Abstract
Coercive measures are a highly controversial issue in mental health. Although scientific evidence on their impact is limited, they are frequently used. Furthermore, they lead to a high number of ethical, legal, and clinical repercussions on both patients, and professionals and institutions. This review aims to assess the impact of the main alternative measures to prevent or limit the use of coercive measures with restraints in the management of agitated psychiatric patients. The research was conducted following the guidelines recommended by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) in Medline, Cochrane Library, CINAHL, Web of Science, PsycInfo, LILACS, and Health Database of records between 2015 and 2020. After a critical reading, 21 valid articles were included. Both simple interventions and complex restraint programs were evaluated. Training in de-escalation techniques, risk assessment, and implementation of the “six core strategies” or “Safewards” program were the most assessed and effective interventions to reduce aggressive behaviors and the use of coercive measures. According to the revised literature, it is possible to reduce the use of restraints and coercive measures and not increase the number of incidents and violent behaviors among the patients through a non-invasive and non-pharmacological approach. However, further research and further randomized clinical trials are needed to compare the different alternatives and provide higher quality evidence.
Highlights
IntroductionPsychomotor agitation can be defined as a feeling of agitation associated with an increase in motor activity caused by organic (stroke, seizures, sepsis, etc.) or psychiatric (derived from confusional states, psychotic or manic manifestations, effect or abstinence of substances, etc.) causes, which can quickly scale towards aggressive behaviors (ABs), considered to be any type of verbal aggression or threats, damage to property, to themselves, or to other patients or staff members [1]
Psychomotor agitation can be defined as a feeling of agitation associated with an increase in motor activity caused by organic or psychiatric causes, which can quickly scale towards aggressive behaviors (ABs), considered to be any type of verbal aggression or threats, damage to property, to themselves, or to other patients or staff members [1]
As happened in the last selection phase, 21 studies met the quality criteria established in the critical reading phase as follows: nine systematic reviews, three randomized clinical trials, three observational studies, and six quasi-experimental trials of interrupted time series
Summary
Psychomotor agitation can be defined as a feeling of agitation associated with an increase in motor activity caused by organic (stroke, seizures, sepsis, etc.) or psychiatric (derived from confusional states, psychotic or manic manifestations, effect or abstinence of substances, etc.) causes, which can quickly scale towards aggressive behaviors (ABs), considered to be any type of verbal aggression or threats, damage to property, to themselves, or to other patients or staff members [1]. Psychomotor agitation and aggressive behaviors are situations that can occur in any healthcare network service [2] It is in mental health hospitalization units (MHHU) and psychiatric emergencies where psychomotor agitation or treating with aggressive or altered users is common [2,3]. And generally in almost every developed country, the management of psychomotor agitation and AB is done through restrictive approaches, with the aim of controlling and reducing violent behaviors against the patient, others, or the environment [4,5]. This approach generally includes involuntary admittance and treatment, seclusion, and restraint [5]. Restraint explicitly refers to methods that limit freedom of movement, including physical restraints or mechanical restraint (MR), which is the method most widely used and, at the same time, the most controversial [4]
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