The Clinical Management of Acute Disturbance Including Rapid Tranquillisation

doi:10.1017/9781911623465.022

Chapter 20 - The Clinical Management of Acute Disturbance Including Rapid Tranquillisation

from Part 3 - Specific Therapeutic Areas

Published online by Cambridge University Press: 29 May 2020

Faisil Sethi ,

Caroline Parker ,

Aileen O’Brien and

Maxine X. Patel

Edited by

Peter M. Haddad and

David J. Nutt

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Peter M. Haddad: Affiliation:
Hamad Medical Corporation, Qatar
David J. Nutt: Affiliation:
Centre for Neuropsychopharmacology, Division of Psychiatry, Department of Brain Sciences, Imperial College London

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Summary

In psychiatric and emergency healthcare settings, episodes of agitation and violence are relatively common. One meta-analysis reported that 32.4% of patients behaved violently during admission to a psychiatric ward; this was the mean rate of violence based on 122 studies from 11 countries (Bowers et al., 2011). The comparable rate in the UK studies was 41.7%. A study of general adult wards of a UK inner-city mental health trust found violence rates for 49% of men and 39% of women in the 6-month period studied (Hodgins et al., 2007).

Type: Chapter
Information: Seminars in Clinical Psychopharmacology , pp. 599 - 618

DOI: https://doi.org/10.1017/9781911623465.022 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2020

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References

Abdulrahim, D, Bowden-Jones, O, on behalf of the NEPTUNE Expert Group (2015). Guidance on the Management of Acute and Chronic Harms of Club Drugs and Novel Psychoactive Substances. London: Novel Psychoactive Treatment UK Network (NEPTUNE).Google Scholar

Alexander, J, Tharyan, P, Adams, C, et al. (2004). Rapid tranquillisation of violent or agitated patients in a psychiatric emergency setting. Pragmatic randomised trial of intramuscular lorazepam v. haloperidol plus promethazine. Br J Psychiatry, 185, 63–69.CrossRef Google Scholar PubMed

Andrezina, R, Josiassen, RC, Marcus, RN, et al. (2006). Intramuscular aripiprazole for the treatment of acute agitation in patients with schizophrenia or schizoaffective disorder: a double blind, placebo-controlled comparison with intramuscular haloperidol. Psychopharmacology, 188, 281–292.Google Scholar

Azeem, MW, Aujla, A, Rammerth, M, Binsfeld, G, Jones, RB (2011). Effectiveness of six core strategies based on trauma informed care in reducing seclusions and restraints at a child and adolescent psychiatric hospital. J Child Adolesc Psychiatr Nurs, 24, 11–15. https://doi.org/10.1111/j.1744–6171.2010.00262.x.Google Scholar

Bowers, L (2014). Safewards: a new model of conflict and containment on psychiatric wards. J Psychiatr Ment Health Nurs, 21, 499–508.CrossRef Google Scholar PubMed

Bowers, L, Stewart, D, Papadopoulos, C, et al. (2011). Inpatient Violence and Aggression: A Literature Review. London: Institute of Psychiatry, King’s College London.Google Scholar

Bowers, L, James, K, Quirk, A, et al. (2015). Reducing conflict and containment rates on acute psychiatric wards: the Safewards cluster randomised controlled trial. Int J Nurs Stud, 52, 1412–1422. https://doi.org/10.1016/j.ijnurstu.2015.05.001.Google Scholar

Breier, A, Meehan, K, Birkett, M, et al. (2002). A double-blind, placebo-controlled dose response comparison of intramuscular olanzapine and haloperidol in the treatment of acute agitation in schizophrenia. Arch Gen Psychiatry, 59, 441–448.CrossRef Google Scholar PubMed

Canadian Agency for Drugs and Technologies in Health (CADTH) (2015). Use of Antipsychotics and/or Benzodiazepines as Rapid Tranquilization in In-Patients of Mental Facilities and Emergency Departments: A Review of the Clinical Effectiveness and Guidelines. CADTH Rapid Response Reports.Google Scholar

