Location of Repository

Establishing gold standard approaches to rapid tranquillisation: a review and discussion of the evidence on the safety and efficacy of medications currently used\ud

By J. Peter Pratt, Jacqueline Chandler-Oatts, Louise Nelstrop, David Branford, Stephen M. Pereira and Susan Johnston

Abstract

Background: Rapid tranquillisation is used when control of agitation, aggression or excitement is required. Throughout the UK there is no consensus over the choice of drugs to be used as first line treatment. The NICE guideline on the management of violent behaviour involving psychiatric inpatients conducted a systematic examination of the literature relating to the effectiveness and safety of rapid tranquillisation (NICE, 2005). This paper presents the key findings from that review and key guideline recommendations generated, and discusses the implications for practice of more recent research and information.\ud \ud Aims: To examine the evidence on the efficacy and safety of medications used for rapid tranquillisation in inpatient psychiatric settings.\ud \ud Method: Systematic review of current guidelines and phase III randomised, controlled trials of medication used for rapid tranquillisation. Formal consensus methods were used to generate clinically relevant recommendations to support safe and effective prescribing of rapid tranquillisation in the development of a NICE guideline.\ud \ud Findings: There is a lack of high quality clinical trial evidence in the UK and therefore a ‘gold standard’ medication regime for rapid tranquillisation has not been established.\ud \ud Rapid tranquillisation and clinical practice: The NICE guideline produced 35 recommendations on rapid tranquillisation practice for the UK, with the primary aim of calming the service user to enable the use of psychosocial techniques.\ud \ud Conclusions and implications for clinical practice: Further UK specific research is urgently needed that provides the clinician with a hierarchy of options for the clinical practice of rapid tranquillisation

Topics: R1, BF
Publisher: Cambridge University Press
Year: 2008
OAI identifier: oai:wrap.warwick.ac.uk:869

Suggested articles

Preview

Citations

  1. 2008:4:43 57 57 Establishing gold standard approaches to rapid tranquillisation
  2. (1986). A comparison of parenteral loxapine and haloperidol in hostile and aggressive acutely schizophrenic patients.
  3. (1977). A double blinded comparison between loxapine and haloperidol by parenteral route in acute schizophrenia.
  4. (1998). A double-blinded study of lorazepam versus the combination of haloperidol and lorazepam in managing agitation.
  5. (2002). A doubleblind, placebo-controlled dose-response comparison of intramuscular olanzapine and haloperidol in the treatment of acute agitation in schizophrenia. doi
  6. (2007). and TREC Collaborative Group doi
  7. (2001). Antipsychotics and the risk of sudden cardiac death. doi
  8. (1999). Contemporary practices in managing acutely violent patients in 20 psychiatric emergency rooms. Psychiatric Services. doi
  9. (1989). Development of a scale of assessment of agitation following traumatic brain injury. doi
  10. (2001). Double-blind, placebo-controlled comparison of intramusclar olanzapine and intramuscular haloperidol in the treatment of acute agitation in schizophrenia. doi
  11. (1994). Drug management of disturbed behaviour by psychiatrists. doi
  12. (2001). Effects of the atypical antipsychotic risperidone on hostility and aggression in schizophrenia: A meta-analysis of controlled trials. doi
  13. (1989). Efficacy of combinations of intramuscular antipsychotics and sedative-hypnotics for control of psychotic agitation. doi
  14. (1997). Efficacy of lorazepam and haloperidol for rapid tranquillisation in a psychiatric emergency room setting. doi
  15. (1996). Electrocardiographic changes in patients receiving neuroleptic medication. doi
  16. (1997). Emergency drug treatment of disturbed psychotic patients.
  17. (2004). Haloperidol and promethazine for psychosis induced aggression. Cochrane Database of Systematic Reviews. doi
  18. (1997). Haloperidol, lorazepam, or both for psychotic agitation? A multicenter, prospective double-blind, emergency department study. doi
  19. (2001). How to Develop Cost Conscious Guidelines. doi
  20. (1999). Intramuscular flunitrazepam versus intramuscular haloperidol in the emergency treatment of aggressive psychotic behavior. doi
  21. (2000). Intramuscular ziprasidone compared with intramuscular haloperidol in the treatment of acute psychosis. doi
  22. (1977). Loxapine versus haloperidol parenterally in acute NAPICU 2008:4:43 57 55 Establishing gold standard approaches to rapid tranquillisationpsychosis with agitation.
  23. (1993). M a k k a r ,R . R . ,F r o m m ,B . S . ,S t e i n m a n ,R . doi
  24. (2001). Management of acutely disturbed behaviour. doi
  25. (1998). Management of Imminent Violence: Clinical Practice Guidelines to Support Mental Health Services. OP41. London: Royal College of Psychiatrists.
  26. (1974). Parenteral haloperidol for rapid control of severe, disruptive symptoms of acute schizophrenia.
  27. (1992). Positive and Negative Syndrome Scale (PANSS) Manual. Toronto: Multi-Health Systems. doi
  28. (1998). Prolongation of QT interval in isolated feline hearts by antipsychotic drugs. doi
  29. (1997). Prolonged QT interval and cocaine use. doi
  30. (1993). QT prolongation and sudden death in patients with alcoholic liver disease. doi
  31. (1996). QT-interval prolongation with ecstasy.
  32. (2000). QTc-interval abnormalities and psychotropic drug therapy in psychiatric patients. doi
  33. (2003). Rapid tranquillisation for agitated patients in emergency psychiatric rooms: A randomised trial of midazolam versus haloperidol plus promethazine. doi
  34. (2007). Rapid tranquillisation in psychiatric emergency settings in India: Pragmatic randomised controlled trial of intramuscular olanzapine versus intramuscular haloperidol plus promethazine. doi
  35. (2004). Rapid tranquillisation of violent or agitated patients in a psychiatric emergency setting. Pragmatic randomised trial of intramuscular lorazepam versus haloperidol plus promethazine. doi
  36. (2002). Rapid tranquillisation: Time for a reappraisal of options for parenteral therapy. doi
  37. (2001). Rapid tranquillisation. doi
  38. (2002). Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care.
  39. (1992). Sex differences in the evolution of the electrocardiographic QT interval with age. doi
  40. (2002). Systematic review methods for national guidelines. Unpublished discussion paper.
  41. (1962). The Brief Psychiatric Rating Scale. doi
  42. (2001). The Effectiveness and Safety of Drug Treatment for Urgent Sedation in Psychiatric Emergencies: A Critical Appraisal of the Literature. New Zealand Health Technology Assessment Report
  43. (1997). The overt agitation severity scale for the objective rating of agitation. doi
  44. (2002). The Recognition, Prevention and Therapeutic Management of Violence in Acute In-Patient Psychiatry: A Literature Review and Evidence-Based Recommendations for Good Practice. London: United Kingdom Central Council for Nursing, Midwifery and Health Visiting.
  45. (1990). The use of midazolam in acutely agitated psychiatric patients.
  46. (2005). Violence: The Short Term Management of Disturbed/Violent Behaviour in In-Patient Psychiatric Settings and Emergency Departments. London: RCN. www.rcn.org.uk/development/practice/clinicalguidelines/ violence Royal College of Psychiatrists
  47. (2000). Zuclopenthixol acetate for acute schizophrenia and similar serious mental illnesses. Cochrane Database of Systematic Reviews doi

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.