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A growing evidence base for management guidelines: Revisiting… Guidelines for the management of acutely disturbed psychiatric patients

  • Rob Macpherson, Roland Dix and Sally Morgan
Abstract

We review key recent research and guidance for staff working with acutely disturbed psychiatric patients. Assessment of aggressive patients and their situation should enable full risk assessment, which may ideally involve the use of advance directives. We discuss appropriate use of the Mental Health Act 1983 and consider benefits and adverse effects of rapid tranquillisation. We present a simple protocol for oral or intramuscular rapid tranquillisation. Staff using physical restraint should be properly trained and consider sensitively issues of the patient's diginity, gender and the most appropriate location for restraint to occur. Simple precautions can improve safety when working with potentially disturbed patients. Staff need support during and after the management of an aggressive incident.

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References
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Agid, O., Kapur, S., Arenovich, T. et al (2003) Delayed-onset hypothesis of antipsychotic action. A hypothesis tested and rejected. Archives of General Psychiatry, 60, 12281235.
Amering, M., Stastny, P. & Hopper, K. (2005) Psychiatric advance directives: qualitative study of informed deliberations by mental health service users. British Journal of Psychiatry, 186, 247252.
Appelbaum, P. (1999) Seclusion and restraint: Congress reacts to reports of abuse. Psychiatric Services, 50, 881885.
Banerjee, S., Bingley, W. & Murphy, E. (1995) Deaths of Detained Patients. London. Mental Health Foundation.
Belfrage, H. (1998) Implementing the HCR 20 scheme for risk assessment in a forensic psychiatry hospital: integrating research and practice. Journal of Forensic Psychiatry, 9, 328338.
Belgamwar, R. B., Duggan, L. & Fenton, M. (2004) Olanzapine for acutely disturbed/agitated people with suspected serious mental illness. Cochrane Database of Systematic Reviews, issue 3. Oxford: Update Software.
Binder, R. L. & McNeil, D. E. (1999) Contemporary practices in managing acute violent patients in 20 psychiatric emergency rooms. Psychiatric Services, 50, 15531554.
Broadstock, M. (2001) The effectiveness and safety of drug treatment for urgent sedation in psychiatric emergencies. New Zealand Health Technology Assessment, 4, 138.
Carpenter, S., Berk, M. & Rathbone, J. (2004) Clotiapine for acute psychotic illness. Cochrane Database of Systematic Reviews, issue 4. Oxford: Update Software.
Chouinard, G. (1985) Antimanic effects of clonazepam, Psychosomatics, 26 (suppl.), 712.
Committee on Safety of Medicines (2004) Atypical Antipsychotic Drugs and Stroke: Message from Gordon Duff, Chairman, Committee on Safety of Medicines. CEM/CMO/2004/1. London: Medicines and Healthcare Products Regulatory Agency.
Crichton, J. (1997) The response of nursing staff to psychiatric inpatient misdemeanour. Journal of Forensic Psychiatry, 1, 3661.
Crowner, M., Dougon, R., Convit, A. et al (1990) Akathisia and violence. Psychopharmacology Bulletin, 26, 115118.
Cure, S., Rathbone, J. & Carpenter, S. (2004) Droperidol for acutely disturbed behaviour. Cochrane Library, issue 2, Oxford: Update Software.
Davison, S. E. (2005) The management of violence in general psychiatry. Advances in Psychiatric Treatment, 11, 362370.
DeFruyt, J. & Demyttenaere, K. (2004) Rapid tranquillisation: new approaches in the emergency treatment of behaviour disturbances. European Psychiatry, 19, 243249.
Department of Health (2002) National Minimum Standards for General Adult Services in Psychiatric Intensive Care Units and Low Secure Environments. London: Stationery Office.
Department of Health (2004) Mental Health Policy Implementation Guide. Developing Positive Practice to Support the Safe and Therapeutic Management of Aggression and Violence in Mental Health In-Patient Settings. London: Stationery Office.
Department of Health (2005) Delivering Race Equality in Mental Health Care. The Government's Response to the Independent Inquiry into the Death of David Bennett. London: Stationery Office.
Dix, R. (2001) De-escalation. In Psychiatric Intensive Care (eds Beer, M. D., Pereira, S. M. & Patton, C.) pp. 3240. London: Greenwich Medical Media.
Dix, R. (2004) Advances in the management of acute schizophrenia and bipolar disorder: impact of the new rapid-acting atypical intramuscular formulations of treatment choice. Therapeutic Focus, 510.
Dix, R. & Betteridge, C. (2001) Seclusion. In Psychiatric Intensive Care (eds Beer, M. D., Pereira, S. M. & Patton, C.) pp. 133157. London: Greenwich Medical Media.
Dubin, W. R. (1988) Rapid tranquillisation: antipsychotics or benzodiazepines. Journal of Clinical Psychiatry, 49, 511.
Duggan, L., Fenton, M., Dardennes, R. M. et al (2002) Olanzapine for schizophrenia. Cochrane Library, issue 2. Oxford: Update Software.
Fava, M. (1997) Psychopharmacologic treatment of pathologic aggression. Psychiatric Clinics of North America, 20, 427451.
