title: The use of Pro Re Nata or Statim medications for behavioral control: a summary of experience at a tertiary care children's mental health center.
abstract: The present study aims to identify patterns for use of medication given pro re nata (PRN or "on an as needed [preordered] basis") or statim (STAT [a new order] or "at once, immediately") and their efficacy in controlling aggressive behavior in the mental health (MH) services environment. PRN and STAT medication data were combined and referred to as PRN throughout this article, as the data were not collected in a manner required to differentiate between PRN and STAT medication administration. Analyzed data were extracted from the clinical records of a sample of children and youth admitted for the first time to a tertiary MH center. MH Program patients (characterized by at least one Axis I psychiatric diagnosis [Axis I group]) were compared to Dual Diagnosis Program patients (characterized by an Axis I diagnosis in addition to an Axis II diagnosis of mental retardation [Axis II group]). Age, gender, Program (Axis I or II group), and the length of stay for treatment produced significant differences in the use of PRNs between the two groups. Further, the study investigated the precipitating factors leading to use of PRNs, in conjunction with the level of supervision and the de-escalation techniques used to avoid the use of PRNs. Axis I patients were more likely to endanger others, whereas Axis II patients were more likely to endanger themselves. Both groups of patients demonstrated a need for an increased level of supervision prior to the crisis. Olanzapine, chlorpromazine, and lorazepam were effective in calming patients and preventing further aggressive outbursts.
authors.affiliation: 1 Applied Research and Education Department, Child and Parent Resource Institute , London, Ontario, Canada .
authors.forename: Greta Toni
authors.initials: GT
authors.lastname: Swart
authors.forename: Emilian
authors.initials: E
authors.lastname: Siman
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000374:Aggression / Q000187:drug effects; D014151:Anti-Anxiety Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001569:Benzodiazepines / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002746:Chlorpromazine / Q000008:administration & dosage / Q000627:therapeutic use; D017831:Diagnosis, Dual (Psychiatry); D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000150:complications / Q000188:drug therapy; D007902:Length of Stay; D008140:Lorazepam / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000503:physiopathology; D008605:Mental Health Services; D000077152:Olanzapine; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012737:Sex Factors
chemical_list: D014151:Anti-Anxiety Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D000077152:Olanzapine; D008140:Lorazepam; D002746:Chlorpromazine