Emergency Management of Acute Psychosis

Freudenreich, Oliver

doi:10.1007/978-3-030-29450-2_10

Cited by 1 publication

(7 citation statements)

References 19 publications

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“…The most recent guidelines from Australia, [16][17][18] the UK 19,20 and the US [21][22][23][24][25][26] (Table 1) and eleven original studies [27][28][29][30][31][32][33][34][35][36][37] and a transcript of evidence 15 (Table 2) were included in this review.…”

Section: Resultsmentioning

confidence: 99%

“…[19][20][21][22][23][24][25][26] Risperidone was only recommended in the US guidelines. [21][22][23][24][25][26] Droperidol was recommended in most guidelines for managing acutely agitated individuals, [16][17][18]20,26 except for the American Association for Emergency Psychiatry. [22][23][24][25] The NICE guidelines included antihistamines and suggested combining promethazine and haloperidol for rapid tranquilisation.…”

Section: Current Guidelinesmentioning

confidence: 99%

“…Lastly, Freudenreich (2020) recommended the oral route over IM, and IV as third line. 26 Table 1. Guidelines for the management of acute behavioural disturbances and acute psychosis IM: Intramuscular; IV: intravenous.…”

Section: Current Guidelinesmentioning

confidence: 99%

“…All guidelines included benzodiazepines (BZDs) such as diazepam and lorazepam and antipsychotics such as droperidol and olanzapine, with midazolam and ketamine in the Australian 17,18 and UK 20 guidelines only, and haloperidol in all except the Australian guidelines. [19][20][21][22][23][24][25][26] Risperidone was only recommended in the US guidelines. [21][22][23][24][25][26] Droperidol was recommended in most guidelines for managing acutely agitated individuals, [16][17][18]20,26 except for the American Association for Emergency Psychiatry.…”

Section: Current Guidelinesmentioning

confidence: 99%

“…19 The US guidelines recommended multiple medications not reported in other guidelines. [21][22][23][24][25][26] Although specific medications differed between guidelines, they were generally antipsychotics, benzodiazepines or antihistamines, with varying routes of administration. The Australian Therapeutics Guidelines suggested that in EDs, intravenous (IV) route was preferable to intramuscular (IM) and the latter used if patients failed to cooperate.…”

Section: Current Guidelinesmentioning

confidence: 99%

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Guidelines and treatment for illicit drug related presentations in emergency departments: A scoping review

Au,

Hotham,

Suppiah

2023

Australas Psychiatry

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Objective This review aimed to identify current pharmacological and non-pharmacological treatment employed in emergency departments (EDs) for the management of patients presenting with illicit drug-related presentations (IDP) and compare current treatments with recommendations provided in guidelines. Method The review consists of English peer-reviewed journal articles and grey literature published in electronic databases: Ovid MEDLINE, PubMed, Embase Classic+Embase, Ovid Emcare and APA PsycInfo between 2015 and 2022. Results Twelve studies were identified from the search, with agitation and aggression being the most common presentations, and cannabis being the most prevalent illicit drug. Ventilatory support and restraints were the most reported non-pharmacological interventions while benzodiazepines and antipsychotics were the most commonly prescribed pharmacological agents. Non-coercive de-escalation strategies were recommended in all guidelines, with verbal de-escalation being the initial approach before other interventions, such as medications and restraints. However, de-escalation strategies were not reported in any studies. Conclusions Pharmacological interventions for patients with IDP and related symptoms were in accordance with guidelines. Use of restraints was identified in included studies with notable lack of reporting of de-escalation strategies which may have been deemed insignificant and not reported. Future research could investigate the appropriateness of restrictive interventions as well as the employment of non-restrictive de-escalation strategies.

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