Please use this identifier to cite or link to this item:
Full metadata record
DC FieldValueLanguage
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.identifier.citationREVISTA BRASILEIRA DE PSIQUIATRIA, v.41, n.2, p.153-167, 2019
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.relation.ispartofRevista Brasileira de Psiquiatria
dc.subjectEnvironmental healtheng
dc.subjectpsychomotor agitationeng
dc.subjectmental disorderseng
dc.subjectpatient care teameng
dc.subjectrisk assessmenteng
dc.subjectphysical restrainteng
dc.subject.otherpatient consensus statementeng
dc.subject.otherpsychiatric emergencyeng
dc.subject.otherproject betaeng
dc.subject.otheramerican associationeng
dc.subject.otherphysical restraintseng
dc.subject.otherrapid tranquilizationeng
dc.subject.otherseverity scaleeng
dc.subject.otherassessing riskeng
dc.titleBrazilian guidelines for the management of psychomotor agitation. Part 1. Non-pharmacological approacheng
dc.rights.holderCopyright ASSOC BRASILEIRA PSIQUIATRIAeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng, 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, 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, Veronica:ABP, Comissao Emergencias Psiquiatr, Rio De Janeiro, RJ, Brazil; Secretaria Estado Saude Tocantins, Palmas, TO, Brazil; Secretaria Saude Municipio Palmas, Palmas, TO, Brazil, 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, 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 JUNIOR, Vicentede P.:ABP, Comissao Emergencias Psiquiatr, Rio De Janeiro, RJ, Brazil; Assoc Psiquiatr Piaui APPI, Teresina, PI, Brazil, 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, Alexandre P.:Univ Sul Santa Catarina UNISUL, Tubarao, SC, Brazil, 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, 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, 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, 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, Antonio Geraldo da:APAL, Bogota, Colombia; ABP, Rio De Janeiro, RJ, Brazil; Univ Porto, Fac Med, CFM, Porto, Portugal
hcfmusp.publisher.citySAO PAULOeng
hcfmusp.relation.referenceAbderhalden C, 2004, J Psychiatr Ment Health Nurs, V11, P422, DOI 10.1111/j.1365-2850.2004.00733.xeng
hcfmusp.relation.referenceAbderhalden C, 2006, BMC PSYCHIATRY, V6, DOI 10.1186/1471-244X-6-17eng
hcfmusp.relation.referenceAlexander J, 2006, J PSYCHIATR MENT HLT, V13, P543, DOI 10.1111/j.1365-2850.2006.00977.xeng
hcfmusp.relation.referenceAlexander J, 2004, BRIT J PSYCHIAT, V185, P63, DOI 10.1192/bjp.185.1.63eng
hcfmusp.relation.referenceAllen MH, 2004, GEN HOSP PSYCHIAT, V26, P42, DOI 10.1016/j.genhosppsych.2003.08.002eng
hcfmusp.relation.referenceAllen MH, 2001, POSTGRAD MED, V110, P1eng
hcfmusp.relation.referenceAllen MH, 2001, POSTGRAD MEDeng
hcfmusp.relation.referenceAlmvik R, 1999, Int J Psychiatr Nurs Res, V4, P498eng
hcfmusp.relation.referenceAraújo Emeli Moura de, 2010, J. bras. psiquiatr., V59, P94, DOI 10.1590/S0047-20852010000200003eng
hcfmusp.relation.referenceBaldacara L, 2018, BRAZ J PSYCHIATeng
hcfmusp.relation.referenceBaldacara L, 2018, EMERGENCIAS PSIQUIATeng
hcfmusp.relation.referenceBaldacara L, 2011, REV BRAS PSIQUIATR, V33, P30, DOI 10.1590/S1516-44462011000100008eng
hcfmusp.relation.referenceBeck NC, 2008, PSYCHIAT SERV, V59, P1027, DOI 10.1176/
