School of Health, University of Northampton, Northampton, UK.
St Andrew's Healthcare, Northampton, UK.
Int Psychogeriatr. 2014 Jun;26(6):943-51. doi: 10.1017/S1041610214000179. Epub 2014 Feb 24.
There is a paucity of research into PRN medication use in older psychiatric inpatients. This is an important topic given the risks of polypharmacy, adverse drug reactions, and high dose medication.
In 2013, we carried out a cross-sectional survey of the prescription and administration of sedative PRN medication to older adult inpatients on seven wards at a UK tertiary referral centre. We compared them with 242 patients of working age.
Of the 92 patients studied, 56 (60.9%) were prescribed PRN sedation and 25 (27.2%) had received one or more doses in the previous fortnight. In total, 70 doses had been administered; all by mouth and all but one as single doses. Lorazepam was by far the most commonly prescribed and administered PRN drug. Agitation was the main indication, although violence was the most commonly cited reason for administration but documentation of antecedents, non-pharmacological strategies and outcome including side effects was uniformly poor with only 37 (52.9%) doses recorded in the case notes. Those with organic disorders were just as likely to receive PRN as those with functional illnesses. Patients very rarely actually received high dose antipsychotics or antipsychotic polypharmacy as a result of PRN prescriptions. Older patients were less likely than adults of working age to be prescribed PRN and dosages were smaller.
Prospective studies of PRN prescription and administration are needed to better understand the reasons underpinning its use and to gain objective data upon its effectiveness or otherwise in this vulnerable patient group.
针对老年精神科住院患者的 PRN 药物使用情况，相关研究甚少。鉴于多药治疗、药物不良反应和高剂量用药的风险，这是一个重要的研究课题。
2013 年，我们对英国一家三级转诊中心的 7 个病房中接受镇静 PRN 药物治疗的老年住院患者的处方和管理情况进行了横断面调查，并与 242 名成年工作患者进行了比较。
在 92 名研究患者中，56 名（60.9%）被开具了 PRN 镇静药物，25 名（27.2%）在过去两周内接受了一次或多次剂量。总共给予了 70 次剂量；均为口服，且除 1 次外均为单剂量。氯羟安定是最常被开具和管理的 PRN 药物。激越是主要的适应症，尽管暴力是最常被引用的给药原因，但对于用药前情况、非药物策略和结果（包括副作用）的记录均很差，只有 37 次（52.9%）剂量记录在病历中。有器质性疾病的患者与有功能性疾病的患者同样可能接受 PRN 治疗。由于 PRN 处方，患者很少真正接受高剂量抗精神病药物或抗精神病药物联合治疗。与成年工作患者相比，老年患者接受 PRN 的可能性更小，剂量也更小。
需要进行 PRN 处方和管理的前瞻性研究，以更好地了解其使用的根本原因，并获得关于该脆弱患者群体的有效性或其他方面的客观数据。
