@article{ref1,
title="Retrospective observational study of daytime add-on administration of zopiclone to difficult-to-treat psychiatric inpatients with unpredictable aggressive behavior, with or without EEG dysrhythmia",
journal="Frontiers in psychiatry",
year="2021",
author="Ceccherini-Nelli, Alfonso and Bucuci, Elena and Burback, Lisa and Li, Daniel and Alikouzehgaran, Maryam and Latif, Zahid and Morin, Kevin and Ganapathy, Karthikeyan and Salsali, Manhaz and Abdullah, Ubaid and Westwood, Wanda and Orris, Janice and White, Patrick J.",
volume="12",
number="",
pages="e693788-e693788",
abstract="Managing violent behavior is a particularly challenging aspect of hospital psychiatric care. Available pharmacological interventions are often unsatisfactory. <br><br>AIM: To assess the effectiveness and safety of daytime zopiclone add-on administration in violent and difficult-to-treat psychiatric inpatients. <br><br>METHODS: Chart review of inpatients treated with daytime zopiclone, between 2014 and 2018, with up to 12 weeks follow-up. Effectiveness was retrospectively assessed with the Clinical Global Impression rating scale (CGI) and the frequency and severity of aggressive incidents recorded with the Staff Observation Aggression Scale-Revised (SOAS-R). <br><br>RESULTS: Forty-five (30 male, 15 female) cases, 18-69 years age range, average (SD) baseline CGI-S score of 5.4 (1.0), and a variety of diagnoses. Sixty-nine percent showed CGI-S improvement of any degree. For patients with at least one aggressive incident within 7 days prior to initiation of zopiclone (N = 22), average (SD) SOAS-R-Severity LOCF to baseline change was -3.5 (2.7) P < 0.0001. Most patients reported no side effects; 24% reported one or more side effects, and 11% discontinued zopiclone due to sedation (4), insomnia (1) or slurred speech (1). No SAEs were recorded. Zopiclone maximum daily dose correlated with CGI-S baseline-to-LOCF change (rho = -0.5, P = 0.0003). The ROC AUC of zopiclone maximum daily dose and improvement on CGI-S was 0.84 (95% CI 0.70-0.93, P < 0.0001). The ROC AUC of zopiclone maximum daily dose and SOAS-R-N improvement was 0.80 (95% CI 0.58-0.92; P = 0.0008) and maximum Youden's index value was achieved at a dose of >30 mg. <br><br>CONCLUSIONS: Zopiclone doses >30 mg daily achieved the best anti-aggressive effect.<p /> <p>Language: en</p>",
language="en",
issn="1664-0640",
doi="10.3389/fpsyt.2021.693788",
url="http://dx.doi.org/10.3389/fpsyt.2021.693788"
}