Pharmacological Management Of Aggression Research Articles

EPA-1279 - Pharmacological management of aggression and violent behaviour : audit of rapid tranquilisation of acutely disturbed service-users in the psychiatric intensive care unit

Prevalence of violent behaviour within acute psychiatric services is about 10%. To assess compliance of management of acutely disturbed patients with the National Institute for Health and Clinical Excellence (NICE) guidance for use of Rapid Tranquilisation (RT). A sample of 24 patients admitted to local Psychiatric Intensive Care Unit (PICU) receiving RT during 2011 was assessed using retrospective analysis of records. 100% compliance was achieved in many of the criteria assessed, including recording the risk assessment and management plan appropriately. None of the patients had up-to-date advance directive detailing their preferred strategies in case of violent incidents. 50% of patients had their baseline blood pressure, pulse, temperature and respiratory rate recorded and 33% at regular intervals. 25% were debriefed and none offered an opportunity to write their account of RT. 38% had their medication reviewed following RT. 46% were suffering from psychotic disorders; manic episode accounted for 25% of all patients. 54% of all (65% of men) received Zuclopenthixol acetate for RT and 46% the combination of Haloperidol plus Lorazepam; however, the combination of Haloperidol plus Lorazepam was used in 71.4% of women and 35% of men. 12.5% required a short period of seclusion. All patients were detained under the Mental Health Act. Training of the PICU staff in the NICE Guidance: The short-term management of disturbed/violent behaviour in psychiatric inpatient settings and emergency departments.

Emergency management of agitation in pregnancy

Objective This study aimed to better understand how agitated pregnant women are pharmacologically managed in a psychiatric emergency service (PES). Method A retrospective chart review was conducted on 80 women admitted to a PES with HCG-positive urine, from January 1, 2004, to June 30, 2005. Of these, 31 patients required medication for agitation. We describe the demographics (age, ethnicity, housing status, insurance status), chief complaint, medical status, drug use and medical management in the PES, as well as pregnancy awareness, prenatal care and trimester. Patient data were analyzed using simple frequency calculations and cross tabulations with SPSS. Results Thirty-one (39%) patients received 34 doses of psychotropic medication. Haloperidol, alone or in combination with a benzodiazepine, was the most frequently administered psychotropic medication, while risperidone was the second most commonly administered medication. Two patients required brief restraint for assaultive behavior that was unresponsive to any other intervention. Conclusion There are algorithms that provide guidance to clinicians regarding the pharmacological management of aggression. However, there are no efficacy or safety studies that recommend strategies for the management of the agitated pregnant patient.

Nurses under threat: A comparison of content of 28 aggression management programs

Staff who work in the health service are now recognized as a high-risk group for assault in the workplace. Recently, professional and industrial organizations have begun to suggest appropriate curricula for training staff in aggression management. However, there is currently a plethora of aggression management training programs (AMP) available, varying both in content and in duration. In this paper, 28 programs were evaluated against 13 major content areas derived from the recommendations made from key professional and industrial organizations, and what may be today considered appropriate/ideal content areas for AMP. Information on programs available in English was sought via standard databases, the Internet, program providers, and through networking with colleagues and professional organizations. The majority of the programs reviewed covered personal safety issues for staff and patients, together with legal issues. The use of restraint, pharmacological management of aggression and seclusion were features of programs specifically addressing the needs of health care staff in mental health settings. Most programs appeared not to address the psychological and organizational costs associated with aggression in the workplace. This is surprising since the literature suggests that the effects of violence are wide and varied, including increased absenteeism and sick leave, property damage, decreased productivity, security costs, litigation, workers' compensation, reduced job satisfaction together with recruitment and retention issues. Also, few programs were based on a systematic evaluation of their outcomes. Suggestions for program development and their teaching are discussed.

P1-317 Pharmacological management of aggression in dementia: a meta-analysis

P1-317 Pharmacological management of aggression in dementia: a meta-analysis

Pharmacological management of aggression and violence.

The pharmacological management of violence and aggression is a common and substantial clinical dilemma in the emergency psychiatric situation. A literature search was conducted through PubMed and using the Cochrane Library. This was followed by a manual search of selected literature. Randomised controlled trials were sought that specifically addressed the acute situation, rather than the ongoing management of chronic conditions. There was a paucity of well-controlled data and insufficient evidence to support the use of many agents in emergency situations. Many studies had considerable limitations making comparison difficult. Efficacy data for a range of treatment options exists, including the use of classical and atypical anti-psychotic agents, benzodiazepines and combination therapies. Clinical risk, tolerability and environmental factors need to form part of a careful and considered judgement in the choice of treatment. Safety, tolerability and the potential for a positive experience are major considerations, thus paving the way for long term compliance.