Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation

Maxine X. Patel; Faisil N. Sethi; Thomas R.E. Barnes; Roland Dix; Luiz Dratcu; Bernard Fox; Marina Garriga; Julie C. Haste; Kai G. Kahl; Anne Lingford-Hughes; Hamish McAllister-Williams; Aileen O’Brien; Caroline Parker; Brodie Paterson; Carol Paton; Sotiris Posporelis; David M. Taylor; Eduard Vieta; Birgit Völlm; Charlotte Wilson-Jones; Laura Woods

doi:10.1177/0269881118776738

Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation

Maxine X. Patel^*, Faisil N. Sethi, Thomas R.E. Barnes, Roland Dix, Luiz Dratcu, Bernard Fox, Marina Garriga, Julie C. Haste, Kai G. Kahl, Anne Lingford-Hughes, Hamish McAllister-Williams, Aileen O’Brien, Caroline Parker, Brodie Paterson, Carol Paton, Sotiris Posporelis, David M. Taylor, Eduard Vieta, Birgit Völlm, Charlotte Wilson-JonesLaura Woods

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

41 Citations (Scopus)

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.

Original language	English
Pages (from-to)	601-640
Number of pages	40
Journal	Journal of Psychopharmacology
Volume	32
Issue number	6
Early online date	8 Jun 2018
DOIs	https://doi.org/10.1177/0269881118776738
Publication status	Published - 8 Jun 2018

Keywords

Acute disturbance
aggression
antipsychotics
benzodiazepines
de-escalation
psychiatric illness
rapid tranquillisation
violence

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10.1177/0269881118776738

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Patel, M. X., Sethi, F. N., Barnes, T. R. E., Dix, R., Dratcu, L., Fox, B., Garriga, M., Haste, J. C., Kahl, K. G., Lingford-Hughes, A., McAllister-Williams, H., O’Brien, A., Parker, C., Paterson, B., Paton, C., Posporelis, S., Taylor, D. M., Vieta, E., Völlm, B., ... Woods, L. (2018). Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation. Journal of Psychopharmacology, 32(6), 601-640. https://doi.org/10.1177/0269881118776738

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title = "Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation",

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.",

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Patel, MX, Sethi, FN, Barnes, TRE, Dix, R, Dratcu, L, Fox, B, Garriga, M, Haste, JC, Kahl, KG, Lingford-Hughes, A, McAllister-Williams, H, O’Brien, A, Parker, C, Paterson, B, Paton, C, Posporelis, S, Taylor, DM, Vieta, E, Völlm, B, Wilson-Jones, C & Woods, L 2018, 'Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation', Journal of Psychopharmacology, vol. 32, no. 6, pp. 601-640. https://doi.org/10.1177/0269881118776738

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AU - Barnes, Thomas R.E.

AU - Dix, Roland

AU - Dratcu, Luiz

AU - Fox, Bernard

AU - Garriga, Marina

AU - Haste, Julie C.

AU - Kahl, Kai G.

AU - Lingford-Hughes, Anne

AU - McAllister-Williams, Hamish

AU - O’Brien, Aileen

AU - Parker, Caroline

AU - Paterson, Brodie

AU - Paton, Carol

AU - Posporelis, Sotiris

AU - Taylor, David M.

AU - Vieta, Eduard

AU - Völlm, Birgit

AU - Wilson-Jones, Charlotte

AU - Woods, Laura

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Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation

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