[Effectiveness results of olanzapine in acute psychotic patients with agitation in the emergency room setting: results from NATURA study].
BACKGROUND
Patterns of use of antipsychotics are not well described in emergency units. The objective of this study was to describe the effectiveness and safety of use of olanzapine in patients with acute psychosis and agitation in the emergency rooms.


METHODS
In this prospective observational study 278 patients with acute psychosis and agitation were consecutively admitted in 16 psychiatric emergency wards and treated with any oral psychopharmacology treatment, including olanzapine, according to investigators clinical criteria. Data were collected prospectively including demographics, diagnosis, concomitant medications, utilization of mechanical restraints, and severity of agitation. Clinical evolution during emergency room stay was assessed with PANSS-Excitement Component, CGI-S and Agitation and Calmness Evaluation Scale (ACES) at baseline, before any re-intervention (if needed) and at discharge from the emergency room. Safety was also evaluated.


RESULTS
Olanzapine alone was used in 148 (53.2%) patients. Most of them (77.7 %) were diagnosed of Schizophrenia and related psychoses. Up to 38 patients (25.7 %) required mechanical restraints. Mean change (confidence interval [CI] 95 %) from baseline to discharge was significant in all rating scales; PANSS-EC: -7.46 (-8.2, -6.7); CGI-S: -1.82 (-2, -1.6) ACES: 1.28 (1.1, 1.5). At discharge 70.3% of patients went to inpatient units. Five patients (3.4%) reported adverse events including: bradycardia, dry mouth, sedation, hypertension, hypotension, and orthostatic hypotension. None of them was serious.


CONCLUSIONS
The utilization of olanzapine alone decreased agitation in psychotic patients in emergency room settings. Incidence of adverse events was low and it was well tolerated.
Escobar
R
R
Lilly Research Laboratories, Alcobendas, Madrid.
San
L
L
Pérez
V
V
Olivares
J M
JM
Polavieja
P
P
López-Carrero
C
C
Casillas
M
M
Montoya
A
A
D000208:Acute Disease; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004637:Emergency Services, Psychiatric; D005260:Female; D006801:Humans; D008297:Male; D000077152:Olanzapine; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000453:epidemiology*; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D011795:Surveys and Questionnaires
D014150:Antipsychotic Agents; D001569:Benzodiazepines; D000077152:Olanzapine