Evaluation of the use of the positive and negative syndrome scale-excited component as a criterion for administration of p.r.n. medication

Abstract

Background: This study evaluates the use of the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) to evaluate control of agitation and aggression in inpatients with schizophrenia as a criterion for administration of p.r.n. (as needed) medication.

Methods: Information was collected retrospectively from clinical records of patients diagnosed with schizophrenia who were admitted to Nakhonsawan Rajanakarindra Psychiatric Hospital, Nakhonsawan, Thailand 1) prior to the adoption of the PANSS-EC, when the decision to administer p.r.n. medication for agitation was based solely on individual judgment, and 2) during the period when the PANSS-EC was used during the first 3 days of admission and its scores were considered as one factor in the decision to administer p.r.n. medication.

Results: The 35 patients in the group who did not receive PANSSEC assessment and the 41 patients in the group who were assessed with the PANSS-EC showed no statistically significant difference in mean number of doses of p.r.n. medication administered for agitation. However, 55.4% of all p.r.n. doses administered in the group assessed with the PANSS-EC were given during the first 3-day period (when the PANSS-EC was used), compared with 37.0% of the p.r.n. doses being administered during the first 3 days in the group not assessed with the PANSS-EC (p = 0.054). The mean number of episodes of aggression during the period of hospitalization was significantly lower in the group assessed with the PANSS-EC (p = 0.021).

Conclusions: Including the score on the PANSS-EC in the criteria used to decide whether to administer p.r.n. psychotropic medication to agitated patients with schizophrenia had an impact on staff decision-making and resulted in a more favorable clinical outcome. Further investigation is warranted to test these findings.