hcfmusp.relation.referenceBeghi M, 2013, RIV PSICHIATR, V48, P10, DOI 10.1708/1228.13611eng
hcfmusp.relation.referenceBenjaminsen S, 1996, NORD J PSYCHIAT, V50, P233, DOI 10.3109/08039489609081413eng
hcfmusp.relation.referenceBoudreaux ED, 2009, GEN HOSP PSYCHIAT, V31, P515, DOI 10.1016/j.genhosppsych.2009.04.009eng
hcfmusp.relation.referenceBowers L, 2010, ARCH PSYCHIAT NURS, V24, P275, DOI 10.1016/j.apnu.2009.09.003eng
hcfmusp.relation.referenceBowers L, 2009, PSYCHIAT SERV, V60, P231, DOI 10.1176/
hcfmusp.relation.referenceBraga Isabela Pinto, 2016, J. bras. psiquiatr., V65, P53, DOI 10.1590/0047-2085000000103eng
hcfmusp.relation.referenceBrakoulias V, 2010, AUSTRALAS PSYCHIATRY, V18, P326, DOI 10.3109/10398562.2010.498051eng
hcfmusp.relation.referenceBuchanan A, 2001, LANCET, V358, P1955, DOI 10.1016/S0140-6736(01)06962-8eng
hcfmusp.relation.referenceCaldieraro MA, 2008, EMERGENCIAS PSIQUIAT, P17eng
hcfmusp.relation.referenceCalfat ELB, 2007, EMERGENCIAS PSIQUIAT, P1eng
hcfmusp.relation.referenceCalver LA, 2011, EMERG MED AUSTRALAS, V23, P732, DOI 10.1111/j.1742-6723.2011.01484.xeng
hcfmusp.relation.referenceCEBM, 2009, OXFORD CTR EVIDENCEeng
hcfmusp.relation.referenceChaput Y, 2011, OPEN ACCESS EMERG M, V3, P13, DOI 10.2147/OAEM.S14307eng
hcfmusp.relation.referenceCitrome L, 2014, CNS SPECTRUMS, V19, P411, DOI 10.1017/S1092852914000054eng
hcfmusp.relation.referenceCornaggia CM, 2011, PSYCHIAT RES, V189, P10, DOI 10.1016/j.psychres.2010.12.024eng
hcfmusp.relation.referenceCowin L, 2003, INT J MENT HEALTH NU, V12, P64, DOI 10.1046/j.1440-0979.2003.00270.xeng
hcfmusp.relation.referenceCruz M Carlos, 2010, Rev. chil. neuro-psiquiatr., V48, P175, DOI 10.4067/S0717-92272010000400002eng
hcfmusp.relation.referenceCurrier GW, 2000, PSYCHIATR SERV, V51, P717, DOI 10.1176/
hcfmusp.relation.referenceDack C, 2013, ACTA PSYCHIAT SCAND, V127, P255, DOI 10.1111/acps.12053eng
hcfmusp.relation.referenceTelles LED, 2009, REV BRAS PSIQUIATR, V31, P253, DOI 10.1590/S1516-44462009005000001eng
hcfmusp.relation.referenceDouglas KS, 1999, J CONSULT CLIN PSYCH, V67, P917, DOI 10.1037/0022-006X.67.6.917eng
hcfmusp.relation.referenceDuxbury J, 2005, J ADV NURS, V50, P469, DOI 10.1111/j.1365-2648.2005.03426.xeng
hcfmusp.relation.referenceFISHER WA, 1994, AM J PSYCHIAT, V151, P1584eng
hcfmusp.relation.referenceGarriga M, 2016, WORLD J BIOL PSYCHIA, V17, P86, DOI 10.3109/15622975.2015.1132007eng
hcfmusp.relation.referenceGovernment of Western Australia Department of Health, 2006, GUID MAN DISTR VIOLeng
hcfmusp.relation.referenceGovernment of Western Australia Department of Health, 2006, MAN DIST VIOL BEH INeng
hcfmusp.relation.referenceGrudnikoff E, 2015, EUR CHILD ADOLES PSY, V24, P731, DOI 10.1007/s00787-014-0618-8eng
hcfmusp.relation.referenceGudjonsson GH, 2004, BRIT J PSYCHIAT, V184, P258, DOI 10.1192/bjp.184.3.258eng
hcfmusp.relation.referenceGuedj MJ, 2004, ENCEPHALE, V30, P32eng
hcfmusp.relation.referenceGuzman-Parra J, 2016, PSYCHIAT RES, V244, P210, DOI 10.1016/j.psychres.2016.07.053eng
hcfmusp.relation.referenceGuzman-Parra J, 2016, J AM PSYCHIAT NURSES, V22, P233, DOI 10.1177/1078390316644767eng
hcfmusp.relation.referenceHankin CS, 2011, J PSYCHIATR PRACT, V17, P170, DOI 10.1097/01.pra.0000398410.21374.7deng
