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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorBALDACARA, Leonardo
dc.contributor.authorISMAEL, Flavia
dc.contributor.authorLEITE, Veronica
dc.contributor.authorPEREIRA, Lucas A.
dc.contributor.authorSANTOS, Roberto M. dos
dc.contributor.authorGOMES JUNIOR, Vicentede P.
dc.contributor.authorCALFAT, Elie L. B.
dc.contributor.authorDIAZ, Alexandre P.
dc.contributor.authorPERICO, Cintia A. M.
dc.contributor.authorPORTO, Deisy M.
dc.contributor.authorZACHARIAS, Carlos E.
dc.contributor.authorCORDEIRO, Quirino
dc.contributor.authorSILVA, Antonio Geraldo da
dc.contributor.authorTUNG, Teng C.
dc.date.accessioned2019-05-30T13:48:02Z
dc.date.available2019-05-30T13:48:02Z
dc.date.issued2019
dc.identifier.citationREVISTA BRASILEIRA DE PSIQUIATRIA, v.41, n.2, p.153-167, 2019
dc.identifier.issn1516-4446
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/31983
dc.description.abstractObjective: 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.eng
dc.language.isoeng
dc.publisherASSOC BRASILEIRA PSIQUIATRIAeng
dc.relation.ispartofRevista Brasileira de Psiquiatria
dc.rightsopenAccesseng
dc.subjectEnvironmental healtheng
dc.subjectpsychomotor agitationeng
dc.subjectaggressioneng
dc.subjectemergencyeng
dc.subjectmental disorderseng
dc.subjectpatient care teameng
dc.subjectrisk assessmenteng
dc.subjectphysical restrainteng
dc.subjectimmobilizationeng
dc.subject.otherpatient consensus statementeng
dc.subject.otherintensive-care-uniteng
dc.subject.otherpsychiatric emergencyeng
dc.subject.otherproject betaeng
dc.subject.otheramerican associationeng
dc.subject.otherphysical restraintseng
dc.subject.otherrapid tranquilizationeng
dc.subject.otherrandomized-trialeng
dc.subject.otherseverity scaleeng
dc.subject.otherassessing riskeng
dc.titleBrazilian guidelines for the management of psychomotor agitation. Part 1. Non-pharmacological approacheng
dc.typearticleeng
dc.rights.holderCopyright ASSOC BRASILEIRA PSIQUIATRIAeng
dc.identifier.doi10.1590/1516-4446-2018-0163
dc.identifier.pmid30540028
dc.subject.wosPsychiatryeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
hcfmusp.author.externalBALDACARA, Leonardo:ABP, Comissao Emergencias Psiquiatr, Rio De Janeiro, RJ, Brazil; Univ Fed Tocantins, Quadra 109 Norte,Ave NS15,ALCNO 14,Campus Palmas, BR-77001090 Palmas, TO, Brazil; Secretaria Estado Saude Tocantins, Palmas, TO, Brazil
hcfmusp.author.externalISMAEL, Flavia:ABP, Comissao Emergencias Psiquiatr, Rio De Janeiro, RJ, Brazil; Coordenadoria Saude Mental, Sao Caetano do Sul, SP, Brazil; ABC, Fac Med, Santo Andre, SP, Brazil; Univ Sao Caetano do Sul, Sao Caetano do Sul, SP, Brazil
hcfmusp.author.externalLEITE, Veronica:ABP, Comissao Emergencias Psiquiatr, Rio De Janeiro, RJ, Brazil; Secretaria Estado Saude Tocantins, Palmas, TO, Brazil; Secretaria Saude Municipio Palmas, Palmas, TO, Brazil
hcfmusp.author.externalPEREIRA, Lucas A.:ABP, Comissao Emergencias Psiquiatr, Rio De Janeiro, RJ, Brazil; FTC, Salvador, BA, Brazil; Univ Salvador UNIFACS, Salvador, BA, Brazil; EBMSP, Salvador, BA, Brazil
hcfmusp.author.externalSANTOS, Roberto M. dos:ABP, Comissao Emergencias Psiquiatr, Rio De Janeiro, RJ, Brazil; Univ Fed Paraiba UFPB, Hosp Univ Lauro Wanderley, Joao Pessoa, Paraiba, Brazil; Pronto Atendimento Saude Mental, Joao Pessoa, Paraiba, Brazil
hcfmusp.author.externalGOMES JUNIOR, Vicentede P.:ABP, Comissao Emergencias Psiquiatr, Rio De Janeiro, RJ, Brazil; Assoc Psiquiatr Piaui APPI, Teresina, PI, Brazil
hcfmusp.author.externalCALFAT, Elie L. B.:ABP, Comissao Emergencias Psiquiatr, Rio De Janeiro, RJ, Brazil; Fac Med Santa Casa Sao Paulo FCMSCSP, Sao Paulo, SP, Brazil; Ctr Atencao Integrada Saude Mental, Franco Da Rocha, SP, Brazil
hcfmusp.author.externalDIAZ, Alexandre P.:Univ Sul Santa Catarina UNISUL, Tubarao, SC, Brazil
hcfmusp.author.externalPERICO, Cintia A. M.:ABP, Comissao Emergencias Psiquiatr, Rio De Janeiro, RJ, Brazil; ABC, Fac Med, Santo Andre, SP, Brazil; Coordenadoria Saude Mental, Sao Bernardo Do Campo, SP, Brazil
hcfmusp.author.externalPORTO, Deisy M.:ABP, Comissao Emergencias Psiquiatr, Rio De Janeiro, RJ, Brazil; Inst Psiquiatria Santa Catarina, Sao Jose, SC, Brazil; Coordenacao Estadual Saude Mental, Florianopolis, SC, Brazil
hcfmusp.author.externalZACHARIAS, Carlos E.:ABP, Comissao Emergencias Psiquiatr, Rio De Janeiro, RJ, Brazil; Secretaria Estado Saude Sao Paulo, Sao Paulo, SP, Brazil; Secretaria Saude Municipio Sorocaba, Sorocaba, SP, Brazil
hcfmusp.author.externalCORDEIRO, Quirino:ABP, Comissao Emergencias Psiquiatr, Rio De Janeiro, RJ, Brazil; Fac Med Santa Casa Sao Paulo FCMSCSP, Sao Paulo, SP, Brazil; Minist Saude, Coordenacao Geral Saude Mental Alcool & Outras Dr, Brasilia, DF, Brazil
hcfmusp.author.externalSILVA, Antonio Geraldo da:APAL, Bogota, Colombia; ABP, Rio De Janeiro, RJ, Brazil; Univ Porto, Fac Med, CFM, Porto, Portugal
hcfmusp.description.beginpage153
hcfmusp.description.endpage167
hcfmusp.description.issue2
hcfmusp.description.volume41
hcfmusp.origemWOS
hcfmusp.origem.idWOS:000462867700009
hcfmusp.origem.id2-s2.0-85064192452
hcfmusp.origem.idSCIELO:S1516-44462019000200009
hcfmusp.publisher.citySAO PAULOeng
hcfmusp.publisher.countryBRAZILeng
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dc.description.indexMEDLINEeng
dc.identifier.eissn1809-452X
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