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Objective@#Intramuscular medications are widely used to treat psychomotor agitation (PMA) in uncooperative patients. We evaluated knowledge and attitude towards guidelines and the prescribing patterns in a sample of Italian psychiatrists. @*Methods@#A structured 28-item questionnaire was submitted to psychiatrists of Italian Departments of Mental Health. We considered 8 clinical scenarios of PMA. For comparing two qualitative variables Chi-square tests were performed. @*Results@#One hundred thirty-four psychiatrists completed the survey. The use of a monotherapy is significatively higher (p ＜ 0.05) over a dual therapy in all clinical scenarios except PMA due to Mood Disorder and Psychotic Disorders, whereas the use of a polytherapy is significatively higher (p ＜ 0.05) in PMA due to Mood Disorders and Psychotic Disorders. The use of second-generation antipsychotic (SGAs) as monotherapy over first-generation antipsychotics (FGAs) is significantly higher (p ＜ 0.05) in PMA due to Central Nervous System (CNS) stimulants. The use of SGAs over FGAs in polytherapy is significantly higher (p ＜ 0.05) in PMA due to CNS stimulants. Knowledge of guidelines results 67.1% and significatively higher (p ＜ 0.05) among those who prefer SGAs as monotherapy rather than FGAs in PMA due to Intellectual Disability, CNS depressants and Delirium. Knowledge of guidelines results significatively higher (p ＜ 0.05) among those who prefer SGAs rather than FGAs in polytherapy in PMA due to Mood disorders. @*Conclusion@#This survey reports variation in prescribing patterns for medication used to treat PMA. While SGAs are often prescribed as first choice following the more recent guidelines, FGAs and multi-drug solutions seem to be still a popular solution.
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Paroxetine and Sertraline are the only medications approved in posttraumatic stress disorder (PTSD). However, about 60% of traumatized patients fail to show an adequate clinical response. Second generation antipsychotics are recommended as second-line monotherapy or third-line augmentation strategies and quetiapine appears as one of the most used and promising agents. Up to date, no reviews assessed the efficacy of quetiapine in the treatment of PTSD. We aimed to assess the effectiveness and general safety of quetiapine on PTSD. A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Cochrane guidelines, selecting studies that evaluated the efficacy of quetiapine on global or specific PTSD symptomatology. Ten studies (n = 894) were considered eligible for qualitative synthesis: one case report, one case series, one prospective cohort study, 3 open-label trials, 3 retrospective studies, one randomized controlled trial. Quetiapine was effective on global PTSD symptomatology assessed in 6 studies as well as on re-experiencing (4/4 studies), avoidance (4/3 studies) and hyperarousal (4/4 studies), flashbacks (2/2 studies), depressive (4/4 studies), anxiety (1/1 studies), psychotic (3/3 studies), insomnia (4/5 studies), nightmares (3/3 studies) specific symptoms and PTSD domains. Sedation was among the most frequently observed adverse effects and the main cause of drug discontinuation. Preliminary findings support the efficacy of quetiapine in ameliorating symptoms relative to PTSD and its overall safety. However, quetiapine use in PTSD cannot be recommended yet as studies mainly rely on open-label, retrospective studies or case series.
RESUMEN
OBJECTIVES: To identify possible differences, in terms of duration and severity of Post-Traumatic Stress Disorder, between victims of terrorist attacks and subjects who underwent other types of traumatic events. METHODS: A sample of subjects suffering from PTSD was selected. After a clinical interview aimed at the collection of anamnestic data, CAPS to confirm the diagnosis of PTSD and DTS to assess frequency and severity of post-traumatic symptoms were administered. One-way ANOVA was used in order to compare the differences in the parameters analysed through the DTS scales and its clusters between the victims of terrorist attacks and patients undergone other traumatic events. RESULTS: The duration of PTSD was 258 +/ - 144.9 months for people who underwent a terrorist attack and 41.6 +/ - 11.8 months for victims of other traumatic events. As regards the severity of the disorder, the total score of the DTS scale was 65.6 +/ - 26.9 in victims of terrorist attacks and 78.2 +/ - 28.2 in people who undergone other traumatic events. However, the difference was not statistically significant; Avoidance and Hypervigilance clusters showed an important statistical significance. CONCLUSIONS: No significant differences are present in terms of severity, showing that PTSD is a disabling disorder regardless the type of event that triggers it; however, a significant difference in terms of duration of the disorder leads to reflec on the importance of an early diagnostic process aimed toward the victims of terrorism, in order to avoid the risk of chronicity and progression to other psychiatric disorders such as depression.