The prescription of psychotropic medications for patients discharged from a psychiatric emergency service.
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.


METHODS
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%), anti-psychotics (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.
Ernst
Carrie L
CL
Department of Psychiatry, Massachusetts General Hospital, Boston, USA.
Bird
Suzanne A
SA
Goldberg
Joseph F
JF
Ghaemi
S Nassir
SN
D000328:Adult; D000359:Aftercare / Q000379:methods / Q000706:statistics & numerical data*; D000553:Ambulatory Care / Q000379:methods / Q000706:statistics & numerical data; D001071:Appointments and Schedules; D001714:Bipolar Disorder / Q000188:drug therapy / Q000453:epidemiology; D003156:Community Mental Health Services / Q000706:statistics & numerical data; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D010351:Patient Discharge; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011570:Psychiatry / Q000379:methods / Q000706:statistics & numerical data; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012017:Referral and Consultation; D019966:Substance-Related Disorders / Q000453:epidemiology; D013405:Suicide / Q000523:psychology
D011619:Psychotropic Drugs