Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-29T02:35:25.605Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment of acute behavioural disturbance: a UK national survey of rapid tranquillisation

Published online by Cambridge University Press:  09 June 2006

Stephen Pereira ,
Carol Paton ,
Lucy M Walkert ,
Susan Shaw ,
Richard Gray  and
Hiram Wildgust
Stephen Pereira
Affiliation:
Consultant Psychiatrist Pathways PICU, Goodmayes Hospital, Essex & Hon Senior Lecturer Guys, Kings & St Thomas School of Medicine, London
Carol Paton
Affiliation:
Chief Pharmacist, Oxleas NHS Trust, Bexley, Kent
Lucy M Walkert
Affiliation:
Psychologist, Pathways PICU, Goodmayes Hospital, Essex
Susan Shaw
Affiliation:
Consultant Psychiatrist, West Middlesex University Hospital
Richard Gray
Affiliation:
Fellow in Health Services Research, Institute of Psychiatry, London
Hiram Wildgust
Affiliation:
Therapeutic Advisor Psychosis, Eli Lilly & Co Ltd
Get access

Abstract

Rapid Tranquillisation (RT), defined as “the use of psychotropic medication to control agitated, threatening or destructive psychotic behaviour”, is a last resort pharmacological intervention. The withdrawal of the widely used droperidol in 2001 due to concerns over QTc prolongation may have increased the variability in RT practice across the UK. This paper reports on a UK wide survey of the practice of RT by psychiatrists. The survey pre-dated publication of NICE guidance on management of distributed behaviour. 257 questionnaires were received (response rate 22%). In comparison with previous surveys of this type, the overall quality of prescribing and monitoring has improved, although some apparently idiosyncratic practice remains. The majority of psychiatrists expressed concerns about prescribing and monitoring RT and would welcome an easy to use algorithm and associated training package. Findings are discussed in terms of training implications and BNF recommendations for high dose prescribing.

Keywords

Rapid TranquillisationUK National Survey
Type
Original Paper
Information
Journal of Psychiatric Intensive Care , Volume 1 , Issue 2 , December 2005 , pp. 84 - 88
Copyright
© 2006 NAPICU

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

ABPI Compendium of Data Sheets and Summaries of Product Characteristics. (2000) London: Datapharm Publications.
Allen, M.H., Currier, G., Hughes, D., Reyes-Harde, M. and Docherty, J.P. (2001) Treatment of Behavioural Emergencies, Expert Consensus Guideline, Special Report, Postgraduate Medicine.
Appleby, L., Thomas, S. and Ferrier, N., et al. (2000) Sudden Unexplained Death in Psychiatric In-patients, British Journal of Psychiatry. 176: 405–406.Google Scholar
Belgamwar, R.B., Duggan, L. and Fenton, M. (2004) Olanzapine for acutely disturbed/agitated people with suspected serious mental illness (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 1. Chichester, UK: John Wiley & Sons, Ltd.
Bieniek, S.A., Ownby, R.L., Penalver, A., et al. (1998) A Double Blind Study of Lorazepam versus the Combination of Haloperidol and Lorazepam in Managing Agitation. Pharmacotherapy. 18: 57–62.Google Scholar
British National Formulary, No 41. (2001) British Medical Association and Royal Pharmaceutical Society of Great Britain. Oxons: Pharmaceutical Press, March.
Cunnane, L.G. (1994) Drug management of disturbed behaviour by psychiatrists. Psychiatric Bulletin. 18: 138–139.Google Scholar
Ellison, J., Hughes, D. and White, K. (1989) An emergency psychiatry update. Hospital and Community Psychiatry. 40(3): 250–260.Google Scholar
Fenton, M., Coutinho, E.S.F. and Campbell, C. (2001) Zuclopenthixol acetate in the treatment of acute schizophrenia and similar mental illnesses (Cochrane Review). In: The Cochrane Library, 4. Oxford: Update Software.
Foster, S., Kessel, J., Berman, M.E., et al. (1997) Efficacy of lorazepam and haloperidol for rapid tranquillisation in an emergency room setting. International Clinical Psychopharmacology. 12: 175–189.Google Scholar
Glassman, A.H. and Bigger, J.T. (2001) Antipsychotic drugs: prolonged OTc interval, T orsade de pointes, and sudden death. American Journal of Psychiatry. 158(11): 1774–1781.Google Scholar
Hyde, C.E., Harrower-Wilson, C. and Morris, J. (1998) Violence, dissatisfaction and rapid tranquillisation in psychiatric intensive care. Psychiatric Bulletin. 22: 477–480.Google Scholar
Man, P.L. and Chen, C.H. (1973) Rapid tranquillisation of acutely psychotic patients with intramuscular haloperidol and chlorpromazine. Psychosomatics. 14: 59–63.Google Scholar
Mannion, L., Sloan, D. and Connolly, L. (1997) Rapid tran-quillisation: Are we getting it right?. Psychiatric Bulletin. 21: 411–413.Google Scholar
National Institute for Clinical Excellence Schizophrenia. (2002) Core interventions in the treatment and management of schizophrenia in primary and secondary care, Clinical Guidance 1, December.
National Institute for Clinical Excellence. (2005) The short term-management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments. Clinical Guidance 25. London: NICE.
Pilowsky, L.S., Ring, H., Shine, P.J., Battersby, M., Lader, M. (1992) Rapid tranquillisation: A survey of emergency prescribing in a general psychiatric hospital. British Journal of Psychiatry. 160: 831–834.Google Scholar
Royal College of Psychiatrists. (1998) Guidelines for the Management of Imminent Violence, Occasional Paper 41, Royal College of Psychiatrists, London.
Simpson, D. and Anderson, I. (1996) Rapids tranquillisa-tion: A questionnaire survey of practice. Psychiatric Bulletin. 20(3): 149–152.Google Scholar
Taylor, O., McConnell, D., McConnell, H. and Kerwin, R. (2001) Maudsley Prescribing Guidelines (6th edn). Martin Dunitz, London.
Thompson, C. (1994) The use of high-dose antipsychotic medication. British Journal of Psychiatry. 164: 448–458.Google Scholar
TREC Collaborative Group. (2003) Rapid tranquillisation for agitated patients in emergency psychiatric rooms: A randomised trial of midazolam versus haloperidol plus promethiazine. British Medical Journal. 327: 708–711.