In severely psychotic, violent patients, add-on benzodiazepines are often prescribed with antipsychotic agents. We examined aggression, suicidality, and self-harm among psychotic patients treated with antipsychotic monotherapy, compared with those treated with add-on benzodiazepines, during the first 2 weeks of psychiatric hospitalization to clarify the association of add-on benzodiazepines and aggression. Electronic medical records of 400 patients consecutively admitted to Abarbanel Mental Health Center from 2012 to 2014 for psychosis, and remained hospitalized for at least 2 weeks were evaluated. Violence toward staff, patients, and property, physical restraints, seclusion, self-harm, and suicidal thoughts, were examined. Falls and referrals to general hospital indicated adverse medication effects, and were recorded. No significant between-group differences were found for sex, age, psychiatric diagnosis, compulsory admissions, antipsychotic dosages, number of previous hospitalizations, or hospitalization days were detected. Maximum dosage for antipsychotics in the monotherapy group did not reveal a statistically significant difference from the add-on benzodiazepine group (2.2 ± 1.4 vs. 2.2 ± 1.3, respectively), expressed in defined daily dose. There were no between-group differences in frequency of any violent event, incidence of self-harm, suicidal thoughts, frequency of falls, and/or referrals to a general hospital. Addition of benzodiazepines might be unnecessary. Benzodiazepine addition to antipsychotic drugs for patients with severe psychosis should be with caution.
aAbarbanel Mental Health Center, Bat-Yam
bSackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv
cGeha Mental Health Center, Felsenstein Medical Research Center, Petah Tiqva, Israel
*Stanislav Baranchik and Rafael Stryjer contributed equally to the writing of this article.
Received 5 January 2019 Accepted 6 February 2019
Correspondence to Assaf Shelef, MD, MHA, Abarbanel Mental Health Center, 15 KKL Street, Bat-Yam 59100, Israel, Tel: + 972 3555 2783; fax: +972 3658 3503; e-mail: email@example.com