Skip to main content Accessibility help
×
Hostname: page-component-76fb5796d-wq484 Total loading time: 0 Render date: 2024-04-29T15:02:43.964Z Has data issue: false hasContentIssue false

Chapter 18 - Rapid Tranquillisation

Published online by Cambridge University Press:  15 March 2024

Roland Dix
Affiliation:
Gloucestershire Health and Care NHS Foundation Trust, Gloucester
Stephen Dye
Affiliation:
Norfolk and Suffolk Foundation Trust, Ipswich
Stephen M. Pereira
Affiliation:
Keats House, London
Get access

Summary

This chapter explores the evolving use of rapid tranquillisation (RT) through the years, examining the complexities surrounding its definition and the factors that need consideration before, during and after its administration. Every acute disturbance experienced by a patient is different and a multidisciplinary approach with good communication is key. The chapter discusses the use of covert medication in

RT, the SafeWards approach to creating engaging and meaningful ward programmes for patients, laws for governing the use of restrictive procedures, and the medications used for RT and their routes of administration along with their potential side effects.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2024

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

Allison, L and Moncrieff, J (2014) ‘Rapid Tranquillisation’: An Historical Perspective on Its Emergence in the Context of the Development of Antipsychotic Medications. History of Psychiatry 25 (1) 5769.CrossRefGoogle ScholarPubMed
Baldaçara, L, Sanches, M, Cordeiro, DC and Jackoswski, AP (2011) Rapid Tranquilization for Agitated Patients in Emergency Psychiatric Rooms: A Randomized Trial of Olanzapine, Ziprasidone, Haloperidol Plus Promethazine, Haloperidol Plus Midazolam, and Haloperidol Alone. Brazil Journal of Psychiatry 33 (1) 30–9.CrossRefGoogle Scholar
Beveridge, A (2014) The History of Psychiatry: Personal Reflections. Journal of Royal College of Physicians Edinburgh 44 (1) 7884.CrossRefGoogle ScholarPubMed
Bowers, L (2014) Safewards: A New Model of Conflict and Containment on Psychiatric Ward. Journal of Psychiatric and Mental Health Nursing 21 (6) 99508.CrossRefGoogle Scholar
Braslow, J (1997) Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century. Berkeley and Los Angeles: University of California Press.CrossRefGoogle Scholar
Burton, N (2010) A Brief History of Psychiatry. In Burton, N (ed.), Psychiatry, 2nd ed. Chichester: Blackwell Publishing. pp. 310.Google Scholar
Cameron, RWD (1883) The Philosophy of Restraint in the Management and Treatment of the Insane. Journal of Mental Science 28 (124) 519–31.CrossRefGoogle Scholar
Cole, J, Moore, JC, Dolan, BJ, O’Brien-Lambert, A, Fryza, BJ, Miner, JR, et al. (2017) A Prospective Observational Study of Patients Receiving Intravenous and Intramuscular Olanzapine in the Emergency Department. Annals of Emergency Medicine 69 (3) 327–36.CrossRefGoogle ScholarPubMed
Connolly, G, Evans, T, Leitch, S, MacDonald, A and Ridley, J (2019) Reducing Restrictive Interventions in People with ‘Challenging’ Behaviors. Nursing Times 115 (12) 42–6.Google Scholar
Cox, A, Hayter, M and Ruane, J (2010) Alternative Approaches to ‘Enhanced Observations’ in Acute Inpatient Mental Health Care. Journal of Psychiatric and Mental Health Nursing 17 (2) 162–71.CrossRefGoogle ScholarPubMed
