Retrospective Observational Study of Daytime Add-On Administration of Zopiclone to Difficult-to-Treat Psychiatric Inpatients With Unpredictable Aggressive Behavior, With or Without EEG Dysrhythmia
Managing violent behavior is a particularly challenging aspect of hospital psychiatric care. Available pharmacological interventions are often unsatisfactory.Aim: To assess the effectiveness and safety of daytime zopiclone add-on administration in violent and difficult-to-treat psychiatric inpatient...
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Frontiers Media S.A.
2021-08-01
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| Series: | Frontiers in Psychiatry |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2021.693788/full |
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| author | Alfonso Ceccherini-Nelli Alfonso Ceccherini-Nelli Elena Bucuci Elena Bucuci Lisa Burback Lisa Burback Daniel Li Daniel Li Maryam Alikouzehgaran Maryam Alikouzehgaran Zahid Latif Zahid Latif Kevin Morin Kevin Morin Karthikeyan Ganapathy Karthikeyan Ganapathy Manhaz Salsali Manhaz Salsali Ubaid Abdullah Ubaid Abdullah Wanda Westwood Janice Orris Patrick J. White Patrick J. White |
| author_facet | Alfonso Ceccherini-Nelli Alfonso Ceccherini-Nelli Elena Bucuci Elena Bucuci Lisa Burback Lisa Burback Daniel Li Daniel Li Maryam Alikouzehgaran Maryam Alikouzehgaran Zahid Latif Zahid Latif Kevin Morin Kevin Morin Karthikeyan Ganapathy Karthikeyan Ganapathy Manhaz Salsali Manhaz Salsali Ubaid Abdullah Ubaid Abdullah Wanda Westwood Janice Orris Patrick J. White Patrick J. White |
| author_sort | Alfonso Ceccherini-Nelli |
| collection | DOAJ |
| description | Managing violent behavior is a particularly challenging aspect of hospital psychiatric care. Available pharmacological interventions are often unsatisfactory.Aim: To assess the effectiveness and safety of daytime zopiclone add-on administration in violent and difficult-to-treat psychiatric inpatients.Methods: Chart review of inpatients treated with daytime zopiclone, between 2014 and 2018, with up to 12 weeks follow-up. Effectiveness was retrospectively assessed with the Clinical Global Impression rating scale (CGI) and the frequency and severity of aggressive incidents recorded with the Staff Observation Aggression Scale-Revised (SOAS-R).Results: Forty-five (30 male, 15 female) cases, 18–69 years age range, average (SD) baseline CGI-S score of 5.4 (1.0), and a variety of diagnoses. Sixty-nine percent showed CGI-S improvement of any degree. For patients with at least one aggressive incident within 7 days prior to initiation of zopiclone (N = 22), average (SD) SOAS-R-Severity LOCF to baseline change was −3.5 (2.7) P < 0.0001. Most patients reported no side effects; 24% reported one or more side effects, and 11% discontinued zopiclone due to sedation (4), insomnia (1) or slurred speech (1). No SAEs were recorded. Zopiclone maximum daily dose correlated with CGI-S baseline-to-LOCF change (rho = −0.5, P = 0.0003). The ROC AUC of zopiclone maximum daily dose and improvement on CGI-S was 0.84 (95% CI 0.70–0.93, P < 0.0001). The ROC AUC of zopiclone maximum daily dose and SOAS-R-N improvement was 0.80 (95% CI 0.58–0.92; P = 0.0008) and maximum Youden's index value was achieved at a dose of >30 mg.Conclusions: Zopiclone doses >30 mg daily achieved the best anti-aggressive effect. |
| first_indexed | 2024-12-16T12:09:08Z |
| format | Article |
| id | doaj.art-b1df81cdd5244644bc4dd2834b6e9436 |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-12-16T12:09:08Z |
| publishDate | 2021-08-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Psychiatry |
| spelling | doaj.art-b1df81cdd5244644bc4dd2834b6e94362022-12-21T22:32:15ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402021-08-011210.3389/fpsyt.2021.693788693788Retrospective Observational Study of Daytime Add-On Administration of Zopiclone to Difficult-to-Treat Psychiatric Inpatients With Unpredictable Aggressive Behavior, With or Without EEG DysrhythmiaAlfonso Ceccherini-Nelli0Alfonso Ceccherini-Nelli1Elena Bucuci2Elena Bucuci3Lisa Burback4Lisa Burback5Daniel Li6Daniel Li7Maryam Alikouzehgaran8Maryam Alikouzehgaran9Zahid Latif10Zahid Latif11Kevin Morin12Kevin Morin13Karthikeyan Ganapathy14Karthikeyan Ganapathy15Manhaz Salsali16Manhaz Salsali17Ubaid Abdullah18Ubaid Abdullah19Wanda Westwood20Janice Orris21Patrick J. White22Patrick J. White23Department of Psychiatry, University of Alberta, Edmonton, AB, CanadaAlberta Health Care Services, Edmonton, AB, CanadaDepartment of Psychiatry, University of Alberta, Edmonton, AB, CanadaAlberta Health Care Services, Edmonton, AB, CanadaDepartment of Psychiatry, University of Alberta, Edmonton, AB, CanadaAlberta Health Care Services, Edmonton, AB, CanadaDepartment of Psychiatry, University of Alberta, Edmonton, AB, CanadaAlberta Health Care Services, Edmonton, AB, CanadaDepartment of Psychiatry, University of Alberta, Edmonton, AB, CanadaAlberta