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Management of violent behaviour and rapid tranquillisation during acute psychotic episode: discrepancy between routine practice and evidence. The SIEP-DIRECT's Project

Published online by Cambridge University Press:  11 April 2011

Antonio Lora ,
Carla Morganti ,
Arcadio Erlicher ,
Lorenzo Burti ,
Giacinto Buscaglia ,
Marco Pegoraro ,
Jacchetti Davide ,
Doriana Cristofalo ,
Mirella Ruggeri  and
Domenico Semisa
Antonio Lora*
Affiliation:
Dipartimento di Salute Mentale, Azienda Ospedaliera di Vimercate, Vimercate (Milano)
Carla Morganti
Affiliation:
Dipartimento di Salute Mentale, Azienda Ospedaliera Niguarda, Ca' Granda (Milano)
Arcadio Erlicher
Affiliation:
Dipartimento di Salute Mentale, Azienda Ospedaliera Niguarda, Ca' Granda (Milano)
Lorenzo Burti
Affiliation:
Sezione di Psichiatria e di Psicologia Clinica, Università di Verona, Verona
Giacinto Buscaglia
Affiliation:
Dipartimento di Salute Mentale, Azienda Sanitaria Locale Savona, Savona
Marco Pegoraro
Affiliation:
Dipartimento di Salute Mentale, Azienda Ospedaliera di Crema, Crema
Jacchetti Davide
Affiliation:
Dipartimento di Salute Mentale, Azienda Ospedaliera di Crema, Crema
Doriana Cristofalo
Affiliation:
Sezione di Psichiatria e di Psicologia Clinica, Università di Verona, Verona
Mirella Ruggeri
Affiliation:
Sezione di Psichiatria e di Psicologia Clinica, Università di Verona, Verona
Domenico Semisa
Affiliation:
Dipartimento Salute Mentale ASL Provinciale di Bari, Centro di Salute Mentale Acquaviva delle Fonti (Bari)
*
Address fo correspondence: Dr. A. Lora, Dipartimento di Salute Mentale, Azienda Ospedaliera di Vimercate (Milano), Servizio Psichiatrico di Diagnosi e Cura, Presidio di Desio, Via Mazzini 1, 20033 Desio (Milano). Fax: +39-0362-383.865 E-mail: antoniolora@virgilio.it
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Summary

Aims – To evaluate the quality of acute psychiatric care concerning the management of violent behaviour and rapid tran-quilization. Methods – Data concerning 13 indicators, drawn from NICE recommendations, were collected in 19 Departments of Mental Health, in the frame of the SIEP-DIRECT's Project, to evaluate the implementation of NICE recommendations in Italian Mental Health Services. Results – In about two thirds of Departments of Mental Health (DMHs) professionals were trained in the management of violent behaviour, while written procedures existed only in one fourth of DMHs. About a half of the professionals working in Psychiatric Wards in General Hospital were trained in rapid tranquilization, while procedures on this topic are practically absent and specific care for monitoring intensively the heavily sedated patient was not frequent. Conclusions – Management of violent behaviour and rapid tranquilization are two critical areas in the care performed by Psychiatric Wards in General Hospital. Training on these topics is more frequent than implementation of procedures. NICE recommendations and SIEP indicators are useful tools for improving the quality of acute psychiatric care.

Declaration of Interest: None.

Keywords

violent behaviourrapid tranquilizationPsychiatric Wards in General Hospitalguidelineprocedure
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 17 , Issue 4 , December 2008 , pp. 349 - 357
Copyright
Copyright © Cambridge University Press 2008