Chin, CN, Hamid, ARA, Philip, G, et al. (1998). A double-blind comparison of zuclopenthixol acetate with haloperidol in the management of acutely disturbed schizophrenics. Med J Malaysia, 53(4), 365–371.Google Scholar PubMed

Citrome, L (2012). Inhaled loxapine for agitation revisited: focus on effect sizes 2 from Phase III randomised controlled trials in persons with schizophrenia or bipolar disorder. Int J Clin Pract, 66, 318–325. https://doi.org/10.1111/j.1742–1241.2011.02890.x.Google Scholar

Cole, JB, Moore, JC, Nystrom, PC, et al. (2016). A prospective study of ketamine versus haloperidol for severe prehospital agitation. Clin Toxicol (Phila), 54, 556–562.Google Scholar

Department of Health (DH) (2014). Positive and Proactive Care: Reducing the Need for Restrictive Interventions. London: Department of Health. Available at: www.gov.uk/government/publications/positive-and-proactive-care-reducing-restrictive-interventions (last accessed 15.8.19).Google Scholar

Department of Health (DH) (2015). Mental Health Act 1983: Code of Practice. London: The Stationery Office. Available at: www.gov.uk/government/uploads/system/uploads/attachment_data/file/435512/MHA_Code_of_Practice.PDF (last accessed 15.8.19).Google Scholar

Douglas-Hall, P, Whicher, EV (2015). ‘As required’ medication regimens for seriously mentally ill people in hospital. Cochrane Database Syst Rev, (12), CD003441. https://doi.org/10.1002/14651858.CD003441.pub3.Google Scholar

eMC (2017). Summary of Product Characteristics (updated January 2017): Clopixol Acuphase Injection. Available at: www.medicines.org.uk/emc/medicine/1071 (last accessed 15.8.19).Google Scholar

Galbally, M, Snellen, M, Lewis, A (2014). Psychopharmacology and Pregnancy. New York: Springer. https://doi.org/10.1007/978–3-642–54562-7.Google Scholar

Garriga, M, Pacchiarotti, I, Kasper, S, et al. (2016). Assessment and management of agitation in psychiatry: expert consensus. World Biol Psychiatry, 17(2), 86–128. https://doi.org/10.3109/15622975.2015.1132007.Google Scholar

Gaskin, CJ, Elsom, SJ, Happell, B (2007). Interventions for reducing the use of seclusion in psychiatric facilities. Br J Psychiatry, 191, 298–303. https://doi.org/10.1192/bjp.bp.106.034538.Google Scholar

Gillies, D, Sampson, S, Beck, A, Rathbone, J (2013). Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev, (4), CD003079. https://doi.org/10.1002/14651858.CD003079.pub3.Google Scholar

Gillings, M, Grundlingh, J, Aw-Yong, M (2016). Guidelines for the Management of Excited Delirium/Acute Behavioural Disturbance (ABD). London: The Royal College of Emergency Medicine, Best Practice Guidance.Google Scholar

Hardy, S, Bennett, L, Rosen, P, et al. (2017). The feasibility of using body worn cameras in an inpatient mental health setting. Ment Health Fam Med, 357, 393–400.Google Scholar

Hodgins, S, Alderton, J, Cree, A, Aboud, A, Mak, T (2007). Aggressive behaviour, victimisation and crime among severely mentally ill patients requiring hospitalisation. Br J Psychiatry, 191, 343–350. https://doi.org/10.1192/bjp.bp.106.06.029587.CrossRef Google Scholar

Huckshorn, KA (2006). Six Core Strategies for Reducing Seclusion and Restraint Use: A Snapshot of Six Core Strategies for the Reduction of S/R. National Association of State Mental Health Program Directors (NASMHPD). Available at: www.nasmhpd.org/sites/default/files/ConsolidatedSixCore StrategiesDocument.pdf (last accessed 15.8.19).Google Scholar

Huf, G, Countinho, ESF, Adams, CE; TREC Collaborative Group (2007). Rapid tranquillisation in psychiatric emergency settings in Brazil: pragmatic randomised controlled trial of intramuscular haloperidol versus intramuscular haloperidol plus promethazine. BMJ, 335, 869. https://doi.org/10.1136/bmj.39339.448819.AE.Google Scholar

