Rapid Tranquilization: A Reevaluation

Abstract

Years of experience have indicated that the widespread and frequent use of rapid tranquilization is not based on demonstrated efficacy. Multiple high-dose administration of neuroleptics parenterally does not produce rapid relief of psychosis and, at the same time, exposes the patient to risk of severe side effects. Rapid tranquilization may only have a limited and specific applicability; therefore, it is important to reexamine its clinical indications and to search for safer alternatives.

Neuroleptización rápida: una revisión

“…Muchos autores coinciden actualmente en que la neuroleptización rápida es un método que ya no debe utilizarse como tratamiento de primera línea, pues tiene una mayor probabilidad de producir síntomas colaterales tales como distonía aguda, síndrome parkinsoniano, acatisia, síndrome neuroléptico maligno e hipotensión ortostática, entre otros, y no ha demostrado fehacientemente su superioridad frente a las dosis convencionales de antipsicóticos 1,21,31,37,38,[40][41][42][56][57][58][59][60][61][62][63][64] .…”

Producing different analytical narratives, coproducing integrated analytical narrative: a qualitative study of UK detained mental health patient experience involving service user researchers

“…Relatively little research has attempted to assess how the patients themselves experience being physically restrained (Sequeira & Halstead, 2002). Critics of rapid tranquilisation internationally have highlighted the physical and psychological dangers posed to the patient as a result of rapid tranquilisation (Dubin & Feld, 1989;Solano, Sadow, & Ananth, 1989). However, there is a notable paucity of studies in the literature exploring experience of these restrictive practices from the perspective of the patient (De Fruyt & Demyttenaere, 2004).…”

Sublingual Dexmedetomidine as a Potential New Treatment for Agitation

“…In a study of acute agitation in an emergency department, 66% (27 of 41) of patients who received ketamine were sedated within 15 minutes, compared with 7% (3 of 45) of patients who received haloperidol and lorazepam . In contrast, in psychiatry, consensus recommendations for managing agitation emphasize that “the ‘ideal’ medication should calm without over-sedate.” A sleeping patient is difficult to engage, but psychiatry’s aversion to excessive sedation may also reflect a salutary reaction to its earlier enthusiasm for rapid tranquilization with megadose, parenteral antipsychotics; an approach that is now thoroughly discredited …”

“…5 A sleeping patient is difficult to engage, but psychiatry's aversion to excessive sedation may also reflect a salutary reaction to its earlier enthusiasm for rapid tranquilization with megadose, parenteral antipsychotics; an approach that is now thoroughly discredited. 6 Critical care is another setting where agitation is common and must be quickly controlled. Untreated agitated delirium could be catastrophic for a critically ill patient in the intensive care unit (ICU) connected to multiple monitors, intravenous (IV) and intra-arterial lines, and receiving mechanical ventilation.…”