Currier, GW (2003) The Controversy over ‘Chemical Restraint’ in Acute Care Psychiatry. Journal of Psychiatric Practice 9 (1) 5970.CrossRefGoogle ScholarPubMed
Currier, G and Medori, R (2006) Orally Versus Intramuscularly Administered Antipsychotic Drugs in Psychiatric Emergencies. Journal of Psychiatric Practice 12 (1) 3040.CrossRefGoogle ScholarPubMed
Duxbury, J, Baker, J, Downe, S, Jones, F, Greenwood, P, Thygesen, H, et al. (2019) Minimising the Use of Physical Restraint in Acute Mental Health Services: The Outcome of a Restraint Reduction Programme (‘REsTRAIN YOURSELF’). International Journal of Nursing Studies 95: 40–8.CrossRefGoogle ScholarPubMed
Equality and Human Rights Commission (2019) Human Rights Framework for Restraint: Principles for the Lawful Use of Physical, Chemical, Mechanical and Coercive Restrictive Interventions.Google Scholar
Francescangeli, J, Karamchandani, K, Powell, M and Bonavia, A (2019) The Serotonin Syndrome: From Molecular Mechanisms to Clinical Practice. International Journal of Molecular Sciences 20 (9) 2288.CrossRefGoogle ScholarPubMed
Huf, G, Alexander, J, Gandhi, P and Allen, MH (2016) Haloperidol Plus Promethazine for Psychosis-Induced Aggression. Cochrane Database of Systematic Reviews 11 (11) CD005146.Google ScholarPubMed
Isbister, GK, Calver, LA, Page, CB, Stokes, B, Bruant, JL and Downes, MA (2010) Randomized Controlled Trial of Intramuscular Droperidol Versus Midazolam for Violence and Acute Behavioral Disturbance: The DORM Study. Annals of Emergency Medicine 56 (4) 392401.CrossRefGoogle ScholarPubMed
Joint Formulary Committee (2021) ‘Flumazenil’, in British National Formulary. www.bnf.nice.org.uk/drugs/flumazenil/.Google Scholar
Kang, M and Ghassemzadeh, S (2019) Benzodiazepine Toxicity. Treasure Island (FL): StatPearls Publishing.Google Scholar
Ko, S, Goldstein, DH and VanDenKerkhof, EG (2003) Definitions of ‘Respiratory Depression’ with Intrathecal Morphine Postoperative Analgesia: A Review of the Literature. Canadian Journal of Anaesthesia 50 (7) 679–88.CrossRefGoogle ScholarPubMed
Lesem, MD, Tran-Johnson, TK, Riesenberg, RA, Feifel, D, Allen, MH, Fishman, R, et al. (2011) Rapid Acute Treatment of Agitation in Individuals with Schizophrenia: Multicentre, Randomised, Placebo-Controlled Study of Inhaled Loxapine. British Journal of Psychiatry 198 (1) 51–8.CrossRefGoogle ScholarPubMed
Loynes, B, Innes, J and Dye, S (2013) Assessment of Physical Monitoring Following Rapid Tranquillisation: A National Survey. Journal of Psychiatric Intensive Care 9 (2) 8590.CrossRefGoogle Scholar
Metherall, A, Worthington, R and Keyte, A (2006) Twenty-Four-Hour Medical Emergency Response Teams in a Mental Health In-Patient Facility: New Approaches for Safer Restraint. Journal of Psychiatric Intensive Care 2 (1) 21–9.CrossRefGoogle Scholar
Murri, M, Guaglianone, A, Bugliani, M, Calcagno, P, Respino, M, Serafini, G, et al. (2015) Second-Generation Antipsychotics and Neuroleptic Malignant Syndrome: Systematic Review and Case Report Analysis. Drugs in R&D 15 (1) 4562.Google Scholar
National Institute of Health and Care Excellence (NICE) (2015) Violence & Aggression: Short-Term Management in Mental Health, Health, and Community Settings. London: NICE.Google Scholar
Negroni, AA (2017) On the Concept of Restraint in Psychiatry. European Journal of Psychiatry 31 (3) 99104.CrossRefGoogle Scholar
