Schizophrenia is a mental health problem whose symptoms can cause agitation, aggression and distress to those who have it. The drugs used to treat it are called antipsychotics and usually take several weeks to work. In the interim for people in hospital, medication can be given ‘as required’ (sometimes called 'pro re nata' or prn) and is often used to help them to feel less anxious and/or to reduce disturbed behaviour. It is usually written on the drug chart by the clinician so that the nurses can administer it at their discretion and in the doctor’s absence. Although there are many advantages to this practice, there are also potential disadvantages in that staff on the ward might use medication for individuals who are upset, rather than spending time with them or considering other approaches.
This review attempts to find evidence to find out whether the use of ‘as required’ medication is good clinical practice or not, when compared to the same drug given regularly, for people with a diagnosis of schizophrenia who are in hospital. However the search strategy used only found trials that compared two different drugs both of which were used as required. No trials were found that compared ‘as required’ with regular medication.
Although the practice of using medication as required is common, there is no good evidence whether this is the best way of helping people to be less agitated when comparing it to being given a regular dose of medication. A well designed, conducted and reported randomised trial would help to answer this question.
(Plain language summary prepared for this review by Janey Antoniou of RETHINK, UK www.rethink.org)