Treatment of Behavioral Emergencies: A Summary of the Expert Consensus Guidelines

  title={Treatment of Behavioral Emergencies: A Summary of the Expert Consensus Guidelines},
  author={Michael H. Allen and Glenn Currier and Douglas H. Hughes and John P Docherty and Daniel Carpenter and Ruth Ross},
  journal={Journal of Psychiatric Practice},
Objectives. Behavioral emergencies are a common and serious problem for consumers, their communities, and the healthcare settings on which they rely, but there is little research to guide provider responses to this challenge. Key constructs such as agitation have not been adequately operationalized so that the criteria defining a behavioral emergency are vague. A significant number of deaths of patients in restraint has focused government and regulators on these issues, but a consensus about… 

[Consensus document: a model of integrated management of patients with psycomotor agitation].

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The present document reports the results of this consensus process, whose main principles are the centrality of the patient, as an active and collaborating subject, the importance of prompt and not coercive interventions able to block the escalation to violence and to allow a correct diagnostic and therapeutic workup.

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Results of a performance improvement survey reveal that staff nurses have had positive experiences with BERT but that many nurses are still not comfortable caring for psychiatric patients on their units.

Managing Psychiatric Emergencies

Clinician should be aware of the differences among the major psychiatric disorders, also to look for medical reasons in patients with psychiatric presentations, to reach an accurate diagnosis.

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Recommendations on the assessment of agitation emphasise the importance of identifying any possible medical cause and the “ideal” medication should calm without over-sedate.

Covert medication in psychiatric emergencies: is it ever ethically permissible?

Whether there may be exceptions to the practice of covert medication in emergency psychiatry that would be ethical is explored, and how consumers view this practice and their treatment preferences during a psychiatric emergency are investigated.

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The 17-item Agitation Severity Scale demonstrated acceptable levels of reliability and validity when used with acute psychiatric patients in the emergency setting and holds promise as a method of enhancing clinical communication about agitation, evaluating the efficacy of interventions aimed at decreasing agitation, and as a research tool.

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A rapid and effective guide for paramedics who take care of patients in a pre-hospital setting to answer developing demands and can be a solution to improve emergency technician training.

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Psychiatric emergencies are a common and serious problem, 1 and the primary goals of intervention are rapid evaluation, containment, and referral. Clinicians are usually called on to assess and

Prevalence and predictors of restrictive interventions in a youth‐specific mental health inpatient unit

This study aimed to determine the prevalence and determinants of restrictive interventions (restraint, seclusion and medication without consent) in a youth specialist mental health IPU.



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Patients who were clients in a public psychiatric emergency service were anonymously surveyed and asked to state their preferences for specific interventions in a psychiatric emergency, finding that patients preference is an important factor in determining the appropriate intervention in an emergency.

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The first objective of the CTG project was the development of a formal decision model for use in psychiatric assessments in emergency rooms, and an effective and workable model required not only careful study of relevant research, but also required a consensus among experts.

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Debate now arises about the use of physical and chemical restraint or seclusion in the psychiatric emergency service, where emergency mental health professionals are asked to weigh a number of clinical, legal, and economic issues.

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Droperidol, while not in widespread use, may prove to be the superior typical neuroleptic for psychiatric emergencies and increased clinical utilization and study of droperodol for this use is warranted.

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A consensus survey of expert opinion on the treatment of 4 depressive conditions specific to women found a high level of consensus on the appropriateness of including both antidepressant medication, specifically SSRIs, and nonpharmacological modalities in treatment plans for severe depression in 4 key clinical situations unique to women.

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The purpose of the study reported here was to survey current practices in a nationally representative sample of psychiatric emergency rooms to assess whether clinicians believed it was possible to determine the cause of the violent behavior before a patient is medicated and whether current treatments are effective in reducing violence.

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This study conducted over a eight-month period on the locked crisis intervention unit of the Langley Porter Psychiatric Institute in San Francisco provides short-term therapy and serves as a community mental health facility for the local area.

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The literature on restraint and seclusion supports the following: 1) Seclusion and restraint are basically efficacious in preventing injury and reducing agitation, and 2) Training in prediction and prevention of violence, in self-defense, and in implementation of restraint and/or seclusion is valuable in reducing rates and untoward effects.

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A consensus survey of expert opinion on the pharmacotherapy of depressive disorders in older patients to address clinical questions not definitively answered in the research literature reached a high level of consensus on the appropriateness of including both antidepressant medication, specifically SSRIs, and nonpharmacological modalities in treatment plans for severe depression.