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

作者: Leonardo Baldaçara , Flávia Ismael , Verônica Leite , Lucas A. Pereira , Roberto M. dos Santos

DOI: 10.1590/1516-4446-2018-0163

关键词: Psychomotor agitationHealth careMEDLINEEvidence-based medicineCritical appraisalReferralMedical emergencyMedicineDisease management (health)Inclusion (disability rights)

摘要: Objective To present the essential guidelines for non-pharmacological management of patients with psychomotor agitation in Brazil. Methods These were developed based on a systematic review articles published from 1997 to 2017, retrieved MEDLINE (PubMed), Cochrane Database Systematic Review, and SciELO. Other relevant identified by searching reference lists included studies also used develop these guidelines. The search strategy structured questions formulated using PICO model, as recommended Guidelines Project Brazilian Medical Association. Recommendations summarized according their level evidence, which was determined Oxford Centre Evidence-based Medicine system critical appraisal tools. Results We initially selected 1,731 abstracts among 5,362 articles. final sample 104 that fulfilled all inclusion criteria. agitated should always start least coercive approach. initial measures include verbal referral patient appropriate setting, preferably facility designed care psychiatric controlled noise, lighting, safety aspects. Verbal de-escalation techniques have been shown decrease reduce potential associated violence emergency setting. possibility underlying medical etiologies must be considered first foremost. Particular attention paid patient's appearance behavior, physical signs, mental state. If is severe, rapid tranquilization medications recommended. Finally, if fail contain patient, restraint performed ultimate measure protection, accompanied tranquilization. Healthcare teams thoroughly trained use overcome difficulties approach fails. It important healthcare professionals part requirements degree graduate degree. Conclusion follow hierarchy less invasive more measures, starting an environment, team, techniques, performance assessment, medications, and, unavoidable, mechanical restraint. registry number CRD42017054440.

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