Managing the aggressive and violent patient in the psychiatric emergency

Rocca, Paola; Villari, Vincenzo; Bogetto, Filippo

doi:10.1016/j.pnpbp.2006.01.015

Cited by 41 publications

(21 citation statements)

References 61 publications

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“…Due to this, there was a clear indication for temporary two hours physical immobilization with intermittent periods of thirty minutes deliberation. Patients were under the intensive control of medical staff including follow-up of vital parameters, displaying of possible injuries, right belts setting [4][5][6] . According to data from the literature prolonged physical immobilization of three or more days with simultaneous appliciation of antipsychotics is a major risk factor for DVT appearance being in correlation with the data given in our study [7][8][9] .…”

Section: Discussionmentioning

confidence: 99%

Fatal pulmonary thromboembolism after prolonged physical immobilization in hospitalized psychiatric patients

2013

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Section: Discussionmentioning

confidence: 99%

Fatal pulmonary thromboembolism after prolonged physical immobilization in hospitalized psychiatric patients

2013

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“…Inhaled loxapine should only be used in the case of agitated, but somewhat or partial collaborative patients, and in such cases, this drug may be as useful as IM SGAs, to obtain a more rapid tranquillisation than the oral administration [59]. Moreover, it frequently occurs that, in everyday clinical practice, the agitated patients may initially and apparently accept the oral medications (often to avoid involuntary admissions), but they may spit out the oral medications, or need a relatively long time to achieve tranquilisation after oral administration [1,2,3]. The use of inhaled loxapine may overcome these shortcomings, as the administration and the rapid onset of the anti-agitation effect are warranted [52,53,54,55].…”

Section: A Clinical Perspective On the Role Of Inhaled Loxapine Inmentioning

confidence: 99%

“…Even if agitation or violence are not common symptoms of all psychiatric disorders, and the majority of persons with such disorders are not violent [2], it is undoubtable that these manifestations may more often occur in some psychiatric disorders (e.g., schizophrenia or bipolar disorders) [3,4], when there are comorbid conditions (e.g., substance and alcohol abuse or dependence, some personality disorders) [5], or lack of medication compliance [6]. …”

Section: Introductionmentioning

confidence: 99%

The Role of Inhaled Loxapine in the Treatment of Acute Agitation in Patients with Psychiatric Disorders: A Clinical Review

Berardis

Fornaro

Orsolini

et al. 2017

IJMS

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Loxapine is a first generation antipsychotic, belonging to the dibenzoxazepine class. Recently, loxapine has been reformulated at a lower dose, producing an inhaled powder that can be directly administered to the lungs to treat the agitation associated with psychiatric disorders, such as schizophrenia and bipolar disorder. Thus, the aim of this narrative and clinical mini-review was to evaluate the efficacy and tolerability of inhaled loxapine in the treatment of acute agitation in patients with psychiatric disorders. The efficacy of inhaled loxapine has been evaluated in one Phase II trial on patients with schizophrenia, and in two Phase III trials in patients with schizophrenia and bipolar disorder. Moreover, there are two published case series on patients with borderline personality disorder and dual diagnosis patients. Inhaled loxapine has proven to be effective and generally well tolerated when administered to agitated patients with schizophrenia and bipolar disorder. Two case series have suggested that inhaled loxapine may also be useful to treat agitation in patients with borderline personality disorder and with dual diagnosis, but further studies are needed to clarify this point. However, the administration of inhaled loxapine requires at least some kind of patient collaboration, and is not recommended in the treatment of severe agitation in totally uncooperative patients. Moreover, the drug-related risk of bronchospasm must always be kept in mind when planning to use inhaled loxapine, leading to a careful patient assessment prior to, and after, administration. Also, the higher costs of inhaled loxapine, when compared to oral and intramuscular medications, should be taken into account when selecting it for the treatment of agitation.

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“…According to the National Institute of Clinical Excellence's Clinical Guideline (National Collaborating Centre for Mental Health 2015), a number of definite strategies for treating violent behaviour were routinely performed by experienced nurses and psychiatrists to avoid physical restraint: for example empathic listening and communication, verbal and non-verbal de-escalation techniques such as quite approach in a non-confrontational manner and multiple steps of talk-down interventions. Moreover, when prior procedures were not effective and patients became seriously violent, the use of so-called "show of force" was conducted (Rocca et al 2006 ). Only when these non-coercive approaches were ineffective and in case of current severe violent behaviour, physical restraint was prescribed by the ward's staff psychiatrist and applied by five staff members.…”

Section: Assessmentmentioning

confidence: 99%

Involuntary admissions in Italy: the impact of seasonality

Aguglia

Moncalvo

Solia

et al. 2016

International Journal of Psychiatry in Clinical Practice

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Objective: The aim of this study is to assess the prevalence of involuntary admissions with regard to seasonality and clinical associated features, in a sample of patients admitted to a psychiatric unit in a period of 24 months. Methods: All subjects consecutively admitted to the Psychiatric Inpatient Unit of the San Luigi Gonzaga Hospital, Orbassano (University of Turin, Italy) from September 2013 to August 2015 were recruited. Socio-demographic and clinical characteristics were collected. Results: Seven hundred and thirty admissions in psychiatric ward were recognized. The prevalence of involuntary admission was 15.4%. Patients with involuntary hospitalizations showed a higher education level, a higher prevalence of admission in spring/summer with a significant peak in June, a longer duration of hospitalization and a lower suicide ideation. Among involuntary admissions, physical restraint and suicide attempts were more prevalent during spring compared to the other seasons. Conclusions: Seasonality has an important role in the psychopathology of psychiatric disorders, particularly in bipolar and related disorder, and may represent an influencing factor in hospital admissions and hospitalizations. Seasonal pattern must be considered while managing diagnosis and treatment of mental disorders, with regard to prevention and psychoeducation of patients.

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Managing the aggressive and violent patient in the psychiatric emergency

Cited by 41 publications

References 61 publications

Fatal pulmonary thromboembolism after prolonged physical immobilization in hospitalized psychiatric patients

Fatal pulmonary thromboembolism after prolonged physical immobilization in hospitalized psychiatric patients

The Role of Inhaled Loxapine in the Treatment of Acute Agitation in Patients with Psychiatric Disorders: A Clinical Review

Involuntary admissions in Italy: the impact of seasonality

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