substance abuse or dependence, and with little evidence that initiating such medications in
the emergency setting promotes more successful bridging to outpatient treatment.