Diagnostic variability for schizophrenia and major depression in a large public mental health care system dataset.

Administrative datasets can provide information about mental health treatment in real world settings; however, an important limitation in using these datasets is the uncertainty regarding psychiatric diagnosis. To better understand the psychiatric diagnoses, we investigated the diagnostic variability of schizophrenia and major depression in a large public mental health system. Using schizophrenia and major depression as the two comparison diagnoses, we compared the variability of diagnoses assigned to patients with one recorded diagnosis of schizophrenia or major depression. In addition, for both of these diagnoses, the diagnostic variability was compared across seven types of treatment settings. Statistical analyses were conducted using t tests for continuous data and chi-square tests for categorical data. We found that schizophrenia had greater diagnostic variability than major depression (31% vs. 43%). For both schizophrenia and major depression, variability was significantly higher in jail and the emergency psychiatric unit than in inpatient or outpatient settings. These findings demonstrate that the variability of psychiatric diagnoses recorded in the administrative dataset of a large public mental health system varies by diagnosis and by treatment setting. Further research is needed to clarify the relationship between psychiatric diagnosis, diagnostic variability and treatment setting.

Safety of droperidol in behavioural emergencies.

By the year 2000, droperidol had become a standard drug for the treatment of behavioural emergencies in both psychiatric and medical settings. In 2001, the US FDA issued a 'black box' warning, citing cases of QT prolongation and/or torsades de pointes. As a result, the use of droperidol has been sharply circumscribed. The authors will review the literature on antipsychotic medications in general, focusing on droperidol in particular, with regard to QT interval prolongation, dysrhythmia, and sudden death. In addition, the mechanism of drug-induced QT interval prolongation will be discussed. The authors will then review their extensive experience with droperidol. The authors conclude that, while in theory droperidol may prolong the QT interval to an extent similar to thioridazine, its long history of clinical use has shown no pattern of sudden deaths analogous to those that provoked the FDA warning. Although the numbers presented by the FDA initially appear alarming, after further evaluation it is clear that more definitive studies should have been carried out. Droperidol is safe, extremely effective, and now underused as a treatment for severely agitated or violent patients.

A review of the safety and efficacy of droperidol for the rapid sedation of severely agitated and violent patients.

BACKGROUND: Droperidol had become a standard treatment for sedating severely agitated or violent patients in both psychiatric and medical emergency departments. However, several recent articles have suggested that droperidol may have a quinidine-like effect similar to that of thioridazine in inducing dysrhythmia. METHOD: In view of the recent U.S. Food and Drug Administration (FDA) position regarding the use of thioridazine, the authors reviewed the literature regarding droperidol and dysrhythmia in a MEDLINE search for the years 1960-2002 using the search terms droperidol, dysrhythmia, QTc interval, and sudden death as well as their own experience in using droperidol in a busy psychiatric emergency department. This review was done before the FDA's very recent and peremptory warning about droperidol. RESULTS: The authors report that, in treating approximately 12,000 patients over the past decade, they have never experienced a clinically significant adverse dysrhythmic event using droperidol to sedate severely agitated or violent patients. CONCLUSION: The authors conclude that, in clinical practice, droperidol is an extremely effective and safe method for treating severely agitated or violent patients. While in theory droperidol may prolong the QT interval to an extent similar to thioridazine, in clinical use there is no pattern of sudden deaths analogous to those that provoked the FDA warning about thioridazine.