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List of contributors
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- By Nazia M. Alam, Enrico Alleva, Hiroyuki Arakawa, Robert H. Benno, Fred G. Biddle, D. Caroline Blanchard, Robert J. Blanchard, Richard J. Bodnar, John D. Boughter, Igor Branchi, Richard E. Brown, Abel Bult-Ito, Jonathan M. Cachat, Peter R. Canavello, Francesca Cirulli, Giovanni Colacicco, John C. Crabbe, Jacqueline N. Crawley, Wim E. Crusio, Sietse F. de Boer, Ekrem Dere, Brenda A. Eales, Robert T. Gerlai, Howard K. Gershenfeld, Thomas J. Gould, Martin E. Hahn, Peter C. Hart, Andrew Holmes, Joseph P. Huston, Allan V. Kalueff, Benjamin Kest, Robert Lalonde, Sarah R. Lewis-Levy, Hans-Peter Lipp, Sheree F. Logue, Stephen C. Maxson, Jeffrey S. Mogil, Douglas A. Monks, Dennis L. Murphy, Lee Niel, Timothy P. O’Leary, Susanna Pietropaolo, Peter K.D. Pilz, Claudia F. Plappert, Bernard Possidente, Glen T. Prusky, Laura Ricceri, Heather Schellinck, Herbert Schwegler, Burton Slotnick, Frans Sluyter, Shad B. Smith, Catherine Strazielle, Douglas Wahlsten, Hans Welzl, James F. Willott, David P. Wolfer, Armin Zlomuzica
- Edited by Wim E. Crusio, Université de Bordeaux, Frans Sluyter, Robert T. Gerlai, University of Toronto, Susanna Pietropaolo, Université de Bordeaux
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- Book:
- Behavioral Genetics of the Mouse
- Published online:
- 05 May 2013
- Print publication:
- 25 April 2013, pp ix-xii
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4 - Rapid tranquillisation
- from Part I - Therapeutic interventions
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- By Caroline L. Holmes, Consultant, Forensic Psychiatrist, The Essex Forensic Mental Health Service, Runwell Hospital, Wickford, Essex, UK, Helen Simmons, Consultant Psychiatrist
- M. Dominic Beer, Stephen M. Pereira, Carol Paton
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- Book:
- Psychiatric Intensive Care
- Published online:
- 22 August 2009
- Print publication:
- 27 March 2008, pp 32-49
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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.