Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-11T14:48:36.214Z Has data issue: false hasContentIssue false
  • English
  • Français

Rapid tranquilization: new approaches in the emergency treatment of behavioral disturbances

Published online by Cambridge University Press:  16 April 2020

Jürgen De Fruyt  and
Koen Demyttenaere
Jürgen De Fruyt*
Affiliation:
Department of Psychiatry, University Hospital Gasthuisberg, Merestraat 49, 3000Leuven, Belgium Department of Psychiatry, General Hospital Sint-Jan av, AZ Sint-Jan AV, Ruddershove 10, 8000Brugge, Belgium
Koen Demyttenaere
Affiliation:
Department of Psychiatry, University Hospital Gasthuisberg, Merestraat 49, 3000Leuven, Belgium
*
*Corresponding author. E-mail address: jurgen.defruyt@azbrugge.be (J. De Fruyt).
Get access

Abstract

Psychiatric emergencies are often accompanied by behavioral disturbances that interfere with normal assessment and call for immediate intervention. Different pharmacological treatment regimens have been used for this purpose. Most of these regimens are based upon common clinical practice and have limited evidence base. Recently, a major publication by experts in the field of emergency psychiatry has covered this topic and the therapeutic armamentarium has been extended with the atypical antipsychotics. However, research is still hampered by different methodological limitations: unclear definition of the agitated state and therapeutic goal, idiosyncratic measurement, small sample sizes. The perspective of the patient and the interaction between the emergency care setting and treatment regimen also need further attention. All these important, but often neglected issues are covered in a selective review of the literature.

Keywords

Emergency psychiatryPsychosisAgitationViolenceRapid tranquilizationSedation
Type
Review
Information
European Psychiatry , Volume 19 , Issue 5 , August 2004 , pp. 243 - 249
Copyright
Copyright © 2004 European Psychiatric Association

