Journal of Psychiatry

Relative efficacy of psychotropic medications for the management of acute agitation in children and adolescents in the psychiatric emergency room

Webinar of European Conference on Psychiatry

February 24, 2022 | Webinar

Rama Krishna Makani

Atlantic care Health System, USA

Scientific Tracks Abstracts: J Psychiatry

Abstract:

Objective: Children and adolescents frequently present to the emergency room (ER) with acute agitation and often require physical restraints (PR). Due to a dearth of evidence-based guidelines, clinicians may find it daunting to choose the most appropriate pharmacologic intervention in a given patient encounter. Our retrospective cohort study aims to compare the efficacy of psychotropic medications used to treat acutely agitated youth in our ER, as measured by subsequent need for PR. Methods:Retrospective chart review of patients aged 5-17 who visited our ER from 1/1/2019-12/31/2020 was conducted. Data on pharmacologic management of ‘agitation’ or ‘aggression’ was gathered to assess the subsequent need for PR use (primary outcome measure). Data analysis was completed to evaluate the relative differences in neuroleptic, anxiolytic and combination medication use, and of PR use. Results: We identified 1,346 total admissions (630 males, 716 females), of which 59 (47 males, 12 females; average age 14.1) required PRN medications for agitation. 32 patients (54.2%) who required medication received a combination of anxiolytics and neuroleptics, while 20 (33.9%) received anxiolytics alone, and 3 (0.05%) received neuroleptics alone. 32 patients (54.2%) required PR despite pharmacologic attempts at de-escalation. Specifically, 23 (71.9%) who received combination medications, 7 (35%) who received anxiolytics alone, and 2 (66.7%) who received neuroleptics alone subsequently required PR use. The most common diagnoses amongst patients requiring PRN. Medications were ADHD (35.6%), ODD (33.9%), ASD (27.1%) and Bipolar Disorders (20.3%). Conclusions: Our results correlate with current consensus guidelines for the potential benefit of anxiolytic medication use alone as compared to combination medication or neuroleptics alone in providing first line pharmacological management of agitation in this patient population. Through continued research, we aim to give providers confidence to use anxiolytics to effectively de-escalate agitated patients. Further consideration should be given to tailoring pharmacologic approaches to the etiology of agitation and to reproducibly demonstrating these findings through prospective studies.

Biography :

Makani has completed his medical school from esteemed Gujarat University (Smt. NHL Medical College) and then pursued MPH from West Chester University of Pennsylvania, Unites States. He did clinical research at IV league academic institution (University of Pennsylvania) for 3 years and then pursued his psychiatry residency from Cooper University Hospital with “best resident award in clinical and research excellence”. He continued this success and earned his child and adolescent psychiatry fellowship and completed from the best children’s hospital in United States (Children’s Hospital of Philadelphia). He has published more than 14 papers in reputed journals and also serving as reviewers in 4 journals. He is currently at Atlanti Care health System and soon going to be Director of Psychiatry Residency Training at Atlanti Care from March of 2022.