Influence of Psychotropic Pro Re Nata Drug Use on Outcomes in Hospitalized Patients with Schizophrenia

Objective@#In the treatment of patients with schizophrenia, pro re nata (PRN) drugs are commonly prescribed for medical indications such as agitation, acute psychiatric symptoms, insomnia, and anxiety. However, high-quality evidence supporting the use of PRN medications is lacking, and these drugs are administered on the basis of clinical experience and habits. Therefore, the actual use of psychotropic PRN drugs and its influence on the patients’ outcomes need to be investigated. @*Methods@#This study included 205 patients who underwent inpatient treatment for schizophrenia. We investigated the prescription of psychotropic drugs before admission and at discharge, as well as the dosing frequency of PRN drugs during hospitalization. We also examined the influence of psychotropic PRN drug use on hospitalization days, antipsychotic polypharmacy, and readmission rates. @*Results@#Patients who used psychotropic PRN drugs during hospitalization had significantly longer hospitalization days (p = 7.5 × 10−4 ) and significantly higher rates of antipsychotic polypharmacy (p = 2.4 × 10−4 ) at discharge than those who did not use psychotropic PRN drugs. Moreover, a higher number of psychotropic PRN drugs used per day was associated with higher readmission rates within 3 months of discharge (p = 4.4 × 10−3 ). @*Conclusion@#Psychotropic PRN drug use is associated with prolonged hospitalization, antipsychotic polypharmacy, and increased readmission rates in inpatients with schizophrenia. Therefore, psychiatric symptoms should be stabilized with regularly prescribed medications without the extensive use of psychotropic PRN drugs. Moreover, a system for monitoring and reexamining PRN drug use needs to be established.

Patient and family perceptions of palliative care units in Japan

<b>Objectives</b>: The purpose of this study was to examine common experiences among patients and primary family caregivers as they transition to hospice and palliative care units (PCU), with focus on the perspectives of cancer patients and their primary family caregivers. <b>Methods</b>: We conducted semi-structured interviews using a questionnaire with a purposive sample of 5 terminal cancer patients and 9 primary family members of patients who were admitted to the PCU from November 2005 to December 2006. The questionnaires consisted of questions about the PCU, and semi-structured interviews inquired about perceptions of the PCU. We analyzed interview contents from 14 participants (mean age ±SD; patients, 77.2±4.0 years; family members, 53.7±14.6) by summarizing content analysis. The Aiwa Hospital Institutional Review Board approved the present study. <b>Results</b>: Content analysis identified common perceptions about the PCU. Perceptions prior to the transition were summarized into 2 categories for patients and 5 categories for families, including general impressions of the PCU, PCU environment and equipment, treatment, cost, and other patients. After being admitted to the PCU, perceptions were summarized into 3 categories for patients and 7 categories for families, including general impressions of the PCU, PCU environment and equipment, treatment, staff, cost, other patients, and religion. <b>Conclusion</b>: Identification of these themes from patient and family perspectives suggested that patients transitioned to hospice with no particular impressions about the PCU, while families perceived the PCU as both “a place to relax” and “a place where one only waits to die” before entering the PCU. These results may aid in designing interventions that consider patient and family needs and desires during the transition to the PCU.