Protocol for the management of psychiatric patients with psychomotor agitation

BMC Psychiatry

Research Article

Laura Cardete¹  Victòria Soler¹  Noélia Ortuño¹  María Lombraña¹  Mireia Vázquez¹  Marina Garriga²  Rosa Catalán³  Eduard Vieta³  Anabel Martínez-Arán³  Miquel Bernardo³  Jordi Blanch⁴ 

[1] Hospital Clínic de Barcelona, Institute of Neuroscience, Barcelona, Catalonia, Spain;Hospital Clínic de Barcelona, Institute of Neuroscience, Barcelona, Catalonia, Spain;Center of Biomedical Network Research on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain;Hospital Clínic de Barcelona, Institute of Neuroscience, Barcelona, Catalonia, Spain;University of Barcelona, Barcelona, Catalonia, Spain;Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain;Center of Biomedical Network Research on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain;Hospital Clínic de Barcelona, Institute of Neuroscience, Barcelona, Catalonia, Spain;University of Barcelona, Barcelona, Catalonia, Spain;Center of Biomedical Network Research on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain;Numancia Salut Mental, Parc Sanitari Sant Joan de Déu, Barcelona, Catalonia, Spain;

关键词: Inhaled loxapine;    Psychomotor agitation;    Protocol;    Verbal de-escalation;    Physical restraint;   

DOI  :  10.1186/s12888-017-1490-0

 received in 2017-02-28, accepted in 2017-08-31,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundPsychomotor agitation (PMA) is a state of motor restlessness and mental tension that requires prompt recognition, appropriate assessment and management to minimize anxiety for the patient and reduce the risk for escalation to aggression and violence. Standardized and applicable protocols and algorithms can assist healthcare providers to identify patients at risk of PMA, achieve timely diagnosis and implement minimally invasive management strategies to ensure patient and staff safety and resolution of the episode.MethodsSpanish experts in PMA from different disciplines (psychiatrists, psychologists and nurses) convened in Barcelona for a meeting in April 2016. Based on recently issued international consensus guidelines on the standard of care for psychiatric patients with PMA, the meeting provided the opportunity to address the complexities in the assessment and management of PMA from different perspectives. The attendees worked towards producing a consensus for a unified approach to PMA according to the local standards of care and current local legislations. The draft protocol developed was reviewed and ratified by all members of the panel prior to its presentation to the Catalan Society of Psychiatry and Mental Health, the Spanish Society of Biological Psychiatry (SEPB) and the Spanish Network Centre for Research in Mental Health (CIBERSAM) for input. The final protocol and algorithms were then submitted to these organizations for endorsement.ResultsThe protocol presented here provides guidance on the appropriate selection and use of pharmacological agents (inhaled/oral/IM), seclusion, and physical restraint for psychiatric patients suspected of or presenting with PMA. The protocol is applicable within the Spanish healthcare system. Implementation of the protocol and the constituent algorithms described here should ensure the best standard of care of patients at risk of PMA. Episodes of PMA could be identified earlier in their clinical course and patients could be managed in the least invasive and coercive manner, ensuring their own safety and that of others around them.ConclusionEstablishing specialized teams in agitation and providing them with continued training on the identification of agitation, patient management and therapeutic alternatives might reduce the burden of PMA for both the patient and the healthcare system.

【 授权许可】

CC BY   
© The Author(s). 2017