Huf, G, Alexander, J, Gandhi, P, Allen, MH (2016). Haloperidol plus promethazine for psychosis-induced aggression. Cochrane Database of Syst Rev, (11), CD005146. https://doi.org/10.1002/14651858.CD005146.pub3.Google Scholar

Innes, J, Sethi, F (2012). Current rapid tranquillisation documents in the UK: a review of the drugs recommended, their routes of administration and clinical parameters influencing their use. J Psychiatr Intensive Care, 9, 110–118. https://doi.org/10.1017/S174264641200026X.Google Scholar

Jayakody, K, Gibson, RC, Kumar, A, Gunadasa, S (2012). Zuclopenthixol acetate for acute schizophrenia and similar serious mental illnesses. Cochrane Database Syst Rev, (4), CD000525. https://doi.org/10.1002/14651858.CD000525.pub3.Google Scholar

Kerr, I, Taylor, D (1997). Acute disturbed or violent behaviour: principals of treatment. J Psychopharmacology, 11, 271–277.CrossRef Google Scholar PubMed

Khwaja, M, Beer, D (eds.) (2013). Prevention and Management of Violence: Guidance for Mental Healthcare Professionals. College Report CR177. London: Royal College of Psychiatrists.Google Scholar

Krug, EG, Dahlberg, LL, Mercy, JA, Zwi, AB, Lozano, R (eds.) (2002). World report on violence and health. Geneva: World Health Organization.Google Scholar

Kwentus, J, Riesenberg, RA, Marandi, M, et al. (2012). Rapid acute treatment of agitation in patients with bipolar I disorder: a multicentre, randomized, placebo-controlled trial with inhaled loxapine. Bipolar Disord, 14, 31–40. https://doi.org/10.1111/j.1399–5618.2011.00975.x.Google Scholar

Lesem, MD, Tran-Johnson, TK, Riesenberg, RA, et al. (2011). Rapid acute treatment of agitation in individuals with schizophrenia: multicentre, randomised, placebo-controlled trial of inhaled loxapine. Br J Psychiatry, 198, 51–58. https://doi.org/10.1192/bjp.bp.110.081513.Google Scholar

Lingford-Hughes, L, Welch, W, Peters, L, Nutt, D; British Association for Psychopharmacology Expert Reviewers Group (2012). BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. J Psychopharmacol, 26(7), 899–952. https://doi.org/10.1177/0269881112444324.Google Scholar

Lukens, TW, Wolf, SJ, Edlow, JA, et al. (2006). Clinical policy: critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department. Ann Emerg Med, 47, 79–99.Google Scholar

Martel, M, Sterzinger, A, Miner, J, Clinton, J, Biros, M (2005). Management of acute undifferentiated agitation in the emergency department: a randomized double-blind trial of droperidol, ziprasidone, and midazolam. Acad Emerg Med, 12(12), 1167–1172.Google Scholar PubMed

McAllister-Williams, RH, Baldwin, DS, Cantwell, R, et al. (2017). British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol, 31(5), 519–552. https://doi.org/10.1177/0269881117699361.Google Scholar

NASMHPD (2008). Six Core Strategies to Reduce Seclusion and Restraint Use. Alexandria, VA: National Association of State Mental Health Program Directors. Available at: www.nasmhpd.org/sites/default/files/Consolidated%20Six%20Core%20Strategies%20Document.pdf (last accessed 15.8.19).Google Scholar

National Institute of Health and Clinical Excellence (NICE) (2005). Violence: the short-term management of disturbed and violent behaviour in inpatient psychiatric settings and emergency departments. Clinical guideline [CG25]. London: National Institute for Health and Care Excellence.Google Scholar

National Institute for Health and Care Excellence (NICE) (2015). Violence and aggression: short-term management in mental health, health and community settings. NICE guideline [NG10]. London: National Institute for Health and Care Excellence. Available at: http://nice.org.uk/guidance/ng10 (last accessed 15.8.19).Google Scholar

National Institute for Health and Care Excellence (NICE) (2017). Violent and Aggressive Behaviours in People with Mental Health Problems. Quality Standard [QS154]. London: National Institute for Health and Care Excellence. Available at: www.nice.org.uk/guidance/qs154 (last accessed 15.8.19).Google Scholar