hcfmusp.relation.referenceHendryx M, 2010, J BEHAV HEALTH SER R, V37, P272, DOI 10.1007/s11414-009-9191-1eng
hcfmusp.relation.referenceHolloman GH, 2012, WEST J EMERG MED, V13, P1, DOI 10.5811/westjem.2011.9.6865eng
hcfmusp.relation.referenceHuber CG, 2008, SCHIZOPHR RES, V100, P342, DOI 10.1016/j.schres.2007.12.480eng
hcfmusp.relation.referenceHubner-Liebermann B, 2005, INT J SOC PSYCHIATR, V51, P83, DOI 10.1177/0020764005050337eng
hcfmusp.relation.referenceHuf G, 2012, PSYCHOL MED, V42, P2265, DOI 10.1017/S0033291712000372eng
hcfmusp.relation.referenceHusum TL, 2010, BMC HEALTH SERV RES, V10, DOI 10.1186/1472-6963-10-89eng
hcfmusp.relation.referenceHvidhjelm J, 2014, ISSUES MENT HEALTH N, V35, P464, DOI 10.3109/01612840.2013.879359eng
hcfmusp.relation.referenceIrving Kate, 2004, Aust J Adv Nurs, V21, P23eng
hcfmusp.relation.referenceJegede OO, 2017, INT J MENT HEALTH, V46, P125, DOI 10.1080/00207411.2017.1295781eng
hcfmusp.relation.referenceKaltiala-Heino R, 2000, EUR PSYCHIAT, V15, P213, DOI 10.1016/S0924-9338(00)00223-6eng
hcfmusp.relation.referenceKawakami D, 2016, REV DEBATES PSIQUIAT, V6, P28eng
hcfmusp.relation.referenceKlimitz H, 1998, PSYCHIAT PRAX, V25, P235eng
hcfmusp.relation.referenceKnox DK, 2012, WEST J EMERG MED, V13, P35, DOI 10.5811/westjem.2011.9.6867eng
hcfmusp.relation.referenceKnutzen M, 2007, NORD J PSYCHIAT, V61, P201, DOI 10.1080/08039480701352520eng
hcfmusp.relation.referenceLangstrom N, 2009, J INTERPERS VIOLENCE, V24, P1358, DOI 10.1177/0886260508322195eng
hcfmusp.relation.referenceLukens TW, 2006, ANN EMERG MED, V47, P79, DOI 10.1016/j.annemergmed.2005.10.002eng
hcfmusp.relation.referenceBarros REM, 2010, REV BRAS PSIQUIATR, V32, P145, DOI 10.1590/S1516-44462009005000014eng
hcfmusp.relation.referenceMantovani C, 2010, REV BRAS PSIQUIATR, V32, pS96, DOI 10.1590/S1516-44462010000600006eng
hcfmusp.relation.referenceMarder SR, 2006, J CLIN PSYCHIAT, V67, P13eng
hcfmusp.relation.referenceMartin Veronika, 2007, Clin Pract Epidemiol Ment Health, V3, P1, DOI 10.1186/1745-0179-3-1eng
hcfmusp.relation.referenceMcAllister-Williams RH, 2002, BRIT J PSYCHIAT, V180, P485, DOI 10.1192/bjp.180.6.485eng
hcfmusp.relation.referenceMcNiel DE, 2003, J CONSULT CLIN PSYCH, V71, P945, DOI 10.1037/0022-006X.71.5.945eng
hcfmusp.relation.referenceMigon MN, 2008, GEN HOSP PSYCHIAT, V30, P263, DOI 10.1016/j.genhosppsych.2007.12.005eng
hcfmusp.relation.referenceMinnick AF, 2007, J NURS SCHOLARSHIP, V39, P30, DOI 10.1111/j.1547-5069.2007.00140.xeng
hcfmusp.relation.referenceMontoya A, 2011, HEALTH QUAL LIFE OUT, V9, DOI 10.1186/1477-7525-9-18eng
hcfmusp.relation.referenceMott Sarah, 2005, Int J Nurs Pract, V11, P95, DOI 10.1111/j.1440-172X.2005.00510.xeng
hcfmusp.relation.referenceNassar AP, 2008, SAO PAULO MED J, V126, P215, DOI 10.1590/S1516-31802008000400003eng
hcfmusp.relation.referenceNational Institute for Clinical Excellence (NICE), 2005, VIOL SHORTT MAN DISTeng
hcfmusp.relation.referenceNijman HLI, 1999, AGGRESSIVE BEHAV, V25, P197, DOI 10.1002/(SICI)1098-2337(1999)25:3<197::AID-AB4>3.3.CO;2-3eng
hcfmusp.relation.referenceNordstrom K, 2012, WEST J EMERG MED, V13, P3, DOI 10.5811/westjem.2011.9.6863eng
hcfmusp.relation.referenceO'Brien L, 2003, INT J MENT HEALTH NU, V12, P165, DOI 10.1046/j.1440-0979.2003.t01-1-00286.xeng
hcfmusp.relation.referenceOdawara T, 2005, PSYCHIAT CLIN NEUROS, V59, P605, DOI 10.1111/j.1440-1819.2005.01422.xeng
