title: Reducing Restraint With Clozapine in Involuntarily Admitted Patients With Schizophrenia.
abstract: BACKGROUND
  In the entire world, restraint and seclusion are common interventions in psychiatric inpatient settings because of aggressive behavior.
  
  
  OBJECTIVE
  Our objective was to test for the immediate antiaggressive property of clozapine compared with other antipsychotic treatments in an enriched cohort with high rates of restraint during early hospitalization.
  
  
  METHODS
  We present a retrospective chart review in all involuntary admissions with schizophrenia during 2011-2014 in Psychiatry and Neurology Hospital, Brasov, Romania. Timing and number of restraints in addition to clinical, demographic, and treatment characteristics were extracted. Based on our earlier observation of clinical efficacy of early, fast titration of clozapine, we tested the hypothesis that clozapine treatment was associated with reduced use of restraint and with longer restraint-free periods.
  
  
  RESULTS
  In 115 consecutive patients with schizophrenia (age = 39.7 ± 11.1 years; male = 59%) involuntarily admitted because of externalized (74.7%) or self-directed violence (25.2%), restraint was used in 89.6%; with a median duration of 3 hours until restraint past admission. Antipsychotics used immediately after hospitalization included haloperidol (70.4%), clozapine (11.3%), olanzapine (10.4%), and other second-generation antipsychotics (7.9%). Comparison of restraint characteristics favored immediate clozapine use with highly reduced rates of restraint (23% vs. 95.6%; P < 0.001) and significantly extended hours until restraint [(118, 24, 426 hours) vs. (3, 0.25, 48 hours); median; 25th, 75th percentile; P < 0.001] relative to the remaining cohort. These effects remained highly significant after controlling for potential moderators of restraint use in multivariate models.
  
  
  CONCLUSIONS
  These retrospective data suggest an early antiaggressive effect of clozapine during the immediate use of clozapine in highly problematic patients.
authors.affiliation: 1Psychiatry and Neurology Hospital, Brasov, Romania; 2Faculty of Medicine, Transilvania University, Brasov, Romania; and 3Faculty of Medicine, UMF "Gr.T.Popa," Iasi, Romania.
authors.forename: Petru
authors.initials: P
authors.lastname: Ifteni
authors.forename: Andreea S
authors.initials: AS
authors.lastname: Szalontay
authors.forename: Andreea
authors.initials: A
authors.lastname: Teodorescu
mesh_terms: D000328:Adult; D000374:Aggression; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D003024:Clozapine / Q000627:therapeutic use*; D015331:Cohort Studies; D003134:Commitment of Persons with Psychiatric Disorders; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D012149:Restraint, Physical; D012189:Retrospective Studies; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D016728:Self-Injurious Behavior / Q000517:prevention & control*; D013997:Time Factors; D014754:Violence / Q000517:prevention & control*
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D003024:Clozapine; D006220:Haloperidol; D000077152:Olanzapine