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

Agitation calmness scale. Eli Lilly and Company; 1998 Copyright.Google Scholar
Allen, MHLevel 1 psychiatric emergency services. The tools of the crisis sector. Psychiatr Clin North Am 1999;22:713–34.CrossRefGoogle ScholarPubMed
Allen, MHManaging the agitated psychotic patient: a reappraisal of the evidence. J Clin Psychiatry 2000;61(Suppl 14):11–20.Google Scholar
Allen, MHCurrier, GWHughes, DHet al. The Expert Consensus Guideline Series: treatment of behavioral emergencies. Postgraduate Medicine Special Report 2001:1–90.Google ScholarPubMed
Atakan, ZDavies, TABC of mental health. Mental health emergencies. BMJ 1997;314:1740–2.CrossRefGoogle ScholarPubMed
Battaglia, JMoss, SRush, JKang, JMendoza, RLeedom, Let al.Haloperidol, lorazepam, or both for psychotic agitation? A multi-center, prospective, double-blind, emergency department study. Am J Emerg Med 1997;15:335–40.CrossRefGoogle ScholarPubMed
Bellnier, TJContinuum of care: stabilizing the acutely agitated patient. Am J Health-Syst Pharm 2002;59(Suppl 5):12–8.CrossRefGoogle ScholarPubMed
Bieniek, SAOwnby, RLPenalver, ADominguez, RAA double-blind study of lorazepam versus the combination of haloperidol and lorazepam in managing agitation. Pharmacotherapy 1998;18:57–62.Google ScholarPubMed
Binder, RLMcNeil, DEContemporary practices in managing acutely violent patients in 20 psychiatric emergency rooms. Psychiatr Serv 1999;50:1553–4.CrossRefGoogle ScholarPubMed
Breier, AMeehan, KBirkett, MDavid, SFerchland, et al.A double-blind, placebo-controlled dose–response comparison of intramuscular olanzapine and haloperidol in the treatment of acute agitation in schizophrenia. Arch Gen Psychiatry 2002;59:441–8.CrossRefGoogle Scholar
Breslow, REKlinger, BIErickson, BJAcute intoxication and sub stance abuse among patients presenting to a psychiatric emergency service. Gen Hosp Psychiatry 1996;18:183–91.CrossRefGoogle Scholar
Broadstock, MThe effectiveness and safety of drug treatment for urgent sedation in psychiatric emergencies. A critical appraisal of the literature. N Z Health Technol Assess Clearing House Rep 2001;4(1).Google Scholar
Brook, SLucey, JVGunn, KPfor the Ziprasidone IM Study Group. Intramuscular ziprasidone compared with intramuscular haloperidol in the treatment of acute psychosis. J Clin Psychiatry 2000;61:933–41.CrossRefGoogle ScholarPubMed
Canas, FSustaining short-term gains for future progress. Int Clin Psychopharmacol 2001;16(Suppl 1):9–13.Google ScholarPubMed
Corrigan, JDDevelopment of a scale for assessment of agitation following traumatic brain injury. J Clin Exp Neuropsychol 1989;11: 261–77.CrossRefGoogle ScholarPubMed
Cunnane, JGDrug management of disturbed behaviour by psychiatrists. Psychiatr Bull 1994;18:138–9.CrossRefGoogle Scholar
Currier, GWAtypical antipsychotic medications in the psychiatric emergency service. J Clin Psychiatry 2000;61(Suppl 14):21–6.Google ScholarPubMed
Currier, GWAllen, MHAmerican Association for Emergency Psychiatry survey: I. Psychiatric emergency service structure and function. Presented at the Institute on Psychiatric Services, New Orleans, Oct 29–Nov 2, 1999.Google Scholar
Currier, GWSimpson, GMRisperidone liquid concentrate and oral lorazepam versus intramuscular haloperidol and intramuscular lorazepam for treatment of psychotic agitation. J Clin Psychiatry 2001;62:153–7.CrossRefGoogle ScholarPubMed
Currier, GWTrenton, APharmacological management of psychotic agitation. CNS Drugs 2002;16:219–28.CrossRefGoogle Scholar
Daniel, DGPotkin, SGReeves, KRSwift, RHHarrigan, EPIntramuscular (IM) ziprasidone 20 mg is effective in reducing acute agitation associated with psychosis: a double-blind, randomized trial. Psychopharmacology 2001;155:128–34.CrossRefGoogle ScholarPubMed
Dawes, SSBloniarz, PAMumpower, JLet al.Supporting psychiatric assessments in emergency rooms. Albany (NY): Center for Technology in Government; 1995.Google Scholar
Donlon, PTHopkin, JTRapid “digitalization” of decompensated schizophrenic patients with antipsychotic drugs. Am J Psychiatry 1974;131:310–2.CrossRefGoogle Scholar
Donlon, PTHopkin, JTTupin, JPet al.Haloperidol for acute schizophrenic patients: an evaluation of three oral regimens. Arch Gen Psychiatry 1980;37:691–5.CrossRefGoogle ScholarPubMed
Dubin, WRRapid tranquilization: antipsychotics or benzodiazepines? J Clin Psychiatry 1988;49(Suppl 12):5–11.Google ScholarPubMed
Dubin, WRFeld, JARapid tranquilization of the violent patient. Am J Emerg Med 1989;7:313–20.CrossRefGoogle ScholarPubMed
Dubin, WRWaxman, HMWeiss, KJRamchandani, DTavani-Petroni, CRapid tranquilization: the efficacy of oral concentrate. J Clin Psychiatry 1985;46:475–8.Google ScholarPubMed
Dubin, WRWeiss, KJDorn, JMPharmacotherapy of psychiatric emergencies. J Clin Psychopharmacol 1986;6:210–22.CrossRefGoogle ScholarPubMed
Fenton, MCoutinho, ESFCampbell, CZuclopenthixol acetate in the treatment of acute schizophrenia and similar serious mental illnesses (Cochrane review). 2002 The Cochrane library. No. 3. Oxford: Update Software.Google Scholar