NHS England (2021) The National Patient Safety Improvement Programmes. www.england.nhs.uk/patient-safety/patient-safety-improvement-programmes/#MHSIP.Google Scholar
Oruch, R, Pryme, IF, Engelson, BA and Lund, A (2017) Neuroleptic Malignant Syndrome: An Easily Overlooked Neurologic Emergency. Neuropsychiatric Disease and Treatment 13: 161–75.CrossRefGoogle ScholarPubMed
Ostinelli, EG, Brooke-Powney, MJ, Xue, L and Adams, CE (2017) Haloperidol for Psychosis-Induced Aggression or Agitation (Rapid Tranquillisation). Cochrane Database of Systematic Reviews 7 (7) CD009377.Google ScholarPubMed
Ostinelli, E, Jajawi, S, Spyridi, S, Sayal, K and Jayaram, MB (2018) Aripiprazole (Intramuscular) for Psychosis-Induced Aggression or Agitation (Rapid Tranquillisation). Cochrane Database of Systematic Reviews 1 (1) CD008074.Google ScholarPubMed
Oxehealth (2021) How Does Oxevision Work? (online) www.oxehealth.com/oxevision.Google Scholar
Patel, M, Sethi, FN, Barnes, TRE, Dix, R, Dractu, L, Fox, B, et al. (2018) Joint BAP NAPICU Evidence-Based Consensus Guidelines for the Clinical Management of Acute Disturbance: De-Escalation and Rapid Tranquillisation. Journal of Psychopharmacology 32 (6) 601–40.CrossRefGoogle ScholarPubMed
Paton, C, Adams, CE, Dye, S, Delgado, O, Okocha, C and Barnes, TRE (2019) Physical Health Monitoring After Rapid Tranquillisation: Clinical Practice in UK Mental Health Services. Therapeutic Advances in Psychopharmacology 9: 112.CrossRefGoogle ScholarPubMed
Parker, C (2015) Midazolam for Rapid Tranquillisation: Its Place in Practice. Journal of Psychiatric Intensive Care 11 (1) 6672.CrossRefGoogle Scholar
Racz, R, Soldatos, TG, Jackson, D and Burkart, K (2018) Association Between Serotonin Syndrome and Second-Generation Antipsychotics via Pharmacological Target-Adverse Event Analysis. Clinical and Translational Science 11 (3) 322–9.CrossRefGoogle ScholarPubMed
Ridley, J and Leitch, S (2019) Restraint Reduction Network (RRN) Training Standards. Birmingham: BILD Publications.Google Scholar
Royal College of Psychiatrists (RCP) (2021) Reducing Restrictive Practice Collaborative. www.rcpsych.ac.uk/improving-care/nccmh/reducing-restrictive-practice.Google Scholar
Savage, GH (1887) The Use of Sedatives in Insanity. The Practitioner: A Journal of Therapeutics and Public Health XXXVIII., 32-36.Google Scholar
Scotton, WJ, Hill, LJ, Williams, AC and Barnes, NM (2019) Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions. International Journal of Tryptophan Research 12: 114.CrossRefGoogle ScholarPubMed
Suzuki, H, Gen, K and Takahashi, Y (2013) A Naturalistic Comparison of the Efficacy and Safety of Intramuscular Olanzapine and Intramuscular Haloperidol in Agitated Elderly Patients with Schizophrenia. Therapeutic Advances in Psychopharmacology 3 (6) 314–21.CrossRefGoogle ScholarPubMed
Talukdar, R, Ludlam, M, Pout, L and Lekka, NP (2016) Ensuring Patient Safety: Physical Health Monitoring in Rapid Tranquillisation for Aggression and Violence of Adult Acute Inpatients. European Psychiatry 33: S170–1.CrossRefGoogle Scholar
Taylor, DM, Barnes, TRE and Young, AH (2021) The Maudsley Prescribing Guidelines in Psychiatry Chichester: John Wiley & Sons. pp. 109–16.CrossRefGoogle Scholar
Tse, L, Barr, AM, Scarapicchia, V and Vila-Rodriguez, F (2015) Neuroleptic Malignant Syndrome: A Review from a Clinically Oriented Perspective. Current Neuropharmacology 13 (3) 395406.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×