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References

BIBLIOGRAFIA

AIFA (2007). Nota AIFA Antipsicotici. Gazzetta Ufficiale 13.3.2007, serie generale N° 60, allegato I pag 15–17.Google Scholar
Allen, J. (1997). Assessing and managing risk of violence in the mentally disordered. Journal of Psychiatric and Mental Health Nursing 4, 369–378.CrossRefGoogle ScholarPubMed
Allen, M. H., Currier, G. W., Carpenter, D., Ross, R. W. & Docherty, J. P. (2005). The expert consensus guideline series. Treatment of behavioral emergencies 2005. Journal of Psychiatric Practice 11, Suppl. 1, 5–108.CrossRefGoogle ScholarPubMed
Barbui, C. (2008). Intramuscolar haloperidol plus promethazine is more effective and safer than haloperidol alone for rapid tranquillization of agitated mentally ill patients. Evidence Based Mental health 11, 86–87.CrossRefGoogle Scholar
Baskak, B., Atbasoglu, E. C., Ozguven, H. D., Saka, M. C. & Gogus, A. K. (2007). The effectiveness of intramuscular biperiden in acute akathi-sia: a double-blind, randomized, placebo-controlled study. Journal of Clinical Psychopharmacology 27(3), 289–294.CrossRefGoogle ScholarPubMed
Battaglia, J. (2005). Pharmacological management of acute agitation. Drugs 65(9), 1207–1222.CrossRefGoogle ScholarPubMed
Bezzi, R., Erlicher, A. & Lora, A. (2006). L'efficacia nella pratica del ricovero nei Servizi Psichiatrici di Diagnosi e Cura in Lombardia. Epidemiologia e Psichiatria Sociale 15(3), 233–237.CrossRefGoogle Scholar
Binder, R. L. & McNeil, D. E. (1999). Emergency psychiatry: contemporary practices in managing acutely violent patients in 20 psychiatric emergency rooms. Psychiatric Services 50, 1553–1554.CrossRefGoogle ScholarPubMed
Broadstock, M. (2001). The effectiveness and safety of drug treatment for urgent sedation in psychiatric emergencies. NZHTA Report 4(1). Retrieved July 17, 2008, from http://nzhta.chmeds.ac.nz/publica-tions/nzhtav4n1.pdfGoogle Scholar
Carrà, G., Barale, F. & Marinoni, A. (Eds.) (2004). Schizofrenia. Linee Guida Cliniche Complete per gli Interventi Fondamentali nella Medicina di Base e Specialistica. I1 Pensiero Scientifico Editore: Roma.Google Scholar
Cowin, L., Davies, R., Estall, G., Berlin, T., Fitzgerald, M. & Hoot, S. (2003). De-escalating aggression and violence in the mental health setting. International Journal of Mental Health Nursing 12, 64–73.CrossRefGoogle ScholarPubMed
Currier, G. W. & Medori, R. (2006). Orally versus intramuscularly administered antipsychotic drugs in psychiatric emergencies. Journal of Psychiatric Practice 12(1), 30–40.CrossRefGoogle ScholarPubMed
Fasanelli, E., Miti, G. & Zanasi, M. (2006). Il comportamento aggressivo in soggetti ospedalizzati con schizofrenia. Psichiatria e Psicoterapia 25, 147–159.Google Scholar
Huf, G., Alexander, J. & Allen, M. H. (2005). Haloperidol plus prometha-zine for psychosis induced aggression. Cochrane Database of Systematic Reviews Issue 4. Art. No.:CD005146. DOI: 10.1002/ 14651858.CD005146.Google Scholar
Huf, G., Coutinho, E. S. F., Adams, C. E. & TREC collaborative Group (2007). Rapid tranquillisation in psychiatric emergency setting in Brazil: pragmatic randomized controlledtrial of intramuscular halo-peridol versus intramuscular haloperidol plus promethazine. British Medical Journal 335, 869–872.CrossRefGoogle Scholar
Kamin, J., Manwani, S. & Hughes, D. (2000). Emergency psychiatry: extrapyramidal side effects in the psychiatric emergency service. Psychiatric Services 51(3), 287–289.CrossRefGoogle ScholarPubMed
Leucht, S. (2007). Psychiatric treatment guidelines: doctors ' non-compliance or insufficient evidence? Acta Psychiatrica Scandinavica 115(6), 417–419.CrossRefGoogle ScholarPubMed
Lora, A., Corlito, G., Miceli, M., Di Munzio, W., Lasalvia, A., Tanini, A., Mari, L., Casacchia, M., Magnani, N., Cristofalo, D., Semisa, D., Ruggeri, M.per il Gruppo SIEP-DIRECT's (2008). The treatment of acute psychotic episode: discrepancy between routine practice and evidence. The SIEP-DIRECT's Project (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 319–330.CrossRefGoogle Scholar
Lukens, T. W., Wolf, S. J., Edlow, J. A., Shahabuddin, S., Allen, M. H., Currier, G. W. & Jagoda, A. S. (2006). Clinical policy: critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department. Annals of Emergency Medicine 47(1), 79–99.CrossRefGoogle ScholarPubMed
Morales, E. & Duphorne, P. L. (1995). Least restrective measures: alternatives to four-point restraints and seclusion. Journal of Psychosocial Nursing and Mental Health Services 33 (10), 13–16, 42–43.CrossRefGoogle Scholar
Muralidharan, S. & Fenton, M. (2006). Containment strategies for people with serious mental illness. Cochrane Database of Systematic Reviews Issue 3. Art. No.: CD002084. DOI: 10.1002/14651858. CD002084.pub2.CrossRefGoogle Scholar
Pilling, S & Price, K. (2006). Developing and implementing clinical guidelines: lessons from the NICE schizophrenia guideline. Epidemiologia e Psichiatria Sociale 15(2), 109–116.CrossRefGoogle ScholarPubMed
National Institute for Clinical Excellence (2005). Clinical Guideline 25 - Violence: the Short-Term Management of Disturbed/Violent Behaviour in Psychiatric Inpatient Settings and Emergency Departments. Retrieved August 27, 2008, from http:\\www.nice. org.uk/CG025NICEguidelineGoogle Scholar
Rathbone, J. & Soares-Weiser, K. (2006). Anticholinergics for neurolep-tic-induced acute akathisia. Cochrane Database of Systematic Reviews Issue 4. Art. No.: CD003727. DOI: 10.1002/14651858. CD003727.pub3.CrossRefGoogle Scholar
Raveendran, N. S., Tharyan, P., Alexander, J., Adams, C. E. & TREC collaborative Group (2007). Rapid tranquillisation in psychiatric emergency setting in India: pragmatic randomized controlled trial of intramuscular olanzapine versus intramuscular haloperidol pluspro-methazine. British Medical Journal 335, 865–869.CrossRefGoogle Scholar
Royal College of Psychiatrists (1998). Management of Imminent Violence: Clinical Practice Guidelines to Support Mental Health Services. Occasional Paper 41. RCP: London.Google Scholar
Ruggeri, M. (2008). Guidelines for treating mental illness: love them, hate them. Can the SIEP-DIRECT's Project serve in the search of a happy medium? Epidemiologia e Psichiatria Sociale 17(4), 270–277.CrossRefGoogle ScholarPubMed
Ruggeri, M., Lora, A. & Semisa, D.on behalf of the SIEP-DIRECT's Group (2008). The SIEP-DIRECTU's Project on the discrepancy between routine practice and evidence. An outline of the main findings and the practical implications for the future of community based mental health services. Epidemiologia e Psichiatria Sociale 17(4), 358–368.CrossRefGoogle ScholarPubMed
Semisa, D, Lora, A, Morosini, P & Ruggeri, M. (2008a). The SIEP-DIRECT's Project onthe discrepancy between routine practice and evidence in the treatment of schizophrenia.The design, the indicators, and the methodology of the study (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 278–290.CrossRefGoogle Scholar
Semisa, D., Lasalvia, A., Miceli, M., Dall'Agnola, R. B., Pucci, C., Bissoli, S., Visani, E., Pismataro, P., Vanetti, M., Pioli, R., Ruggeri, M., Lora, A.per il Gruppo SIEP-DIRECT's (2008b). The acceptability of the NICE recommendations for schizophrenia in the Italian Departments of Mental Health. The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 291–304.CrossRefGoogle ScholarPubMed
Tonda, M. E. & Guthrie, S. K. (1994). Treatment of acute neuroleptic-induced movement disorders. Pharmacotherapy 14(5), 543–560.CrossRefGoogle ScholarPubMed
Veser, F. H., Veser, B. D., McMullan, J. T., Zealberg, J. & Currier, G.W. (2006). Risperidone versus haloperidol, in combination with loraze-pam, in the treatment of acute agitation and psychosis: a pilot, randomized, double-blind, placebo-controlled trial. Journal of Psychiatric Practice 12(2), 103–108.CrossRefGoogle ScholarPubMed
Weinmann, S., Koesters, M. & Becker, T. (2007). Effects of implementation of psychiatric guidelines on provider performance and patient outcome: systematic review. Acta Psychiatrica Scandinavica 115(6), 420–433.CrossRefGoogle ScholarPubMed