Association between physical restraint and drug-induced liver injury.
OBJECTIVE
As animal models have suggested enhancement of xenobiotic-induced hepatotoxicity due to restraint stress, a case-control study was undertaken to investigate the effects of physical restraint on the development of drug-induced liver injury (DILI) in a psychiatric intensive care unit.


METHODS
Demographic and clinical characteristics were compared between restrained patients (n = 106) and nonrestrained patients (n = 528) admitted to the psychiatric intensive care unit during a 4-year period from January 2003 to December 2006.


RESULTS
Rates of DILI differed significantly between restrained patients (8.5%) and nonrestrained patients (1.9%; odds ratio 4.81, p = 0.0016), although no initial differences were seen in medical and psychiatric conditions. No differences in mean number of drugs were identified. The rate of patients who received antipsychotics was higher in the restrained group than in the nonrestrained group, whereas the rate of patients who received antidepressants was higher in the nonrestrained group than in the restrained group.


CONCLUSIONS
Despite methodological limitations imposed by the retrospective design, a conservative claim can be made that physical restraint might represent a risk for DILI. This observation deserves confirmation in a prospective study.
Hatta
Kotaro
K
Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan. khatta@med.juntendo.ac.jp
Shibata
Nobuto
N
Ota
Tsuneyoshi
T
Usui
Chie
C
Ito
Masanobu
M
Nakamura
Hiroyuki
H
Arai
Heii
H
D000328:Adult; D016022:Case-Control Studies; D056486:Chemical and Drug Induced Liver Injury; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012149:Restraint, Physical; D012189:Retrospective Studies; D018570:Risk Assessment