Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-16T21:17:35.224Z Has data issue: false hasContentIssue false
  • English
  • Français

Rapid tranquillisation of acutely disturbed and violent patients: a retrospective cohort examination of 24 patients on a psychiatric intensive care unit

Published online by Cambridge University Press:  10 December 2015

Homayun Shahpesandy ,
Nina Tye ,
Amy Hegarty ,
Justyna Czechovska ,
Mona Lisa Kwentoh  and
Amanda Wood
Homayun Shahpesandy*
Affiliation:
Consultant Psychiatrist, Tees, Esk and Wear Valley NHS Foundation Trust, Roseberry Park Hospital, Middlesbrough, UK
Nina Tye
Affiliation:
Clincal Psychologist, Tees, Esk and Wear Valley NHS Foundation Trust, Roseberry Park Hospital, Middlesbrough, UK
Amy Hegarty
Affiliation:
CT in Psychiatry, Tees, Esk and Wear Valley NHS Foundation Trust, Roseberry Park Hospital, Middlesbrough, UK
Justyna Czechovska
Affiliation:
F1; Tees, Esk and Wear Valley NHS Foundation Trust, Roseberry Park Hospital, Middlesbrough, UK
Mona Lisa Kwentoh
Affiliation:
Consultant Psychiatrist, Tees, Esk and Wear Valley NHS Foundation Trust, Roseberry Park Hospital, Middlesbrough, UK
Amanda Wood
Affiliation:
Clincal Psychologist, Tees, Esk and Wear Valley NHS Foundation Trust, Roseberry Park Hospital, Middlesbrough, UK
*
Correspondence to: Dr H. Shahpesandy, Roseberry Park Hospital, Marton Road, Middlesbrough TS4 3AF; E-mail: [email protected]
Get access

Abstract

The prevalence of violent behaviour within acute psychiatric services is about 10%.

Aim

To identify the pharmacological management of acutely disturbed behaviour in patients requiring rapid tranquillisation (RT) on a psychiatric intensive care unit (PICU). Socio-demographic and clinical characteristics were also identified in these patients.

Method and objectives

A retrospective cohort examination was carried out of 24 patients receiving RT, average age of 38.8 years (7 women and 17 men), admitted to the PICU between 1 January 2011 and 31 December 2011. Patient records and hospital incident reporting system were used to obtain relevant data for analysis.

Results

The majority of patients were detained (95%); suffering from schizophrenia (45.8%); bipolar disorder (25%) and substance misuse disorders (12.5%). Verbal aggression (58.3%) and threatening behaviour (29.2%) were the most common factors leading to RT. Fourteen patients (58.3%) were medicated with a combination of haloperidol and lorazepam; nine (37.5%) with zuclopenthixol acetate only; and one (4.2%) with a combination of zuclopenthixol and promethazine.

Conclusion

Haloperidol in combination with lorazepam was the most common medication utilised for RT. Nevertheless, zuclopenthixol acetate alone, or combined with other drugs, was used in over 40% of cases. This finding is in considerable variation with recommended guidelines.

Type
Brief Report
Information
Journal of Psychiatric Intensive Care , Volume 11 , Supplement S1 , December 2015 , e1
Copyright
Copyright © NAPICU 2015 

