A Study of Cardiac Outcomes After Droperidol Administration in an Inpatient Psychiatric Cohort.

PURPOSE/BACKGROUND: Droperidol is an antipsychotic medication used in psychiatric emergencies to manage acute behavioral disturbance. Droperidol use carries a risk of prolonged QT interval on the electrocardiogram and associated cardiac arrhythmias including torsades de pointes and ventricular fibrillation. This study aimed to evaluate the safety of droperidol in adults admitted to the psychiatric inpatient unit of a large Australian hospital. METHODS/PROCEDURES: In this retrospective cohort study, psychiatric inpatients admitted between October 22, 2018, and March 1, 2021, who received at least 1 dose of intramuscular droperidol were consecutively included. Outcomes of interest were death, cardiac arrhythmias, and QT prolongation. QT prolongation was identified using the QT-interval nomogram. FINDINGS/RESULTS: This study included 263 patients without exclusion. No deaths or cases of cardiac arrhythmia were recorded within 24 hours of droperidol administration. Electrocardiogram data were available for 41.1% of patients (n = 108) within 7 days of droperidol administration. Two cases of QT prolongation were identified using the QT-interval nomogram, but these patients were also prescribed other medications that may have contributed to QT prolongation. IMPLICATIONS/CONCLUSIONS: This study contributes the first known large retrospective study of safety outcomes including QT prolongation after droperidol administration in a psychiatric inpatient setting. Our findings corroborate mounting evidence supporting the clinical safety of droperidol use in psychiatric settings. Nonetheless, we note that significant barriers remain with regard to timely electrocardiogram monitoring after droperidol use.

Psychiatry in Nazi Germany: an ethical analysis and relevance to psychiatry today.

OBJECTIVE: To investigate the war crimes committed by psychiatrists during the German Nazi regime in the twentieth century and better understand the moral arguments used to justify them. METHOD: This article provides a historical review of the crimes committed by psychiatrists in Nazi Germany and ethical analysis from the perspectives of consequentialism and deontology. RESULTS: Nazi psychiatrists oversaw the death of more than 200,000 people with mental illnesses and inflicted harm on many more. Consequentialist reasoning may have been used to justify these atrocities. Deontological reasoning proved impervious to exploitation by the Nazi regime, but without codification it was too easily abandoned and thus failed to protect patients. CONCLUSIONS: A duty-based code of ethics that enshrines universal respect for the humanity, dignity and autonomy of all persons, and condemns the misuse of professional knowledge and skills, may be a safeguard against the future political abuse of psychiatry.