Book contents
- Frontmatter
- Contents
- List of contributors
- Preface to second edition
- Preface to first edition
- Foreword
- Part I Therapeutic interventions
- 1 Psychiatric intensive care – development and definition
- 2 Management of acutely disturbed behaviour
- 3 De-escalation
- 4 Rapid tranquillisation
- 5 Pharmacological therapy
- 6 Psychological approaches to the acute patient
- 7 Psychological approaches to longer-term patients presenting with challenging behaviours
- 8 Seclusion – past, present and future
- 9 Restraint and physical intervention
- 10 The complex needs patient
- 11 Therapeutic activities within Psychiatric Intensive Care and Low Secure Units
- 12 Risk assessment and management
- Part II Interface issues
- Part III Management of the Psychiatric Intensive Care Unit/Low Secure Unit
- Index
- References
4 - Rapid tranquillisation
from Part I - Therapeutic interventions
Published online by Cambridge University Press: 22 August 2009
- Frontmatter
- Contents
- List of contributors
- Preface to second edition
- Preface to first edition
- Foreword
- Part I Therapeutic interventions
- 1 Psychiatric intensive care – development and definition
- 2 Management of acutely disturbed behaviour
- 3 De-escalation
- 4 Rapid tranquillisation
- 5 Pharmacological therapy
- 6 Psychological approaches to the acute patient
- 7 Psychological approaches to longer-term patients presenting with challenging behaviours
- 8 Seclusion – past, present and future
- 9 Restraint and physical intervention
- 10 The complex needs patient
- 11 Therapeutic activities within Psychiatric Intensive Care and Low Secure Units
- 12 Risk assessment and management
- Part II Interface issues
- Part III Management of the Psychiatric Intensive Care Unit/Low Secure Unit
- Index
- References
Summary
Introduction
Violence is a continuing problem in both inpatient and outpatient psychiatry. Past authors have concluded that violence is no more likely in the psychiatric population than in the general population, but there is an increasing consensus that people with psychotic illnesses are more likely to exhibit violence in the community (Mullen 1988; Monahan 1992; Mulvey 1994; Swanson et al. 1996).
Violence in the psychiatric setting may be acute, as seen in a severely disturbed patient with paranoid schizophrenia or mania, or ongoing, as seen inpatients who are chronically psychotic or those with personality disorders. In the UK, the acutely violent patient should ideally be treated in a Psychiatric Intensive Care Unit (PICU) until more settled. In the context of acute violence on the ward, the primary concern is to ensure the safety of patients and staff and any intervention should be the minimum required to calm the patient. However, in many cases medication is needed.
Rapid tranquillisation (RT) has been defined as ‘the use of psychotropic medication to control agitated, threatening or destructive psychotic behaviour’ (Ellison et al. 1989). The NICE guidelines describe RT as drug treatment used to achieve a, ‘reduction in agitation or aggression without sedation’ (National Institute for Clinical Excellence; NICE 2005).
It should not be confused with rapid neuroleptisation (RN), which entails giving high loading doses of neuroleptics to achieve an early remission. There is no evidence that RN offers any therapeutic advantages over the use of standard doses while side-effects are significantly greater.
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- Chapter
- Information
- Psychiatric Intensive Care , pp. 32 - 49Publisher: Cambridge University PressPrint publication year: 2008