Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation
- 8 June 2018
- journal article
- research article
- Published by SAGE Publications in Journal of Psychopharmacology
- Vol. 32 (6), 601-640
- https://doi.org/10.1177/0269881118776738
Abstract
The British Association for Psychopharmacology and the National Association of Psychiatric Intensive Care and Low Secure Units developed this joint evidence-based consensus guideline for the clinical management of acute disturbance. It includes recommendations for clinical practice and an algorithm to guide treatment by healthcare professionals with various options outlined according to their route of administration and category of evidence. Fundamental overarching principles are included and highlight the importance of treating the underlying disorder. There is a focus on three key interventions: de-escalation, pharmacological interventions pre-rapid tranquillisation and rapid tranquillisation (intramuscular and intravenous). Most of the evidence reviewed relates to emergency psychiatric care or acute psychiatric adult inpatient care, although we also sought evidence relevant to other common clinical settings including the general acute hospital and forensic psychiatry. We conclude that the variety of options available for the management of acute disturbance goes beyond the standard choices of lorazepam, haloperidol and promethazine and includes oral-inhaled loxapine, buccal midazolam, as well as a number of oral antipsychotics in addition to parenteral options of intramuscular aripiprazole, intramuscular droperidol and intramuscular olanzapine. Intravenous options, for settings where resuscitation equipment and trained staff are available to manage medical emergencies, are also included.Keywords
This publication has 162 references indexed in Scilit:
- Benzodiazepines: Risks and benefits. A reconsiderationJournal of Psychopharmacology, 2013
- A prospective study of high dose sedation for rapid tranquilisation of acute behavioural disturbance in an acute mental health unitBMC Psychiatry, 2013
- BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAPJournal of Psychopharmacology, 2012
- Overview of Project BETA: Best Practices in Evaluation and Treatment of AgitationWestern Journal of Emergency Medicine, 2012
- Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation WorkgroupWestern Journal of Emergency Medicine, 2012
- Patients’ Preference and Experiences of Forced Medication and SeclusionPsychiatric Quarterly, 2011
- The impact of a standardised intramuscular sedation protocol for acute behavioural disturbance in the emergency departmentBMC Emergency Medicine, 2010
- Use of antipsychotics and benzodiazepines in patients with psychiatric emergencies: Results of an observational trialBMC Psychiatry, 2008
- Rapid tranquillisation in psychiatric emergency settings in India: pragmatic randomised controlled trial of intramuscular olanzapine versus intramuscular haloperidol plus promethazineBMJ, 2007
- Rapid tranquillisation in psychiatric emergency settings in Brazil: pragmatic randomised controlled trial of intramuscular haloperidol versus intramuscular haloperidol plus promethazineBMJ, 2007