The Use and Effectiveness of Pro Re Nata Psychotropic Medications in Children and Adolescents: A Systematic Review

Overview

Journal Indian J Psychiatry

Specialty Psychiatry

Date 2017 Nov 1

PMID 29085084

Citations 3

Authors

Kenneth Asogwa

Jerome Okudo

Joel Idowu

Affiliations

Soon will be listed here.

Abstract

Background: Published studies have not demonstrated the benefits of the practice of psychotropic PRN administration.

Aim: The goal of this study is to perform a systematic review on pro re nata (PRN) psychotropic medications administration in children and adolescents and examine the safety and effectiveness of this practice in child and adolescent psychiatric care units.

Settings And Design: This is a systematic review.

Materials And Methods: Several databases were searched till date. One hundred and sixty-five titles and abstracts were found and a total of 14 studies, for which most were retrospective, met the absolute criteria. The patients studied were children, adolescents and patients that presented to the emergency room or admitted as inpatient.

Results: Indications for admission included aggression and agitation for all the studies. Most the medications used include haloperidol, olanzapine, diazepam, and risperidone. Commonly reported adverse effects following the administration of the PRN medications were sleepiness, acute dystonia, and drowsiness. The effectiveness of PRN medications, which was reported in four of reviewed studies, ranged from 30% to 50%.

Conclusion: Different effectiveness/outcome measures were used for all the studies; therefore, we could not generalize effectiveness across all the studies. Findings of the reviewed articles show the imperativeness of more research to evaluate the safety and effectiveness of PRN medications among child and adolescent populations.

Citing Articles

Use of Psychotropic "Pro Re Nata" Medications by Patients Attending the Outpatient Clinic in a Hospital: A Qualitative Exploration.

Rajiah K, Maharajan M, Ramaya H, Wan Ab Rahman W Front Med (Lausanne). 2021; 8:617147.

PMID: 34368172 PMC: 8342918. DOI: 10.3389/fmed.2021.617147.

PRN Medicines Optimization and Nurse Education.

Vaismoradi M, Jordan S, Vizcaya-Moreno F, Friedl I, Glarcher M Pharmacy (Basel). 2020; 8(4).

PMID: 33114731 PMC: 7712763. DOI: 10.3390/pharmacy8040201.

What do we really know about PRN use in agitated children with mental health conditions: a clinical review.

Baker M, Carlson G Evid Based Ment Health. 2018; 21(4):166-170.

PMID: 30361330 PMC: 10270407. DOI: 10.1136/ebmental-2018-300039.

References

Curtis J, Capp K . Administration of 'as needed' psychotropic medication: a retrospective study. Int J Ment Health Nurs. 2007; 12(3):229-34. DOI: 10.1046/j.1440-0979.2003.00293.x. View

Baker J, Lovell K, Easton K, Harris N . Service users' experiences of 'as needed' psychotropic medications in acute mental healthcare settings. J Adv Nurs. 2006; 56(4):354-62. DOI: 10.1111/j.1365-2648.2006.04016.x. View

Winterfeld U, Le Heuzey M, Acquaviva E, Mouren M, Brion F, Bourdon O . The use of prn medication in a child and adolescent mental health inpatient service in France. Int J Psychiatry Clin Pract. 2014; 13(4):253-8. DOI: 10.3109/13651500902849987. View

Barzman D, DelBello M, Forrester J, Keck Jr P, Strakowski S . A retrospective chart review of intramuscular ziprasidone for agitation in children and adolescents on psychiatric units: prospective studies are needed. J Child Adolesc Psychopharmacol. 2007; 17(4):503-9. DOI: 10.1089/cap.2007.5124. View

Jangro W, Preval H, Southard R, Klotz S, Francis A . Conventional intramuscular sedatives versus ziprasidone for severe agitation in adolescents: case-control study. Child Adolesc Psychiatry Ment Health. 2009; 3(1):9. PMC: 2663548. DOI: 10.1186/1753-2000-3-9. View