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

Allen, M.H., Currier, G.W., Carpenter, D., Ross, R and Docherty, J.P. (2005) The Expert Consensus Guideline Series: treatment of behavioral emergencies. Journal of Psychiatric Prac tice . 11(suppl. 1): 5–108.CrossRefGoogle ScholarPubMed
Angermeyer, M.C. (2000) Schizophrenia and violence. Acta Psychiatrica Scandinavica. 102(suppl. S407): 63–67.Google Scholar
Baldaçara, L., Sanches, M., Cordeiro, D.C. and Jackoswski, A.P. (2011) Rapid tranquilization for agitated patients in emergency psychiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone. Revista Brasileira de Psiquiatria. 33(1): 30–39.CrossRefGoogle Scholar
Battaglia, J. (2005) Pharmacological management of acute agitation. Drugs. 65(9): 1207–1222.CrossRefGoogle ScholarPubMed
Battaglia, J., Moss, S., Rush, J., Kang, J., Mendoza, R., Leedom, L., Dubin, W., McGlynn, C. and Goodman, L. (1997) Haloperidol, lorazepam, or both for psychotic agitation? A multicenter, prospective, double-blind, emergency department study. American Journal of Emergency Medicine. 15(4): 335–340.CrossRefGoogle ScholarPubMed
Bimenyimana, E., Poggenpoel, M., Myburgh, C. and van Niekerk, V. (2009) The lived experience by psychiatric nurses of aggression and violence from patients in a Gauteng psychiatric institution. Curationis. 32(3): 4–13.Google Scholar
Brook, S. (2003) Intramuscular ziprasidone: moving beyond the conventional in the treatment of acute agitation in schizophrenia. Journal of Clinical Psychiatry. 64(suppl. 19): 13–18.Google Scholar
Brown, S., Chhina, N. and Dye, S. (2010) Use of psychotropic medication in seven English psychiatric intensive care units. The Psychiatrist. 34: 130–135.Google Scholar
Brown, S. and Bass, N. (2004) The psychiatric intensive care unit: patient characteristics, treatment and outcome. Journal of Mental Health. 13(6): 601–609.Google Scholar
Bushe, C.J., Taylor, M. and Mathew, M. (2007) Intramuscular olanzapine – a UK case series of early cases. Annals of General Psychiatry. 6: 11. http://dx.doi.org/10.1186/1744-859X-6-11 Google Scholar
Cohen, D.P., Akhtar, M.S., Siddiqui, A., Shelley, C., Larkin, C., Kinsella, A. and O’Callaghan, E. (2008) Aggressive incidents on a psychiatric intensive care unit. Psychiatric Bulletin. 32(12): 455–458.Google Scholar
Currier, G.W., Chou, J.C.Y., Feifel, D., Bossie, C.A., Turkoz, I., Mahmoud, R.A. and Gharabawi, G.M. (2004) Acute treatment of psychotic agitation: a randomized comparison of oral treatment with risperidone and lorazepam versus intramuscular treatment with haloperidol and lorazepam. Journal of Clinical Psychiatry. 65: 386–394.Google Scholar
Damsa, C., Adam, E., Lazignac, C., De Gregorio, F., Mihai, A., Lejeune, J., Sarasin, F. and Allen, M.H. (2008) Intramuscular olanzapine in patients with schizophrenia: an observational study in an emergency room. Bulletin de la Société des Sciences Médicales du Grand-Duché de Luxembourg. 2008(2): 209–216.Google Scholar
Department of Health (2008) Code of Practice: Mental Health Act 1983. London: The Stationery Office.Google Scholar
Department of Health (2014) Positive and Proactive Care: Reducing the need for restrictive interventions. Social Care, Local Government and are Partnership Directorate. 43 pp.Google Scholar
Donlon, P. and Tupin, J. (1974) Rapid “digitalization” of decompensated schizophrenic patients with antipsychotic agents. American Journal of Psychiatry . 133: 310–312.Google Scholar
El-Badri, S.M. and Mellsop, G. (2006) Aggressive behaviour in an acute general adult psychiatric unit. Psychiatric Bulletin. 30: 166–168.Google Scholar
Ellison, J.M., Blum, N.R. and Barsky, A.J. (1989) Frequent repeaters in a psychiatric emergency service. Hospital & Community Psychiatry. 40: 958–960.Google Scholar
Falkai, P., Wobrock, T., Lieberman, J., Glenthoj, B., Gattaz, W. F., Möller, H. J. and WFSBP Task Force on Treatment Guidelines for Schizophrenia (2005) World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia. Part 1: acute treatment of schizophrenia. World Journal of Biological Psychiatry. 6(3): 132–191.CrossRefGoogle ScholarPubMed
Fann, W.E. and Linton, P.H. (1972) Use of perphenazine in psychiatric emergencies: the concept of chemical restraint. Current Therapeutic Research, Clinical & Experimental. 14(8): 478–482.Google Scholar
Feinstein, A. and Holloway, F. (2002) Evaluating the use of a psychiatric intensive care unit: is ethnicity a risk factor for admission? International Journal of Social Psychiatry . 48(1): 38–46.Google Scholar
Foley, S.R., Kelly, B.D., Clarke, M., McTique, O., Gervin, M., Kamali, M, Larkin, C., O'Callaghan, E. and Browne, S (2005) Incidence and clinical correlates of aggression and violence at presentation in patients with first episode psychosis. Schizophrenia Research.. 72(2–3): 161–168.Google Scholar
