Attacks on menatl health staff rise at Western State Hospital, Psychiatric drugs blamed.

From a much longer article, as reported here Of course, the drug company reps say "not our problem, not our fault"

Violence has been a growing problem at Western State Hospital for years.

If present trends continue, one in four of the Lakewood mental hospital’s more than 1,700 workers can expect to be assaulted by a patient in 2007, according to the state Department of Labor and Industries.

For years, hospital administrators have blamed the 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.

A News Tribune analysis of drug-prescribing trends at Western 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 drugs, which are expensive compared with older, generic alternatives, have been heavily promoted at the hospital by the pharmaceutical companies that make them. Sales representatives for those companies 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 drug company representatives from visiting the campus to meet with doctors.

Randy Burkholder, an associate vice president for Pharmaceutical Research and Manufacturers of America, the Washington, D.C.-based drug industry lobby group, acknowledged The News Tribune analysis, saying it’s a “great idea” to discover more about the impact of pharmaceuticals through original investigation.

“There may be something there, there may not be,” he said about the findings. But he cautioned that the analysis doesn’t prove cause and effect. Instead, it just hints at a possible association. Only additional research can make that determination, Burkholder said.

The link between changes in drug use at Western and recent increases in violence “is very plausible,” said Dr. Stefan Kruszewski, a Harvard-trained psychiatrist and an expert on the side effects of anti-psychotic drugs who is on the faculty at Eastern University, outside Philadelphia.

“There is a significant relationship between restlessness and agitation induced by medicine and the propensity for violence,” Kruszewski said.

Western has never studied the idea that changes in drug use could contribute to increased violence, said Dr. Roger Jackson, the hospital’s acting medical director and an employee there since 1993.

Western is not alone in that regard.

“This has not been adequately studied” at any psychiatric hospital, Kruszewski said. “Most studies done on (psychiatric) violence assume violence is secondary to the illness or the surroundings, or because of lack of staff, money or social structures.”

Those assumptions, which have dominated internal and state agency violence studies at Western for more than a decade, do not hold up under analysis.

Since 1999, the staffing ratio of ward workers to patients has improved from 1.18 workers for every patient to 1.34 workers per patient in 2006.

Funding has increased about 50 percent overall – going from $106 million in 1999 to $156 million in 2007 – and has kept pace with medical inflation.

Hospital administrators don’t offer statistical evidence that society has become more violent, leading to a more violent patient population. Meanwhile, violent crime in the areas from which Western draws its patients has dropped significantly, according to U.S. Department of Justice statistics.

What does correspond with the increase in violence is the roughly 35 percent increase since 1999 in the use of drugs that a hospital pharmacy handbook and drug experts say are more likely than similar medications to induce agitation and aggression, The News Tribune analysis indicates.

By the end of 2006, there was roughly one order for these drugs for every patient at Western.

Also with the article is this list

SOME DRUGS WITH AGITATIVE SIDE EFFECTS

Here are some anti-psychotic and antidepressant drugs more likely than others in their class to cause agitating side effects such as restlessness, anxiety and insomnia. Taken as a group, there has been about a 35 percent increase in orders for these drugs at Western State Hospital since 1999. There’s also been a steady increase in assaults on workers over that time. Western averages about 900 patients a day.

Atypical anti-psychotics

Drug Manufacturer Orders on Dec. 6, 2006

Risperdal Janssen 307

Geodon Pfizer 118

Abilify Bristol-Myers Squibb 82

Typical anti-psychotics

Haldol Ortho-McNeil, generic makers 98

Prolixin Bristol-Myers Squibb, generic makers 26

Navane Pfizer, generic makers 6

Antidepressants

Zoloft Pfizer, generic makers 74

EffexorWyeth, generic makers 38

Prozac Eli Lilly, generic makers 37

Wellbutrin GlaxoSmithKline, generic makers 22

Cymbalta Eli Lilly 20