title: Prescribing preferences in rapid tranquillisation: a survey in Belgian psychiatrists and emergency physicians.
abstract: BACKGROUND
  The pharmacotherapeutic management of agitation is a common clinical challenge. Pharmacotherapy is frequently used, the use of published guidelines is not known. The purpose of this study was twofold; to describe the prescribing patterns of psychiatrists and emergency physicians and to evaluate to which extent guidelines are used.
  
  
  METHODS
  A cross-sectional survey in the Dutch-speaking part of Belgium is carried out in 39 psychiatric hospitals, 11 psychiatric wards of a general hospital and 61 emergency departments. All physicians are asked for demographic information, their prescribing preferences, their use of guidelines and the type of monitoring (effectiveness, safety). For the basic demographic data and prescription preferences descriptive statistics are given. For comparing prescribing preferences of the drug between groups Chi square tests (or in case of low numbers Fisher's exact test) were performed. Mc Nemar test for binomial proportions for matched-pair data was performed to see if the prescription preferences of the participants differ between secluded and non-secluded patients.
  
  
  RESULTS
  550 psychiatrist and emergency physicians were invited. The overall response rate was 20% (n = 108). The number 1 preferred medication classes were antipsychotics (59.3%) and benzodiazepines (40.7%). In non-secluded patients, olanzapine (22.2%), lorazepam (21.3%) and clotiapine (19.4%) were most frequently picked as number 1 choice drug. In secluded patients, clotiapine (21.3%), olanzapine (21.3%) and droperidol (14.8%) were the three most frequently chosen number 1 preferred drugs. Between-group comparisons show that emergency physicians prefer benzodiazepines significantly more than psychiatrists do. Zuclopenthixol and olanzapine show a particular profile in both groups of physicians. Polypharmacy is more frequently used in secluded patients. Published guidelines and safety or outcome monitoring are rarely used.
  
  
  CONCLUSIONS
  Our results show that prescription practice in Flanders (Belgium) in acute agitation shows a complex relationship with published guidelines. Prescription preferences differ accordingly to medical specialty. These findings should be taken into account in future research.
authors.affiliation: Faculteit geneeskunde en gezondheidswetenschappen, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium. chris.bervoets@uantwerpen.be.|UPC KULeuven, Campus Gasthuisberg, Louvain, Belgium. chris.bervoets@uantwerpen.be.
authors.forename: Chris
authors.initials: C
authors.lastname: Bervoets
authors.affiliation: Faculteit geneeskunde en gezondheidswetenschappen, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium. ella.roelant@uantwerpen.be.|StatUa Center for Statistics, University of Antwerp, Antwerp, Belgium. ella.roelant@uantwerpen.be.
authors.forename: Ella
authors.initials: E
authors.lastname: Roelant
authors.affiliation: AZ Sint Jan Brugge-Oostende AV, Brugge, Belgium. jurgen.defruyt@azbrugge.be.
authors.forename: Jürgen
authors.initials: J
authors.lastname: De Fruyt
authors.affiliation: UPC KULeuven, Campus Kortenberg, Louvain, Belgium. hella.demunter@uc-kortenberg.be.
authors.forename: Hella
authors.initials: H
authors.lastname: Demunter
authors.affiliation: AZ Herentals, Herentals, Belgium. barry.dekeyser@telenet.be.
authors.forename: Barry
authors.initials: B
authors.lastname: Dekeyser
authors.affiliation: UZ Gent, Ghent, Belgium. leen.vandenbussche@ugent.be.
authors.forename: Leen
authors.initials: L
authors.lastname: Vandenbussche
authors.affiliation: AZ Groeninge, Kortrijk, Belgium. koen.titeca@azgroeninge.be.
authors.forename: Koen
authors.initials: K
authors.lastname: Titeca
authors.affiliation: Faculteit geneeskunde en gezondheidswetenschappen, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium. guido.pieters@uc-kortenberg.be.|UPC KULeuven, Campus Kortenberg, Louvain, Belgium. guido.pieters@uc-kortenberg.be.
authors.forename: Guido
authors.initials: G
authors.lastname: Pieters
authors.affiliation: Faculteit geneeskunde en gezondheidswetenschappen, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium. bernard.sabbe@uantwerpen.be.|PZ Sint Norbertus, Duffel, Belgium. bernard.sabbe@uantwerpen.be.
authors.forename: Bernard
authors.initials: B
authors.lastname: Sabbe
authors.affiliation: Faculteit geneeskunde en gezondheidswetenschappen, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium. manuel.morrens@uantwerpen.be.|PZ Boechout, Boechout, Belgium. manuel.morrens@uantwerpen.be.
authors.forename: Manuel
authors.initials: M
authors.lastname: Morrens
mesh_terms: D001291:Attitude of Health Personnel; D001530:Belgium; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D017723:Drug Utilization Review; D004636:Emergency Service, Hospital / Q000639:trends*; D004637:Emergency Services, Psychiatric / Q000639:trends*; D019983:Guideline Adherence / Q000639:trends; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010820:Physicians / Q000639:trends*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D013038:Specialization; D011795:Surveys and Questionnaires; D014149:Tranquilizing Agents / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D014149:Tranquilizing Agents