Patel, MX, Sethi, FN, Barnes, TRE, et al. (2018). Joint BAP NAPICU evidence based consensus guidelines for the clinical management of acute disturbance: de-escalation and rapid tranquillisation. J Psychopharmacol, 32(6), 601–640. [This article was also co-published in the Journal of Psychiatric Intensive Care]CrossRef Google Scholar PubMed

POMH-UK (2017). Topic 16a. Rapid tranquillisation in the context of the pharmacological management of acutely-disturbed behaviour. London: Royal College of Psychiatrists, CCQI263.Google Scholar

Price, O, Baker, J, Bee, P, Lovell, K (2015). Learning and performance outcomes of mental health staff training in de-escalation techniques for the management of violence and aggression. Br J Psychiatry, 206, 447–455. https://doi.org/10.1192/bjp.bp.114.144576.CrossRef Google Scholar PubMed

Raveendran, N, Tharyan, P, Alexander, J, Adams, CE; TREC-India II Collaborative Group (2007). Rapid tranquillisation in psychiatric emergency settings in India: pragmatic randomised controlled trial of intramuscular olanzapine versus intramuscular haloperidol plus promethazine. BMJ, 335, 865. https://doi.org/10.1136/bmj.39341.608519.BE.Google Scholar

Royal College of Psychiatrists (RCPsych) (2014). Consensus Statement on High-Dose Antipsychotic Medication. College Report CR190. London: Royal College of Psychiatrists.Google Scholar

Taylor, D, McConnell, D, McConnell, H, Abel, K, Kerwin, R (1999). The Bethlem and Maudsley NHS Trust Prescribing Guidelines 1999, 5th ed. London: Martin Dunitz.Google Scholar

Taylor, D, McConnell, DH, McConnell, D, Kerwin, R (2001). Maudsley 2001 Prescribing Guidelines, 6th ed. London: Martin Dunitz.Google Scholar

Taylor, D, Okocha, C, Paton, C, Smith, S, Connolly, A (2008). Buccal midazolam for agitation on psychiatric intensive care wards. Int J Psychiatry Clin Pract, 12(4), 309–311. https://doi.org/10.1080/13651500802233886.Google Scholar

Taylor, D, Paton, C, Kapur, S (2015). The Maudsley Prescribing Guidelines in Psychiatry, 12th ed. West Sussex: Wiley Blackwell.Google Scholar

Taylor, D, Barnes, TRE, Young, AH (2018). The Maudsley Prescribing Guidelines in Psychiatry, 13th ed. Hoboken: Wiley Blackwell.Google Scholar

Tran-Johnson, TK, Sack, DA, Marcus, RN, et al. (2007). Efficacy and safety of intramuscular aripiprazole in patients with acute agitation: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry, 68, 111–119.Google Scholar

TREC Collaborative Group (2003). Rapid tranquillisation for agitated patients in psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine. BMJ, 327, 708–711. https://doi.org/10.1136/bmj.327.7417.708.Google Scholar

Wilson, MP, Pepper, D, Currier, GW, Holloman, GH Jr, Feifel, D (2012). The psychopharmacology of agitation: consensus statement of the American Association for Emergency Psychiatry Project Beta Psychopharmacology Workgroup. West J Emerg Med, 13, 26–34. https://doi.org/10.5811/westjem.2011.9.6866.Google Scholar

Wright, P, Birkett, M, David, SR, et al. (2001). Double-blind, placebo-controlled comparison of intramuscular olanzapine and intramuscular haloperidol in the treatment of acute agitation in schizophrenia. Am J Psychiatry, 158(7), 1149–1151.Google Scholar

Zaman, H, Sampson, SJ, Beck, ALS, et al. (2017). Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev, (12), CD003079.Google Scholar

Zimbroff, DL, Marcus, RN, Manos, G, et al. (2007). Management of acute agitation in patients with bipolar disorder: efficacy and safety of intramuscular aripiprazole. J Clin Psychopharmacology, 27, 171–176.Google Scholar