Brazilian guidelines for the management of psychomotor agitation. Part 1. Non-pharmacological approach

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art_BALDACARA_Brazilian_guidelines_for_the_management_of_psychomotor_agitation_2019.PDF (797.89 KB)
Citações na Scopus
19
Tipo de produção
article
Data de publicação
2019
DOI
SciELO
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
ASSOC BRASILEIRA PSIQUIATRIA
Autores
BALDACARA, Leonardo
ISMAEL, Flavia
LEITE, Veronica
PEREIRA, Lucas A.
SANTOS, Roberto M. dos
GOMES JUNIOR, Vicentede P.
CALFAT, Elie L. B.
DIAZ, Alexandre P.
PERICO, Cintia A. M.
PORTO, Deisy M.
Citação
REVISTA BRASILEIRA DE PSIQUIATRIA, v.41, n.2, p.153-167, 2019
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
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.
Palavras-chave
Environmental health, psychomotor agitation, aggression, emergency, mental disorders, patient care team, risk assessment, physical restraint, immobilization
URI
https://observatorio.fm.usp.br/handle/OPI/31983
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Coleções
Artigos e Materiais de Revistas Científicas - HC/IPq
Artigos e Materiais de Revistas Científicas - ODS/03