Gibson, R.C., Fenton, M., Coutinho, E.S. and Campbell, C. (2004) Zuclopenthixol acetate for acute schizophrenia and similar serious mental illnesses. Cochrane Database of Systematic Reviews . 2004(3): CD000525.Google Scholar
Hsu, W.-Y., Huang, S.-S., Lee, B.-S. and Chiu, N.Y. (2010) Comparison of intramuscular olanzapine, orally disintegrating olanzapine tablets, oral risperidone solution, and intramuscular haloperidol in the management of acute agitation in an acute care psychiatric ward in Taiwan. Journal of Clinical Psychopharmacology. 30: 230–234.Google Scholar
Huf, G., Alexander, J., Allen, M.H. and Raveeendran, N.S. (2009) Haloperidol plus promethazine for psychosis-induced aggression. Cochrane Database of Systematic Reviews. 2009(3): CD005146. http://dx.doi.org/10.1002/14651858.CD005146.pub2 Google Scholar
Innes, J. and Sethi, F. (2013) Current rapid tranquillisation documents in the UK: a review of the drugs recommended, their routes of administration and clinical parameters influencing their use. Journal of Psychiatric Intensive Care. 9(2): 110–118.CrossRefGoogle Scholar
Janssen-Cilag Ltd (2014) Haldol. Summary of Product Characteristics, last updated 28 February 2014. http://www.medicines.org.uk Google Scholar
Kasmi, Y. (2007) Characteristics of patients admitted to psychiatric intensive care units. Irish Journal of Psychological Medicine. 24(2): 75–78.Google Scholar
MacDonald, K., Wilson, M.P., Minassian, A., Vilke, G.M., Perez, , Cobb, P., Tallian, K., Becker, O. and Feifel, D. (2010) A retrospective analysis of intramuscular haloperidol and olanzapine in the treatment of agitation in drug- and alcohol-using patients. General Hospital Psychiatry. 32(4): 443–445.Google Scholar
Mental Capacity Act (2005) c. 9) London: The Stationery Office. http://www.legislation.gov.uk/ukpga/2005/9/contents Google Scholar
Mental Health Act (1983) c. 20) London: The Stationery Office. http://www.legislation.gov.uk/ukpga/1983/20/contents Google Scholar
NICE (2005) Violence: The short term management of disturbed and violent behaviour in inpatient psychiatric settings and emergency departments. NICE: CG25.Google Scholar
Nijman, H.L., Allertz, W.W.F., Merckelbach, H.L.G.L., à Campo, J.L.M.G. and Ravelli, D.P. (1997) Aggressive behaviour on an acute psychiatric admissions ward. European Journal of Psychiatry . 11(2): 106–114.Google Scholar
Nijman, H., Merckelbach, H., Evers, C., Palmstierna, T. and à Campo, J. (2002) Prediction of aggression on a locked psychiatric admission ward. Acta Psychiatrica Scandinavica . 105: 390–395.Google Scholar
Noble, P. and Rodger, S. (1989) Violence by psychiatric inpatients. British Journal of Psychiatry . 155: 384–390.Google Scholar
O'Brien, A., Tariq, S., Ashraph, M. and Howe, A. (2014) A staff self-reported retrospective survey of assaults on a psychiatric intensive care ward and attitudes towards assaults. Journal of Psychiatric Intensive Care. 10: 93–99. doi:10.1017/S1742646413000241 Google Scholar
O'Connor, S. (1998) An analytic approach in a psychiatric intensive care unit. Psychoanalytic Psychotherapy. 12(1): 3–15.Google Scholar
Office for National Statistics (2011) http://www.ons.gov.uk Google Scholar
Parker, C. and Khwaja, M.G. (2011) What is new in rapid tranquillisation? Journal of Psychiatric Intensive Care. 7(2): 91–101. doi:10.1017/S1742646410000245 Google Scholar
Pereira, S.M., Sarsam, M., Bhui, K. and Paton, C. (2005) The London survey of psychiatric intensive care units: psychiatric intensive care; patient characteristics and pathways for admission and discharge. Journal of Psychiatric Intensive Care. 1(1): 17–24.Google Scholar
Polak, P. and Laycob, L. (1971) Rapid tranquilization. American Journal of Psychiatry. 128: 640–643.Google Scholar
Raveendran, N.S., Tharyan, P., Alexander, J. and Adams, C.E., and TREC-India II Collaborative Group (2007) Rapid tranquillisation in psychiatric emergency settings in India: pragmatic randomised controlled trial of intramuscular olanzapine versus intramuscular haloperidol plus promethazine. BMJ. 335: 865–873.Google Scholar
Taylor, D., Paton, C. and Kapur, S. (2012) The Maudsley Prescribing Guidelines in Psychiatry, 11th Edition. Wiley-Blackwell.Google Scholar
Wilson, M.P., Pepper, D., Currier, G.W., Holloman, G.H. Jr and Feifel, D. (2012) The psychopharmacology of agitation: consensus statement of the American Association for Emergency Psychiatry Project BETA Psychopharmacology Workgroup. Western Journal of Emergency Medicine. 13(1): 26–34. doi:10.5811/westjem.2011.9.6866 Google Scholar
World Health Organization (1994) The ICD-10 classification of mental and behavioural disorde rs . Geneva: WHO.Google Scholar
Zacher, L.H. and Roche-Desilets, J. (2005) Hypotension secondary to the combination of intramuscular olanzapine and intramuscular lorazepam. Journal of Clinical Psychiatry. 66: 1614–1615.Google Scholar