Fenton, M., Coutinho, E. F. S. & Campbell, C. (2001) Zuclopenthixol acetate in the treatment of acute schizophrenia and similar serious illnesses. Cochrane Database Systematic Review, issue 4. Oxford: Update Software.
Gillies, D., Beck, A. & McCloud, A. (2001) Benzodiazepines alone or in combination with antipsychotics for acute psychosis. Cochrane Database of Systematic Reviews, issue 2. Oxford: Update Software.
Goodwin, G. M. (2003) Evidence-based guidelines for treating bipolar disorder: recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology, 17, 149173.
Health Services Research Department, Institute of Psychiatry (2002) The Recognition, Prevention and Therapeutic Management of Violence in Mental Health Care. London: UKCC. http://www.nmc-uk.org/nmc/main/publications/TherapeuticManagementOfViolence.pdf
Huf, G., Coutinho, E. S. F., Fagundes, H. M. et al (2002) Current priorities in managing acutely disturbed patients at three hospitals in Rio de Janeiro – Brazil: a prevalence study. BioMed Central Psychiatry, 2, 4.
Hyde, C. E., Harrower-Wilson, C. & Morris, J. (1998) Violence, dissatisfaction and rapid tranquillisation in psychiatric intensive care. Psychiatric Bulletin, 22, 477480.
Kumar, A. (1997) Sudden unexplained death in a psychiatric patient – a case report: the role of phenothiazines and physical restraint. Medicine, Science and the Law, 37, 170175.
Lader, M. (1992) Expert Evidence. Committee of Inquiry into Complaints about Ashworth Hospital (Cm 2028). London: HMSO.
Leadbetter, D. & Perkins, J. (2002) An evaluation of aggression management training in a special educational setting. Emotional and Behavioural Difficulties, 7, 1934.
Lindberg, S. R., Beasley, C. M., Alaka, K. et al (2003) Effects of intramuscular olanzapine vs haloperidol and placebo on QTc intervals in acutely agitated patients. Psychiatry Research, 119, 113123.
Macpherson, R., Anstee, B. & Dix, R. (1996) Guidelines for the management of acutely disturbed psychiatric patients [with comment by T. Turner]. Advances in Psychiatric Treatment, 2, 194201.
Mannion, L., Sloan, D. & Connolly, L (1997) Rapid tranquillisation: are we getting it right? Psychiatric Bulletin, 22, 411413.
McAllister-Williams, R. H. & Ferrier, I. N. (2002) Rapid tranquillisation: time for a reappraisal of options for parenteral therapy. British Journal of Psychiatry, 180, 485489.
National Audit Office (2003) A Safer Place to Work - Protecting NHS Hospital and Ambulance Staff from Violence and Aggression. London: Stationery Office.
National Health Service (1999) Campaign to Stop Violence against Staff Working in the NHS: NHS Zero Tolerance Zone (Health Service Circular 226). London: NHS.
National Institute for Clinical Excellence (2005) The Short-term Management of Disturbed/Violent Behaviour in In-patient Psychiatric Settings and Emergency Departments. (Clinical Guideline 25). London: NICE.
Norfolk, Suffolk and Cambridgeshire Strategic Health Authority (2003) Independent Inquiry into the Death of David Bennett. Cambridge: NSCSHA. http://www.nscstha.nhs.uk/4856/11516/David%20Bennett%20Inquiry.pdf
Paterson, B. & Leadbetter, D. (2004) Learning the right lessons. Mental Health Practice, 7, 1215.
Paterson, B., Leadbetter, D. & McComish, A. (1998) Restraint and sudden death from asphyxia. Nursing Times, 4, 6264.
Pilowsky, L.S., Ring, H., Shine, R. J. et al (1992) Rapid tranquillisation. A survey of emergency prescribing in a general psychiatric hospital. British Journal of Psychiatry, 160, 831835.
Royal College of Psychiatrists (1997) The Association Between Antipsychotic Drugs and Sudden Death (Council Report CR57). London: Royal College of Psychiatrists.
Royal College of Psychiatrists (1998) Management of Imminent Violence. Clinical Practice Guidelines to Support Mental Health Services (Occasional Paper OP41). London: Royal College of Psychiatrists.
Royal College of Psychiatrists' Research Unit (2001) National Audit of the Management of Violence in Mental Health Settings: 1999–2000. London: CRU. http://www.rcpsych.ac.uk/cru/complete/audit99-00.htm#findings
Simpson, D. & Anderson, I. (1996) Rapid tranquillisation: a questionnaire survey of practice. Psychiatric Bulletin, 20, 149152.
Standing Nursing and Midwifery Advisory Committee (1999) Mental Health Nursing: ‘Addressing Acute Concerns’. London: Department of Health. http://www.advisorybodies.doh.gov.uk/snmac/snmacmh.pdf
Stimmel, G. L. (1996) Benzodiazepines in schizophrenia. Pharmacotherapy, 16, 14851515.
Webster, C. D., Douglas, K. S., Eaves, D. et al (1997) HCR- 20: Assessing Risk for Violence, Version 2. Burnaby, BC: Mental Health Law and Policy Institute, Simon Fraser University.
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BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
  • URL: /core/journals/bjpsych-advances
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A growing evidence base for management guidelines: Revisiting… Guidelines for the management of acutely disturbed psychiatric patients

  • Rob Macpherson, Roland Dix and Sally Morgan
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