Usher K, Holmes C, Lindsay D, Luck L . PRN psychotropic medications: the need for nursing research. Contemp Nurse. 2003; 14(3):248-57. DOI: 10.5172/conu.14.3.248. View

Petti T, Stigler K, Gardner-Haycox J, Dumlao S . Perceptions of P.R.N. psychotropic medications by hospitalized child and adolescent recipients. J Am Acad Child Adolesc Psychiatry. 2003; 42(4):434-41. DOI: 10.1097/01.CHI.0000046817.95464.A6. View

Yoshida K, Suzuki T, Uchida H, Mimura M . Absence of evidence that the pro re nata regimen confers benefit: a review of the studies. Int Clin Psychopharmacol. 2013; 28(5):228-37. DOI: 10.1097/YIC.0b013e328362db99. View

Dean A, Scott J, McDermott B . Changing utilization of pro re nata ('as needed') sedation in a child and adolescent psychiatric inpatient unit. Aust N Z J Psychiatry. 2009; 43(4):360-5. DOI: 10.1080/00048670902721095. View

10.

Swart G, Siman E, Stewart S . The use of Pro Re Nata or Statim medications for behavioral control: a summary of experience at a tertiary care children's mental health center. J Child Adolesc Psychopharmacol. 2011; 21(1):67-77. DOI: 10.1089/cap.2010.0010. View

11.

Szczesny S, Miller M . PRN medication use in inpatient psychiatry. J Psychosoc Nurs Ment Health Serv. 2003; 41(1):16-21. DOI: 10.3928/0279-3695-20030101-09. View

12.

Kaplan S, Busner J . The use of prn and stat medication in three child psychiatric inpatient settings. Psychopharmacol Bull. 1997; 33(1):161-4. View

13.

Hazaray E, Ehret J, Posey D, Petti T, McDougle C . Intramuscular ziprasidone for acute agitation in adolescents. J Child Adolesc Psychopharmacol. 2005; 14(3):464-70. DOI: 10.1089/cap.2004.14.464. View

14.

Evans R, Di Scipio W . Nonpharmacologic factors in the administration of p.r.n. psychotropic medication on an adolescent unit. Am J Psychiatry. 1980; 137(1):123-4. DOI: 10.1176/ajp.137.1.123. View

15.

Geffen J, Cameron A, Sorensen L, Stokes J, Roberts M, Geffen L . Pro re nata medication for psychoses: the knowledge and beliefs of doctors and nurses. Aust N Z J Psychiatry. 2002; 36(5):642-8. DOI: 10.1046/j.1440-1614.2002.01068.x. View

16.

Thapa P, Palmer S, Owen R, Huntley A, Clardy J, Miller L . P.R.N. (As-needed) orders and exposure of psychiatric inpatients to unnecessary psychotropic medications. Psychiatr Serv. 2003; 54(9):1282-6. DOI: 10.1176/appi.ps.54.9.1282. View

17.

Garrison W, Ecker B, Friedman M, DAVIDOFF R, Haeberle K, Wagner M . Aggression and counteraggression during child psychiatric hospitalization. J Am Acad Child Adolesc Psychiatry. 1990; 29(2):242-50. DOI: 10.1097/00004583-199003000-00013. View

18.

Vitiello B, Ricciuti A, Behar D . P.R.N. medications in child state hospital inpatients. J Clin Psychiatry. 1987; 48(9):351-4. View

19.

Dean A, McDermott B, Marshall R . PRN sedation-patterns of prescribing and administration in a child and adolescent mental health inpatient service. Eur Child Adolesc Psychiatry. 2006; 15(5):277-81. DOI: 10.1007/s00787-006-0532-9. View

20.

Mckenzie A, Kudinoff T, Benson A, Archillingham A . Administration of PRN medication: a descriptive study of nursing practice. Aust N Z J Ment Health Nurs. 2000; 8(4):187-91. DOI: 10.1046/j.1440-0979.1999.00151.x. View