Health Care Services, Edmonton, AB, CanadaDepartment of Psychiatry, University of Alberta, Edmonton, AB, CanadaAlberta Health Care Services, Edmonton, AB, CanadaDepartment of Psychiatry, University of Alberta, Edmonton, AB, CanadaAlberta Health Care Services, Edmonton, AB, CanadaDepartment of Psychiatry, University of Alberta, Edmonton, AB, CanadaAlberta Health Care Services, Edmonton, AB, CanadaDepartment of Psychiatry, University of Alberta, Edmonton, AB, CanadaAlberta Health Care Services, Edmonton, AB, CanadaDepartment of Psychiatry, University of Alberta, Edmonton, AB, CanadaAlberta Health Care Services, Edmonton, AB, CanadaAlberta Health Care Services, Edmonton, AB, CanadaAlberta Health Care Services, Edmonton, AB, CanadaDepartment of Psychiatry, University of Alberta, Edmonton, AB, CanadaAlberta Health Care Services, Edmonton, AB, CanadaManaging violent behavior is a particularly challenging aspect of hospital psychiatric care. Available pharmacological interventions are often unsatisfactory.Aim: To assess the effectiveness and safety of daytime zopiclone add-on administration in violent and difficult-to-treat psychiatric inpatients.Methods: Chart review of inpatients treated with daytime zopiclone, between 2014 and 2018, with up to 12 weeks follow-up. Effectiveness was retrospectively assessed with the Clinical Global Impression rating scale (CGI) and the frequency and severity of aggressive incidents recorded with the Staff Observation Aggression Scale-Revised (SOAS-R).Results: Forty-five (30 male, 15 female) cases, 18–69 years age range, average (SD) baseline CGI-S score of 5.4 (1.0), and a variety of diagnoses. Sixty-nine percent showed CGI-S improvement of any degree. For patients with at least one aggressive incident within 7 days prior to initiation of zopiclone (N = 22), average (SD) SOAS-R-Severity LOCF to baseline change was −3.5 (2.7) P < 0.0001. Most patients reported no side effects; 24% reported one or more side effects, and 11% discontinued zopiclone due to sedation (4), insomnia (1) or slurred speech (1). No SAEs were recorded. Zopiclone maximum daily dose correlated with CGI-S baseline-to-LOCF change (rho = −0.5, P = 0.0003). The ROC AUC of zopiclone maximum daily dose and improvement on CGI-S was 0.84 (95% CI 0.70–0.93, P < 0.0001). The ROC AUC of zopiclone maximum daily dose and SOAS-R-N improvement was 0.80 (95% CI 0.58–0.92; P = 0.0008) and maximum Youden's index value was achieved at a dose of >30 mg.Conclusions: Zopiclone doses >30 mg daily achieved the best anti-aggressive effect.https://www.frontiersin.org/articles/10.3389/fpsyt.2021.693788/fullviolencezopicloneGABAneurocognitive disordersneurodevelopmental disordersschizophrenia |
| spellingShingle | Alfonso Ceccherini-Nelli Alfonso Ceccherini-Nelli Elena Bucuci Elena Bucuci Lisa Burback Lisa Burback Daniel Li Daniel Li Maryam Alikouzehgaran Maryam Alikouzehgaran Zahid Latif Zahid Latif Kevin Morin Kevin Morin Karthikeyan Ganapathy Karthikeyan Ganapathy Manhaz Salsali Manhaz Salsali Ubaid Abdullah Ubaid Abdullah Wanda Westwood Janice Orris Patrick J. White Patrick J. White Retrospective Observational Study of Daytime Add-On Administration of Zopiclone to Difficult-to-Treat Psychiatric Inpatients With Unpredictable Aggressive Behavior, With or Without EEG Dysrhythmia Frontiers in Psychiatry violence zopiclone GABA neurocognitive disorders neurodevelopmental disorders schizophrenia |
| title | Retrospective Observational Study of Daytime Add-On Administration of Zopiclone to Difficult-to-Treat Psychiatric Inpatients With Unpredictable Aggressive Behavior, With or Without EEG Dysrhythmia |
| title_full | Retrospective Observational Study of Daytime Add-On Administration of Zopiclone to Difficult-to-Treat Psychiatric Inpatients With Unpredictable Aggressive Behavior, With or Without EEG Dysrhythmia |
| title_fullStr | Retrospective Observational Study of Daytime Add-On Administration of Zopiclone to Difficult-to-Treat Psychiatric Inpatients With Unpredictable Aggressive Behavior, With or Without EEG Dysrhythmia |
| title_full_unstemmed | Retrospective Observational Study of Daytime Add-On Administration of Zopiclone to Difficult-to-Treat Psychiatric Inpatients With Unpredictable Aggressive Behavior, With or Without EEG Dysrhythmia |
| title_short | Retrospective Observational Study of Daytime Add-On Administration of Zopiclone to Difficult-to-Treat Psychiatric Inpatients With Unpredictable Aggressive Behavior, With or Without EEG Dysrhythmia |
| title_sort | retrospective observational study of daytime add on administration of zopiclone to difficult to treat psychiatric inpatients with unpredictable aggressive behavior with or without eeg dysrhythmia |
| topic | violence zopiclone GABA neurocognitive disorders neurodevelopmental disorders schizophrenia |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2021.693788/full |
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