Forster, PEmergency psychiatry in a new mental health system: quality versus efficiency, structures versus networks. Presented at the Sixth World Congress of the International Association of Emergency Psychiatry, Barcelona, Jun 9–12, 2002.Google Scholar
Foster, SKessel, JBrman, MESimpson, GMEfficacy of lorazepam and haloperidol for rapid tranquilization in a psychiatric emergency room setting. Int Clin Psychopharmacol 1997;12:175–9.CrossRefGoogle Scholar
Garza-Trevino, ESHollister, LEOverall, JEAlexander, WFEfficacy of combinations of intramuscular antipsychotics and sedative-hypnotics for control of psychotic agitation. Am J Psychiatry 1989; 146:1598–601.Google ScholarPubMed
Hellewell, JSECameron-Hands, DCantillon, MSeroquel: evidence for efficacy in the treatment of hostility and aggression. Schizophr Res 1998;29:154–5.Google Scholar
Hillard, JREmergency treatment of acute psychosis. J Clin Psychiatry 1998;59(Suppl 1):57–60.Google ScholarPubMed
Huf, Get al.Current practices in managing acutely disturbed patients at three hospitals in Rio de Janeiro-Brazil: a prevalence study. BMC Psychiatry 2002;2:4.CrossRefGoogle Scholar
Kamin, JManwani, SHughes, DExtrapyramidal side effects in the psychiatric emergency service. Psychiatr Serv 2000;51:287–9.CrossRefGoogle ScholarPubMed
Karagianis, JLDawe, ICThakur, ABegin, SRaskin, JRoy-chowdhury, SMet al.Rapid tranquilization with olanzapine in acute psychosis: a case series. J Clin Psychiatry 2001;62(Suppl 2):12–6.Google ScholarPubMed
Kay, SRFiszbein, AOpler, LAThe positive and negative scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261–76.CrossRefGoogle Scholar
Kerr, IBTaylor, DAcute disturbed or violent behaviour: principles of treatment. J Psychopharmacol 1997;11:271–7.CrossRefGoogle ScholarPubMed
Lesem, MDZajecka, JMSwift, RHReeves, KRHarrigan, EPIntramuscular ziprasidone, 2 mg versus 10 mg, in the short-term management of agitated psychotic patients. J Clin Psychiatry 2001;62:12–8.CrossRefGoogle ScholarPubMed
Lindenmayer, JPThe pathophysiology of agitation. J Clin Psychiatry 2000;61(Suppl 14):5–10.Google ScholarPubMed
Marson, DCMcGovern, MPPomp, HCPsychiatric decision making in the emergency room: a research overview. Am J Psychiatry 1988;145:918–25.Google ScholarPubMed
McAllister-Williams, HRFerrier, NIRapid tranquillisation: time for a reappraisal of options for parenteral therapy. Br J Psychiatry 2001;179:485–9.Google Scholar
Neborsky, RJanowsky, DMunson, Eet al.Rapid treatment of acute psychotic symptoms with high-and low-dose haloperidol. Arch Gen Psychiatry 1981;38:195–9.CrossRefGoogle ScholarPubMed
Overall, JEGorham, DRThe brief psychiatric rating scale. Psychol Rep 1962;10:799–812.CrossRefGoogle Scholar
Pilowsky, LSRing, HShine, PJBattersby, MLader, MRapid tran-quillisation. A survey of emergency prescribing in a general psychiatric hospital. Br J Psychiatry 1992;160:831–5.CrossRefGoogle Scholar
Raja, MAzzoni, ASecond-generation antipsychotics in the emergency care setting. A prospective naturalistic study. Gen Hosp Psychiatry 2000;22:101–14.CrossRefGoogle ScholarPubMed
Reilly, JGAyis, SAFerrier, INJones, SJThomas, SHQTc-interval abnormalities and psychotropic drug therapy in psychiatric patients. Lancet 2000;355:1048–52.CrossRefGoogle ScholarPubMed
Resnick, MBurton, BTDroperidol vs haloperidol in the initial management of acutely agitated patients. J Clin Psychiatry 1984;45: 298–9.Google ScholarPubMed
Rothschild, AJDisinhibition, amnestic reactions, and other adverse reactions secondary to triazolam: a review of the literature. J Clin Psychiatry 1992;53(12, Suppl):69–79.Google ScholarPubMed
Sailas, EFenton, MSeclusion and restraint for people with serious mental illnesses (Cochrane review). 2002 The Cochrane library. No. 3. Oxford: Update Software.Google Scholar
Salzman, CSolomon, DMiyawaki, EGlassman, RRood, LFlowers, Eet al.Parenteral lorazepam versus parenteral haloperidol for the control of psychotic disruptive behavior. J Clin Psychiatry 1991;52: 177–80.Google ScholarPubMed
Sheline, YNelson, TPatient choice: deciding between psychotropic medication and physical restraints in an emergency. Bull Am Acad Psychiatry Law 1993;21:321–9.Google ScholarPubMed
Swift, RHHarrigan, EPCappelleri, JCKramer, DChandler, LPValidation of the behavioural activity rating scale (BARS)™: a novel measure of activity in agitated patients. J Psych Res 2002;36:87–95.CrossRefGoogle Scholar
ThomasJr, HSchwartz, EPetrilli, RDroperidol versus haloperidol for chemical restraint of agitated and combative patients. Ann Emerg Med 1992;21:407–13.CrossRefGoogle Scholar
Wing, JMarriott, SPalmer, CThomas, VManagement of imminent violence: clinical practice guidelines to support mental health services. R Coll Psychiatrists 1998;41:1–111 [Occasional paper].Google Scholar
Wright, PBirkett, MDavid, SRMeehan, KFerchland, Iet al.Double-blind, placebo-controlled comparison of intramuscular olanzapine and intramuscular haloperidol in the treatment of acute agitation in schizophrenia. Am J Psychiatry 2001;158:1149–51.CrossRefGoogle Scholar
Yudofsky, SCSilver, JM JacksonW, Endicott, JWilliams, DThe overt aggression scale for the objective rating of verbal and physical aggression. Am J Psychiatry 1986;143:35–9.Google ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.