hcfmusp.relation.referencePadilha VM, 2013, SAO PAULO MED J, V131, P398, DOI 10.1590/1516-3180.2013.1316598eng
hcfmusp.relation.referencePajonk FG, 2008, GEN HOSP PSYCHIAT, V30, P360, DOI 10.1016/j.genhosppsych.2008.03.005eng
hcfmusp.relation.referencePascual JC, 2006, ACTAS ESP PSIQUIATRI, V34, P239eng
hcfmusp.relation.referencePassamar M, 2011, ENCEPHALE, V37, P448, DOI 10.1016/j.encep.2011.10.001eng
hcfmusp.relation.referencePetit JR, 2005, PSYCHIAT CLIN N AM, V28, P701, DOI 10.1016/j.psc.2005.05.011eng
hcfmusp.relation.referenceQuevedo J, 2014, EMERGENCIAS PSIQUIATeng
hcfmusp.relation.referenceRamadan M, 2006, INTERNET J EMERG MED, V4, P1eng
hcfmusp.relation.referenceRetsas AP, 1998, INT J NURS STUD, V35, P184, DOI 10.1016/S0020-7489(98)00027-3eng
hcfmusp.relation.referenceRichmond JS, 2012, WEST J EMERG MED, V13, P17, DOI 10.5811/westjem.2011.9.6864eng
hcfmusp.relation.referenceRoberts D, 2009, J PSYCHOSOC NURS MEN, V47, P25, DOI 10.3928/02793695-20090902-01eng
hcfmusp.relation.referenceRyder-Lewis Michelle C, 2008, Intensive Crit Care Nurs, V24, P211, DOI 10.1016/j.iccn.2007.11.004eng
hcfmusp.relation.referenceSan Luis, 2016, Clin Pract Epidemiol Ment Health, V12, P75eng
hcfmusp.relation.referenceSanches M, 2005, ARQ MED HOSP FAC CIE, V50, P18eng
hcfmusp.relation.referenceSantos M E, 2000, Rev Saude Publica, V34, P468eng
hcfmusp.relation.referenceSchleifer JJ, 2011, ADV PSYCHIAT TREAT, V17, P91, DOI 10.1192/APT.BP.109.007310eng
hcfmusp.relation.referenceSessler CN, 2002, AM J RESP CRIT CARE, V166, P1338, DOI 10.1164/rccm.2107138eng
hcfmusp.relation.referenceSimpson SA, 2014, GEN HOSP PSYCHIAT, V36, P113, DOI 10.1016/j.genhosppsych.2013.09.009eng
hcfmusp.relation.referenceSmith AD, 1997, MED SCI LAW, V37, P145, DOI 10.1177/002580249703700210eng
hcfmusp.relation.referenceSteinert T, 2007, J NERV MENT DIS, V195, P492, DOI 10.1097/NMD.0b013r3180302af6eng
hcfmusp.relation.referenceStevenson S, 1998, J Healthc Qual, V20, P28eng
hcfmusp.relation.referenceStowell KR, 2012, WEST J EMERG MED, V13, P11, DOI 10.5811/westjem.2011.9.6868eng
hcfmusp.relation.referenceStrout TD, 2014, ADV EMERG NURS J, V36, P250, DOI 10.1097/TME.0000000000000014eng
hcfmusp.relation.referenceSwift RH, 2002, J PSYCHIAT RES, V36, P87, DOI 10.1016/S0022-3956(01)00052-8eng
hcfmusp.relation.referenceThe New South Wales Department of Health, 2009, REF GUID SYDN NEW Seng
hcfmusp.relation.referenceVaaler AE, 2006, NORD J PSYCHIAT, V60, P144, DOI 10.1080/08039480600583472eng
hcfmusp.relation.referenceXavier RM, 2011, LAB PRATICA CLIN CON, V2aeng
hcfmusp.relation.referenceYudofsky SC, 1997, J NEUROPSYCH CLIN N, V9, P541eng
hcfmusp.relation.referenceYUDOFSKY SC, 1986, AM J PSYCHIAT, V143, P35eng
hcfmusp.relation.referenceZeller SL, 2010, CLIN THER, V32, P403, DOI 10.1016/j.clinthera.2010.03.006eng
Appears in Collections:

Artigos e Materiais de Revistas Científicas - HC/IPq
Instituto de Psiquiatria - HC/IPq

Artigos e Materiais de Revistas Científicas - ODS/03
ODS/03 - Saúde e bem-estar

Files in This Item:
File Description SizeFormat 
art_BALDACARA_Brazilian_guidelines_for_the_management_of_psychomotor_agitation_2019.PDFpublishedVersion (English)797.89 kBAdobe PDFThumbnail

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.