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Brazilian guidelines for the management of psychomotor agitation. Part 1. Non-pharmacological approach
Baldaçara, Leonardo; Ismael, Flávia; Leite, Verônica; Pereira, Lucas A; dos Santos, Roberto M; Gomes Júnior, Vicente de P; Calfat, Elie L. B; Diaz, Alexandre P; Périco, Cintia A. M; Porto, Deisy M; Zacharias, Carlos E; Cordeiro, Quirino; da Silva, Antônio Geraldo; Tung, Teng C.
  • Baldaçara, Leonardo; Associação Brasileira de Psiquiatria (ABP). Comissão de Emergências Psiquiátricas. Rio de Janeiro. BR
  • Ismael, Flávia; Associação Brasileira de Psiquiatria (ABP). Comissão de Emergências Psiquiátricas. Rio de Janeiro. BR
  • Leite, Verônica; Associação Brasileira de Psiquiatria (ABP). Comissão de Emergências Psiquiátricas. Rio de Janeiro. BR
  • Pereira, Lucas A; Associação Brasileira de Psiquiatria (ABP). Comissão de Emergências Psiquiátricas. Rio de Janeiro. BR
  • dos Santos, Roberto M; Associação Brasileira de Psiquiatria (ABP). Comissão de Emergências Psiquiátricas. Rio de Janeiro. BR
  • Gomes Júnior, Vicente de P; Associação Brasileira de Psiquiatria (ABP). Comissão de Emergências Psiquiátricas. Rio de Janeiro. BR
  • Calfat, Elie L. B; Associação Brasileira de Psiquiatria (ABP). Comissão de Emergências Psiquiátricas. Rio de Janeiro. BR
  • Diaz, Alexandre P; Universidade do Sul de Santa Catarina (UNISUL). Tubarão. BR
  • Périco, Cintia A. M; Associação Brasileira de Psiquiatria (ABP). Comissão de Emergências Psiquiátricas. Rio de Janeiro. BR
  • Porto, Deisy M; Associação Brasileira de Psiquiatria (ABP). Comissão de Emergências Psiquiátricas. Rio de Janeiro. BR
  • Zacharias, Carlos E; Associação Brasileira de Psiquiatria (ABP). Comissão de Emergências Psiquiátricas. Rio de Janeiro. BR
  • Cordeiro, Quirino; Associação Brasileira de Psiquiatria (ABP). Comissão de Emergências Psiquiátricas. Rio de Janeiro. BR
  • da Silva, Antônio Geraldo; Asociación Psiquiátrica de América Latina (APAL). BR
  • Tung, Teng C; Associação Brasileira de Psiquiatria (ABP). Comissão de Emergências Psiquiátricas. Rio de Janeiro. BR
Rev. bras. psiquiatr ; 41(2): 153-167, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-990823
Responsible library: BR1.1
ABSTRACT

Objective:

To present the essential guidelines for non-pharmacological management of patients with psychomotor agitation in Brazil.

Methods:

These guidelines were developed based on a systematic review of articles published from 1997 to 2017, retrieved from MEDLINE (PubMed), Cochrane Database of Systematic Review, and SciELO. Other relevant articles identified by searching the reference lists of included studies were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools.

Results:

We initially selected 1,731 abstracts among 5,362 articles. The final sample included 104 articles that fulfilled all the inclusion criteria. The management of agitated patients should always start with the least coercive approach. The initial non-pharmacological measures include a verbal strategy and referral of the patient to the appropriate setting, preferably a facility designed for the care of psychiatric patients with controlled noise, lighting, and safety aspects. Verbal de-escalation techniques have been shown to decrease agitation and reduce the potential for associated violence in the emergency setting. The possibility of underlying medical etiologies must be considered first and foremost. Particular attention should be paid to the patient's appearance and behavior, physical signs, and mental state. If agitation is severe, rapid tranquilization with medications is recommended. Finally, if verbal measures fail to contain the patient, physical restraint should be performed as the ultimate measure for patient protection, and always be accompanied by rapid tranquilization. Healthcare teams must be thoroughly trained to use these techniques and overcome difficulties if the verbal approach fails. It is important that healthcare professionals be trained in non-pharmacological management of patients with psychomotor agitation as part of the requirements for a degree and graduate degree.

Conclusion:

The non-pharmacological management of agitated patients should follow the hierarchy of less invasive to more invasive and coercive measures, starting with referral of the patient to an appropriate environment, management by a trained team, use of verbal techniques, performance of physical and mental assessment, use of medications, and, if unavoidable, use of the mechanical restraint. Systematic review registry number CRD42017054440.
Subject(s)

Full text: Available Index: LILACS (Americas) Main subject: Psychomotor Agitation / Practice Guidelines as Topic / Disease Management Type of study: Practice guideline Limits: Humans Country/Region as subject: South America / Brazil Language: English Journal: Rev. bras. psiquiatr Year: 2019 Type: Article Affiliation country: Brazil Institution/Affiliation country: Asociación Psiquiátrica de América Latina (APAL)/BR / Associação Brasileira de Psiquiatria (ABP)/BR / Universidade do Sul de Santa Catarina (UNISUL)/BR

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Full text: Available Index: LILACS (Americas) Main subject: Psychomotor Agitation / Practice Guidelines as Topic / Disease Management Type of study: Practice guideline Limits: Humans Country/Region as subject: South America / Brazil Language: English Journal: Rev. bras. psiquiatr Year: 2019 Type: Article Affiliation country: Brazil Institution/Affiliation country: Asociación Psiquiátrica de América Latina (APAL)/BR / Associação Brasileira de Psiquiatria (ABP)/BR / Universidade do Sul de Santa Catarina (UNISUL)/BR