Is there a link between violence at a state-run mental hospital in Washington and atypical anti-psychotics?

A new report suggests an association. For years, hospital administrators have blamed violence on familiar causes: not enough staff members, not enough money and increased societal violence that leads to the admission of more-violent patients. But they don’t have the data to back up those assertions.

An analysis by The News Tribune of Tacoma of drug-prescribing trends at Western State Hospital since 1999 finds another possible factor: Western is giving more patients psychiatric drugs with side effects that can include extreme agitation and aggression. The drugs include newer antidepressants and newer anti-psychotics dubbed atypical anti-psychotics.

The newer, more expensive drugs have been heavily promoted at the hospital by drugmakers. Sales reps have logged about 1,200 visits to Western since late 2003, when administrators began tracking their activity. Concerned about their influence on prescribing patterns, the hospital in March banned all reps from visiting the campus to meet with docs.

The newer atypicals are promoted as safer and more effective than older meds, and are widely used at Western - along with ongoing use of older drugs, there’s been an increase since 1999 of about 30 percent in the amount of anti-psychotic meds given to patients at Western, The News Tribune found.

Many patients now receive two or more anti-psychotic drugs at once, a doubling of medication unheard of just eight years ago, when the older drugs were more prevalent. Roger Jackson, Western’s acting medical director, attributes the increased use to several factors. In some cases, he says, disappointing results with one drug lead docs to add a second drug.

And compared with 1999, he said, a greater proportion of patients have schizophrenia and require anti-psychotic drugs. Medical staff at Western said they are aware of the situation, and are rethinking their use of atypicals. “It is not yet clear to me what will eventually happen with regard to prescribing practices,” he says, “because the newer drugs are still believed to have some benefits, despite the recent findings. The jury is still out.”

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