title: Despite expert recommendations, second-generation antipsychotics are not often prescribed in the emergency department.
abstract: BACKGROUND
  Recent expert guidelines recommend oral second-generation antipsychotics (SGAs) as first-line therapy for acute agitation in the emergency department (ED), with intramuscular (IM) SGAs as an alternative. However, little is known about how these meds are used in the ED or how often SGAs are prescribed.
  
  
  OBJECTIVE
  1) The measurement of patient characteristics, concomitant benzodiazepine use, and use of SGAs compared to haloperidol or droperidol; 2) the prescribing rates of SGAs over time in ED patients.
  
  
  METHODS
  This is a structured analysis of a historical patient cohort from 2004-2011 in two university EDs. The cohort consisted of all patients receiving aripiprazole, olanzapine, quetiapine, risperidone, or ziprasidone. Descriptive analysis compared age, gender, use of first-generation antipsychotics (FGAs) such as haloperidol/droperidol, and rates of concomitant benzodiazepine use. Linear regression was used to test whether SGA prescribing increased over time.
  
  
  RESULTS
  There were 1680 unique patients accounting for 1779 ED visits who received SGAs over the study period, which is a minority of patients receiving any antipsychotic. Of patients receiving any SGA in the ED, most were given orally (93%). Adjunctive benzodiazepines were administered on 21% of visits, and were also administered on 21% of the visits involving alcohol + patients. The rate of SGA use in the ED is not increasing over time.
  
  
  CONCLUSIONS
  Despite expert recommendations, SGAs are administered a minority of the time to ED patients. The rate is not increasing over time. When used, SGAs are most commonly given orally, are often administered with benzodiazepines, and are frequently administered to alcohol-intoxicated patients.
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research Lab, UC San Diego, San Diego, California; Department of Emergency Medicine, UC San Diego Health System, San Diego, California.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Wilson
authors.affiliation: Department of Psychiatry, UC San Diego Health System, San Diego, California.
authors.forename: Arpi
authors.initials: A
authors.lastname: Minassian
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research Lab, UC San Diego, San Diego, California.
authors.forename: Maria
authors.initials: M
authors.lastname: Bahramzi
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research Lab, UC San Diego, San Diego, California.
authors.forename: Ashleigh
authors.initials: A
authors.lastname: Campillo
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research Lab, UC San Diego, San Diego, California; Department of Emergency Medicine, UC San Diego Health System, San Diego, California.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000435:Alcoholic Intoxication / Q000188:drug therapy; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000068180:Aripiprazole; D001569:Benzodiazepines / Q000008:administration & dosage / Q000627:therapeutic use; D003987:Dibenzothiazepines / Q000008:administration & dosage; D004329:Droperidol / Q000008:administration & dosage; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D010879:Piperazines / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D000069348:Quetiapine Fumarate; D015363:Quinolones / Q000008:administration & dosage; D018967:Risperidone / Q000008:administration & dosage; D013844:Thiazoles / Q000008:administration & dosage
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D010879:Piperazines; D015363:Quinolones; D013844:Thiazoles; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; C092292:ziprasidone; D000068180:Aripiprazole; D006220:Haloperidol; D018967:Risperidone; D000077152:Olanzapine; D004329:Droperidol
keywords: agitation; aripiprazole; first generation antipsychotic; olanzapine; quetiapine; risperidone; second-generation antipsychotic; ziprasidone