German S3 guidelines on avoidance of coercion: prevention and therapy of aggressive behavior in adults

Abstract

This article reports on the developmental process, significance and scope of clinical practice guidelines and presents changes to the former S2 guidelines on therapeutic interventions for aggressive behavior (2010). Aggressive behavior is understood both in the context of risk characteristics on the patient side and as aresult of escalating conflicts between patients and staff. If coercive measures are unavoidable, they must be carried out in the most bearable and humane way possible for all participants. For the first time these guidelines provide clear evidence-based and consensus-based recommendations for these issues. In addition to prevention, de-escalation, rapid tranquilization and pharmacotherapy of acute states of agitation and of recurrent aggressive behavior, technical, legal and ethical aspects of coercive measures and therapeutic support during coercive measures are covered. Further recommendations concern measures of tertiary prophylaxis, such as debriefing, joint crisis plans and external monitoring by visiting commissions and political committees. Implementation recommendations have been formulated from the guidelines. They are currently being tested in apilot study funded by the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN).