Download the management of aggression and agitation

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Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
NURSE PRACTITIONER CLINICAL PROTOCOL
MANAGEMENT OF AGGRESSION AND AGITATION
For
Mental Health Consultation – Liaison Services
Prepared by:
Mary-Ellen Dodds, RN, RMHN, BSc (Nsing), MN (Nse Pract), MACMHN.
April 2011
Revised Version
Sir Charles Gairdner Hospital
North Metropolitan Health Service
Acknowledgements:
Mack Madahar- NP-Intern, Curtin University of Technology, Bentley, WA- for his
updated clinical research and input
Greater Western Area Health Service (2006). Clinical Guidelines: Nurse
Practitioner Mental Health Baradine.
Royal Prince Alfred Hospital. Central Sydney Area Mental Health Service.
(2004). Nurse Practitioner Guidelines: Role and Scope of Practice.
Western Sydney Area Mental Health Service. Auburn and Westmead Hospitals.
(2004). Clinical Practice Guidelines: Nurse Practitioner Mental Health.
Issued:
2007
Reviewed:
2011
Next Review: 2014
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Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
STATEMENT OF INTENT OF THESE CLINICAL PROTOCOLS AND
DISCLAIMER
The information provided in these Clinical Protocols is intended for information
purposes only. Clinical Protocols are designed to improve the quality of health
care and decrease the use of unnecessary or harmful interventions. These
Clinical Protocols have been developed by clinicians and researchers for use
within Sir Charles Gairdner Hospital. They provide advice regarding the care
and management of patients presenting with mental illnesses or mental health
issues by the Nurse Practitioner – Mental Health.
While every reasonable effort has been made to ensure the accuracy of these
Clinical Protocols, no guarantee can be given that the information is free from
error or admission. The recommendations do not indicate an exclusive course
of action or serve as a definitive mode of patient care. Variations which takes
into account individual circumstances, clinical judgement and patient choice may
also be appropriate. Users are strongly recommended to confirm by way of
independent sources that the information contained within the Clinical Protocol
is correct.
The information contained in these Clinical Protocols is NOT a substitute for
clinical judgement whereby appropriate diagnosis, treatment and advice are
taken into account.
These Clinical Protocols may also include references to the quality of evidence
used in their formulation. Where this has not been located, the Clinical
Protocols include references to support the recommended care. Providing a
reference does not constitute an endorsement or approval of that source or any
information, products or services through that source.
The Minister for Health, the State of Western Australia, and their Employees and
Agents will accept no liability for any act or omission occurring as a
consequence of relying on these Protocols in clinical use or as a result of the
use of these Protocols
Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
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TABLE OF CONTENTS
Disclaimer
5
*
*
*
*
4
4
4
5
Disease Aetiology
Patient Population
Patient Contacts
Expected Outcomes of Protocols
Clinical Protocol
Aggression / Agitation
6-15
Discharge / Referral Criteria
16
Best Practice Evidence
16
Review
17
Implementation Plan
17
Evaluation Plan
17
Formulary
19
References
20
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Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
Disease Aetiology
Although the exact cause of most mental illnesses is not known it is
progressively becoming more evident that many mental illnesses are caused
by a combination of genetic, biological, psychological and environmental
factors.
Some mental illnesses are known to run in families, which suggests that the
illness may be passed on from parents to child through genes making such
children more susceptible to developing the illness. Experts believe that
genetic causes of mental illness occur due to defects in multiple genes – not
just a single gene as with other disorders. Individuals with defective genes
when exposed to other factors such as environmental stressors are more
likely to develop the disorder. Some mental illnesses are closely linked to
biological causes such as an abnormal balance of neuro-transmitter
chemicals in the brain. These chemicals are responsible normal functioning in
the brain and if not working properly, normal communication between nerve
cells in the brain may severely impaired. In addition, injuries to certain parts
of the brain are linked to the development of mental illness. Psychological
trauma especially in childhood has also been shown to be linked to the
development of mental illness in adulthood. In addition, stressors such as
death and divorce and substance abuse can trigger mental illness in a person
who may be at risk for developing mental illness (MedicineNet, 2005; Askey,
2002; Brockington, 2004; Marmot, 2005; Davies, 1997)
Patient Population:
The population of patients to whom these protocols pertain to will include all
patients admitted to the general wards at Sir Charles Gairdner Hospital for
medical reasons that have a mental illness or mental health issue associated
with their medical condition. This includes patients who have behaviours,
which render their management difficult either for themselves or for those
health professionals caring for them.
Patient Contacts:
Since its inception in 2001-2002, requests for mental health review of patients
believed to be suffering from mental illnesses or mental health issues have
been at a steady rise. Patient contacts have risen from 165 patient contacts in
2001 to 949 patient contact in 2010. Addendum 1 illustrates the
incremental growth of patient contacts in a tabled form.
The author believes that the total current levels of patient service have
reached its capacity for 1 full-time equivalent staff. If more patients are to be
referred to the service, will require additional resources in the form of staff and
office space. Such patients are referred directly to the Clinical Nurse
Consultant (Psychiatry) by both medical and nursing staff for primarily mental
health assessment and then ongoing management of the patient’s mental
health problem. Treatments provided cover a wide range of management
options including counselling, relaxation training and behavioural therapy. In
addition, due to the difficulty in managing some of these patients due to
abnormal behaviour, support and education is provided to staff. Currently, if
the patient is considered to require either medication or referral to another
health professional, the treating team must make referrals on the
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Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
recommendation of the Clinical Nurse Consultant (Psychiatry). Thus if the
treating team does not believe that the patient’s mental health problem is a
priority the patient does not receive or the appropriate mental health care is
delayed significantly. The ability to directly refer patients and commence
appropriate mental health treatment would be greatly enhanced by the
designation of a Mental Health Nurse Practitioner.
Expected Outcome of the Protocols:
Early intervention in mental illnesses is believed to be best practice in
management. It is suggested that early access to mental health care will
reduce the loss of function and disability which often results as a
consequence of serious mental illness.
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Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
CLINICAL PROTOCOL : THE MANAGEMENT OF AGGRESSION AND
AGITATION
Perhaps the most problematic behaviour in the management of patients with a
mental illness and /or mental health issues is the potential for agitation and
aggression and in some cases the enactment of these behaviours.
Underlying mental illness and personality traits often make it difficult to deal
with the cumulative stresses of hospitalisation resulting in episodes of
aggression. Currently, instances of aggression rely heavily on medical staff to
prescribe appropriate medication to primarily manage the patient escalating
anxiety and arousal and secondly, to sedate patients in the event that their
behaviour escalating to physical violence. This can be problematic both for
the patient and the health professional. Sullivan (1998) has suggested that
mental health nurses confront potentially hostile and aggressive patients on a
regular basis however, recent developments on this topic suggests that the
issue of workplace aggression and violence are now part of the broader
discussion (Beech & Bowyer, 2004).
Aggression can be verbal and/ or physical and is most likely in the acute
phase of psychosis especially if the patient is experiencing auditory
hallucinations or paranoid delusions. Anger may also be a response to
environmental factors but combined with personality traits and the emotional
stresses associated with hospitalisation, the expression of these feelings may
be exaggerated or distorted (Orygen Research Centre, 2004; Hill, 2000;
McGeorge & Landow, 2000).
A contributing factor to aggression is often agitation which is a degree of
psychological and motor hyperactivity. It is symptomatic of the patient’s
underlying psychological and/or physical disturbance and is often seen in
acutely psychotic and dementing patients. It is a major contributing factor to
aggression.
The need to manage these behaviours is imperative if we are to achieve a
positive hospital experience for the patient. Most patients will become
anxious and upset when faced with threats to their health status and it is
prudent to manage this anxiety in a timely and expedient manner to prevent
escalations. Unfortunately, the medical staff who are likely to spend the most
time are usually the most junior who a) lack the experience in identifying
potential agitation and b) are unfamiliar with the appropriate pharmacological
intervention required. Senior medical staff is often not available due to the
demands on their time and expertise. This often means that there is a time
delay before appropriate management is instigated and thus in many
instances the patient’s behaviour has escalated. At this point simple nonpharmacological strategies for managing aggression will no longer be
effective and more advanced management strategies such as sedation will
need to be utilised.
The increased scope of practice of a Mental Health Nurse Practitioner will
enable timely and efficient management utilising the appropriate
pharmacological and non-pharmacological management. It would also allow
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Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
for the underlying patient concerns to be addressed and vital decisions
relating to ongoing patient management to be addressed much earlier, thus
making the use of a Mental Health Nurse Practitioner more judicious and cost
effective in terms of the existing human resources who currently are involved
in the management of aggression and agitation.
The objectives of management will be;
•
To reduce the patient’s level of agitation and the distress
experienced by the patient.
•
To reduce the potential for harm to the patient or others.
•
To reduce the potential for damage to property.
•
To enable appropriate medical / mental health treatment to be
administered.
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Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
CLINICAL PROTOCOL 3: THE MANAGEMENT OF AGITATION AND AGGRESSION
PROCESS
Assessment
ACTION
1. May include any or a combination of the following;
•
Loss of control by the patient which may include any of the following;
- Physical assault of others
- Forceful damage to property
- Forceful injury to others
- Injury to self
•
Body Language
- Clenched fists
- Clenched jaw
- Rigid posture
- Tautness indicating intense effort to control emotions
- Agitation
- Increasing motor activity
- Pacing
•
Hostile threatening verbalisations
•
Possession of a potential weapon
•
Provocative behaviour
- Argumentative
- Dissatisfied
- Over-reactive
- Hypersensitive
- Poor impulse control.
REFERENCE
Xeniditis et al
(2001)
LEVEL OF EVIDENCE
F
Blair (1991)
G
Fry et al (2002)
D
2. Risk assessment for aggression
•
In collaboration with the treating multi-disciplinary team and other
health professionals, exclude underlying causes of aggression eg.
Pain, delirium, septicaemia, cerebral pathology, metabolic illness and
ensure that organic illness/pathology addressed.
•
Antecedents and warning signs
•
Conduct an assessment for imminent aggression using the Broset
Violence Checklist
National
Collaborating
Centre for
Nursing and
Supportive care
(2005)
Beck et al (1984)
G
Stuart GW et al
(1987)
G
G
Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
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Treatment
Mild –
Moderately
Arousal
Mildly aroused –
pacing , still
willing to talk
reasonably
Moderately
aroused –
agitate,
becoming more
vocal,
unreasonable or
hostile
Administer (oral therapy)
•
Option 1
- Diazepam 2-20 mg
Or
- Clonazepam 0.5 – 2mg
Or
- Lorazepam 1 – 2.5mg
Repeat after 60 minutes if necessary. If ineffective consider Option
2.
•
•
Option 2
- Haloperidol 1.0 – 2.5mg
PLUS
- Diazepam 5 – 20mg
Or
- Clonazepam 0.5 - 2.0 mg
Or
- Lorazepam 1 – 2.5mg
Repeat after 60 minutes if necessary. If ineffective consider Option 3
and/or parental route.
Option 3
- Olanzapine 2.5 – 5 mg
Or
- Risperidone 0.5 – 2.0mg
SCGH
Emergency
medical
Guidelines (2004)
Western
Australian Drug &
Therapeutics
Committee (
2003)
G
G
Rose et al (2002)
Shaw et al (2003)
F
Marcantonio
(2005)
E
Byrne (2005)
F
Bateman (2003)
Gareri et al
(2003)
G
G
Treatment
Moderately –
Highly Aroused
Moderately
aroused –
agitated
becoming more
vocal,
Administer (Intramuscular Route)
•
Option 1
- Clonazepam 2 mg
Repeat after 30 minutes if necessary
•
Option 2
- Haloperidol 2.5 mg
SCGH
Emergency
medical
Guidelines (2004)
Western
Australian Drug &
Therapeutics
G
G
G
Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
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unreasonable or
hostile.
Highly Aroused
– possibly
distressed or
fearful, noisy
and may include
overt violence,
unresponsive to
or refusing oral
medications.
–
PLUS
Clonazepam 2 mg
Repeat after 30 minutes if necessary
Committee (
2003)
Rose et al (2002)
Shaw et al (2003)
F
Marcantonio
(2005)
E
Byrne (2005)
F
Bateman (2003)
Gareri et al
(2003)
G
G
Treatment
Highly Aroused
Highly aroused –
distressed,
fearful, noisy
and may include
overt violence
Administer (IMI or IV)
•
Option 1
- Haloperidol 2.5 – 5 mg
SCGH
Emergency
medical
Guidelines (2004)
G
G
WITH OR WITHOUT
•
Option 2.
- Diazepam 2.5 – 10 mg
Repeat in 2.5mg doses until adequate sedation is
achieved.
Western
Australian Drug &
Therapeutics
Committee (
2003)
G
Rose et al (2002)
Shaw et al (2003)
F
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Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
Marcantonio
(2005)
E
Byrne (2005)
F
Bateman (2003)
Gareri et al
(2003)
G
G
Precautions
associated with
the use of
suggested
medications
Precautions should be used with the prescription and use of the suggested
medications in the following clinical presentations and / or co-existing physical
conditions;
•
Benzodiazepines (includes diazepine, clonazepine, lorazepine)
- History of drug or alcohol abuse / dependence
- Myasthenia Gravis
- Sleep Apnoea
- Severe Respiratory Disease
- Severely impaired Liver or renal function
- Severe intoxication with alcohol and other CNS depressants
•
Antipsychotics – Butyrophenones (Haloperidol)
- Myocardial infarction within 6 weeks
- Tardive dyskinesia
- Aggranulocytosis
- Neuroleptic Malignant Syndrome (NMS)
- Parkinson’s Disease or drugs which antagonise dopamine
blocking.
•
Other antipsychotics (Olanzepine and Risperidone)
- Myocardial infarction within 6 weeks
- History of tardive dysknesia or NMS
- Orthostatic hypotension can occur especially in initial treatment
Waddell et al
(1996)
G
G
Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
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General
Precautions
•
•
•
Elevated proplactin levels
Renal impairment (halve dose)
Liver impairment (halve dose)
Resuscitation and experienced staff need to be available at all times
to ensure first-line management in the event of respiratory
depression.
The patient’s respiratory function needs to be monitored when
benzodiazepines are administered.
Consideration of the patient’s usual medications which are likely to
contribute to the patient’s mental state.
SCGH
Emergency
medical
Guidelines (2004)
Western
Australian Drug &
Therapeutics
Committee (
2003)
G
G
Rose et al (2002)
Shaw et al (2003)
F
Marcantonio
(2005)
E
Gareri et al
(2003)
Ongoing
management
1. Once patient’s arousal has subsided provide the patient with the opportunity to
discuss / de-brief about incident and attempt to discover the reason for patient’s
arousal. This may include utilising skills such as listening skills and negotiation
techniques.
2. Ensure that a pre-emptive management plan is in place for subsequent episodes
of violence
3. Provide opportunity for staff to ventilate / de-brief post incident
National
Collaborating
Centre for
Nursing and
Supportive care
(2005)
F
G
G
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Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
4. If the management of the underlying cause of the aggression is beyond the scope
of practice of the mental health nurse practitioner refer to an appropriate health
practitioner (eg psychiatrist, Social worker, patient liaison officer, Complaints
office, etc.)
5. For patients being cared for under the provisions of the Mental Health Act, the
Office of the Chief psychiatrist must be notified.
Mental Health Act
(1996)
G
Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
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MANAGEMENT OF AGITATION AND AGGRESSION PATHWAY
Assessment of
agitated /
aggressive patient
Mild – Moderate
Arousal
Option 1(Oral)
Diazepam 1-20mg
OR
Lorazepam 1.0 2.5mg
OR
Clonazepam 0.5 2.0mg
(Repeat after 60
Option 2 (Oral)
Haloperidol 1.0 – 2.5mg
PLUS
Diazepam 5.0 – 20mg
OR Lorazepam 1.0 –
2.5mg
OR Clonazepam 0.5 –
2.0 mg
(Repeat after 60 minutes
if necessary)
Moderately –
Highly Aroused
Option 3 (Oral)
Risperidone 0.5 –
2.0 mg
OR
Olanzapine 2.5 –
5mg
Option 1
(Intramuscular
Route)
Clonazepam 2.0mg
(Repeat after 30
minutes if
necessary)
Option 2
(Intramuscular
Route)
Haloperidol 2.5 mg
PLUS
OR
Clonazepam 2.0 mg
(Repeat after 30
minutes if
Highly Aroused
Option 1
(Intramuscular or
Intravenous Route)
Haloperidol 2.5 –
5.0,mg
WITH OR
WITHOUT
DIAZEPAM
Option 2
(Intramuscular or
Intravenous Route)
Diazepam 2.5 – 10
mg
(Repeat in 2.5 mg
doses until adequate
sedation achieved)
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Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
DISCHARGE/REFERRAL CRITERIA:
Discharge Criteria:
•
Patients who have completed their treatment with the above
techniques
•
Patients whose psychiatric symptomatology has resolved and
which is unlikely to re-occur.
Referral Criteria:
•
Patients whose psychiatric symptomatology is unlikely to
respond to the above techniques.
•
Patients who are displaying no current insight into their condition
and are refusing psychiatric treatment.
•
Patients who require additional treatment or the services of
another health professional which is beyond the scope of
practice of the Mental Health Nurse practitioner.
•
Patients who require long-term psychiatric care, psychotherapy
or rehabilitation.
•
Patients under 16 years of age and older than 65 years.
The Mental Health Nurse practitioner will facilitate referrals to departments
within SCGH and to other mental health services and facilities within the North
Metropolitan Health Services.
Referrals will be made to the following services;
•
Other health professionals of the Consultation-Liaison
Psychiatric Service at SCGH.
•
Social Work both within SCGH and other Services within NMHS.
•
Alcohol and Drug Services within the Hospital and the Alcohol
and Drug Services in WA.
•
Aboriginal Mental Health Service.
•
Community mental Health Clinics
•
General practitioners
•
Private psychiatrists
•
Private Psychology and Counselling Services
•
Older-Age Psychiatry (Over 65 years)
•
Child and Adolescent Psychiatry (Under 16 years).
BEST PRACTICE EVIDENCE:
The following coding system is used to specify the quality of the supporting
evidence for the protocol for mental state assessment:
[A] Randomised clinical trial. A study of an intervention in which the
subjects are prospectively followed over time; there are treatment and control
groups; subjects are randomly assigned to the two groups; both the subjects
are the investigators are blind to the assignments.
[B] Clinical trial. A prospective study in which an intervention is made and
the results of that intervention are tracked longitudinally; study does not meet
the standards for a randomised clinical trial.
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Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
[C] Cohort or longitudinal study. A study in which subjects are
prospectively followed over time without any specific intervention.
[D] Case – control study. A study in which a group of patients and a group of
control subjects are identified in the present and information about the
subjects is pursued retrospectively or backwards in time.
[E] Review with secondary data analysis. A structured analytic review of
existing data. Eg. A meta-analysis or a decision analysis.
[F] Review. A qualitative review and discussion of previously published
literature without a qualitative synthesis of the data.
[G] Other. Textbooks, expert opinion, case reports and other reports not
included above.
REVIEW:
This clinical protocol will become effective after approval and will be reviewed
every 3 years or more often if significant research / evidence-based
information is available which is likely to lead to a change in practice.
IMPLEMENTATION PLAN:
As the Mental Health assessment of patients is an ongoing process the
implementation of this clinical protocol will take place subsequent to the
designation of the Mental Health Nurse Practitioner at Sir Charles Gairdner
Hospital. The promotion of changes in practice and the enhancement of
referrals will be commenced approximately 6 weeks of designation.
EVALUATION PLAN:
The use of this protocol will be reviewed annually and evaluated using the
Clinical Governance framework. Reports will be provided to the crucial key
line manager (Nursing Co-Director of Corporate Nursing, Education and
research) and the Director General of Health, as part of the process outlined
by the Office of the Chief Nursing Officer (Department of Health Western
Australia).
Clinical Performance and Evaluation:
The number of mental health referrals, assessments and disposals (eg.
Treated by NP or referred to another health professional) will be monitored
over a 12 month period. These statistics will be maintained on a regular basis
utilising the PSOLIS database for mental health patients.
Professional Development and Management:
The Mental Health Nurse Practitioner will be responsible for own individual
professional development within the designated area, the provision of
education to professional colleagues and own ongoing Performance
Management. The development of Policies, Guidelines and standards within
the hospital and across the health sector will also be noted.
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Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
Clinical Risk:
The identification and minimisation of clinical risks are an important aspect of
clinical safety. Practice guidelines and standards and the use of risk
assessment tools will be utilised by the Mental Health Nurse Practitioner and
probable risks which include clinical incidents and adverse events will be
identified and reported as part of the NP review and reporting to the
Department of Health.
Consumer Value:
Consumer Satisfaction will be determined via satisfaction surveys of selected
customer groups including selected patients, carers and referring sources.
Consumer input into protocols and/or patient information will also be noted.
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Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
DRUG FORMULARY - MENTAL HEALTH
Classification
Antipsychotic
Drug
Olazapine
Dosage
Oral
5.0 – 20 mg / 24 hours
Adverse Effects
Somnolence
Weight Gain
Hypotension
Anticholergic Effects
Antipsychotic
Risperidol
Oral
6.0 – 8.0 mg / 24 hours
Insomnia
Agitation
Extrapyramidal Effects
Anxiety
Headache
Antipsychotic
Haloperidol
Oral:
1.0 – 100 mg / 24 hours
Extrapyramidal Effects
Anticholinergic Effects
Dystonic Reactions
Akathesia
Intramuscular:
2.0 – 10.0 mg initially then
further doses given 30 –
60 minutely depending on
patient response – should
not exceed 100 mg / 24
hours
Benzodiazepine
Clonazepam
Oral / Intramuscular
4.0 – 8.0 mg
Benzodiazepine
Diazepam
Oral / Intramuscular /
Intravenous
5.0 – 20 mg
Benzodiazepine
Lorazepam
Oral
2.0 – 4.0 mg
Anticholinergic
Benztropine
Oral / Intramuscular
1.0 – 2.0 mg
Dependence
CNS depression
Anterograde amnesia
Disinhibition
Intoxication
Respiratory depression
Dependence
CNS depression
Anterograde amnesia
Disinhibition
Intoxication
Respiratory depression
Dependence
CNS depression
Anterograde amnesia
Disinhibition
Intoxication
Respiratory depression
Anticholinergic Effects,
including dry mouth,
dilatation of pupils, flushing,
worsening of glaucoma,
urinary hesitancy,
constipation, nausea and
blurred vision
Central effects including
dizziness, hallucinations,
euphoria and hyperpyrexia
(Therapeutic Guidelines: Psychotropic, 2000; Perry et al, 1997)
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Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
REFERENCES:
American Psychiatric Association, (1995) Practice Guidelines for Psychiatric
Evaluation of Adults. Accessed 13th December 2006 from Medem
Website:
www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZ20OM8QDC&s
ub..
American Psychiatric Association. (2003). Practice Guideline for the
Assessment and treatment of patients with suicidal behaviours.
Arlington (VA): American Psychiatric Association.
Askey, R. (2002). Early onset psychosis: causes and treatment. Mental Health
Practice, 5(10): 16-20.
Bateman N. (2003). Antipsychotics. Medicine, 34-35.
Beck CM, Rawlins PR & Williams SR (eds). (1984). Mental Health –
Psychiatric Nursing. USA: CV Mosby Company.
Beech, B & Bowyer, D. (2004). Management of aggression and violence in
mental health settings. Mental Health Practice, 7(7), 31-37.
Bower, B. (1991). New report offers antipsychotic guidelines – american
psychiatric association task force reports on tardive dyskinesia, the
movement disorder caused by therapy with neuroleptic drugs. Science
News, May 11. Accessed 22nd July, 2007 from Look Smart Website:
http://findarticles.com/p/articles/mi_m1200/is_v139/ai_10816619/print
Brockington, I. (2004). Postpartum psychiatric disorders. The Lancet, 363:
303-310.
Brown PD, Buckner JC, O’Fallon JR, Iturria NL, O’Neill BP, Brown CA,
Scheithauer BW, Dinapoli RP, Arusell RM, Curran WJ, Abrams R,
Shaw EG & North Central Cancer Group. (2004). Importance of
baselline mini-mental state examination as a prognostic factor for
patients with low-grade glioma. The Cochrane Central register of
Controlled Trials (CENTRAL) 2007, 2.
Byrne GJ. (2005). Pharmacological treatment of behavioural problems in
dementias. Australian Prescriber, 28(3), 67-70.
Calvert P & Palmer, C. (2003). Application of the cognitive therapy model to
initial crisis assessment. International Journal of Mental Health
Nursing, 12, 30-38.
Campbell, D. (2001). The management of acute dystonic reactions. Australian
Prescriber, 24(1), 19-20.
21
Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
Chychula, N & Sciamanna, C. (2002). Help substance abusers attain and
sustain abstinence. The Nurse Practitioner, 27(11), 30-47.
Cutcliffe, J. (2002). The beguiling effects of nurse-prescribing in mental
health nursing: re-examining the debate. Journal of psychiatric and
Mental Health Nursing, 9(3), 369-375.
Davies, T. (1997). ABC of mental health:mental health assessment. British
Medical Journal, 314(7093): 1536-1548.
Department of Health Western Australia. Office of the Chief Nursing Officer
(Eds). (2003). Business Case and Clinical Protocol Templates. Perth:
Department of Health Western Australia.
Fry AJ, O’Riorden D, Turner M & Mills KL. (2002). Survey of aggressive
incidents experienced by community mental health staff. International
Journal of Mental Health Nursing, 11, 112-120.
Gareri P, De Fazio P, Stilo M, Ferreri G & De Sarro G. (2003). Conventional
and atypical antipsychotics in the elderly. Clinical Drug Investigation,
23(5), 287-322.
Gomez, J. (1987). Liaison Psychiatry. New York : The Free Press.
Government of Western Australia, (2004). The Carers Recognition Act.
Western Australia: Government Printers.
Henshall, T. (1999). The mental state examination. Accessed on 27th
January, 2007 from the Psychjam Website:
www.psychjam.com/mental_state_examination.htm
Hill, S. (2000). The violent patient, part 2: pharmacotherapy for behavioural
emergencies. Journal of Critical Illness, September, 1-7.
IGDA WORKGROUP WPA. (2003). IGDA. 4: Evaluation of symptoms and
mental state. British Journal of Psychiatry,
182(suppl.45), s46-s47.
Keks, NA (2004). Are typical antipsychotics advantageous? – the case for.
Australian Prescriber 27(6), 146-151.
Laws, T & Rouse, K. (1996) Making sense of mental state assessment. The
Australian Nursing Journal, 4(2), 30-32.
Lawson, F, Galappathie, N, Jethwa, K, Silva do Lima, M & Soares BGO.
(2006). Anticholinergics for neuroleptic-induced parkinsonism
(protocol). Cochrane Database of Systemic Reviews, Issue 2, Art.No.:
CD005964. DOI.1002/14651858.CD005964
22
Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
Lukens TW, Wolf SJ, Edlow JA, Shahabuddin S, Allen MH, Currier GW, &
Jagoda AS (2006). Clinical policy: critical issues in the
diagnosis and management of the adult psychiatric patient in the
emergency department. Annals of Emergency Medicine, 47(1), 79-99.
Marcantonio ER. (2005). Clinical management and prevention of delirium.
Psychiatry, 4(1), 68-72
Marmot, M. (2005). Social determinants of health inequalities. The Lancet,
365:1099-1104.
Mathers, C.D., Vos, E.T., Stevensen, C.E. & Begg, S.J. (2001). The burden of
disease in australia. Bulletin of the World Health Organisation,
79(11):1076-1084.
McGeorge, M & Landow, V. (2000). Safe in our hands. Mental Health
Practice, 4(4), 5-6.
McGorry, P. (2005). ‘ Every me and every you’: responding to the hidden
challenge of mental illness in australia. Australasian psychiatry,
13(1):3-14.
MedicineNet, (2005) Mental Illness Basics. Accessed 24th May 2007 from:
http://www.medicinenet.com
MIMS (1996-2007). NSW: IMS Publishing
Muggli, E. (2002). The effectiveness of the mini mental state examination in
predicting discharge destination for genriatric patients in acute health
care. Clayton, Victoria:Centre for Clinical Effectiveness (CCE), 14.
National Collaborating Centre for Nursing and Supportive Care. (2005).
Violence: the short-term management of disturbed / violent behaviour
in psychiatric in-patient settings and emergency departments.
London(UK): National Institute for Clinical Excellence.
Newell, R. (2000). General consultation skills. In Newell R & Gournay, K
(Eds). Mental Health Nursing: An Evidenced Based Approach.
Churchill Livingstone: Edinburgh.
New Zealand Guidelines Group (NZGG) (2003). The assessment and
management of people at risk of suicide. Accessed 3rd
March 2007 from The National Guideline Clearinghouse Website: www.
guideline. Gov
Office of the Chief Psychiatrist. (1997). Clinicians’ Guide to the Mental Health
Act 1996 (3rd Ed). Perth: Department of Health.
Office of the Chief Psychiatrist. (2006). 2006 Supplement : Clinicians’ Guide to
23
Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
the Mental Health Act 1996). Perth: Department of Health.
Office of the Chief Psychiatrist, (2007). Communicating with Carers and
Families. Perth: Department of Health.
Orygen Research Centre, (2004) The Acute Phase of Early Psychosis: A
Handbook on Management. Melbourne: Orygen
Research Centre.
Peplau, H. (1994) Psychiatric mental health nursing: challenge and change.
Journal of Psychiatric and Mental Health Nursing, 1, 3-7.
Perry PJ, Alexander B & Liskow BI. (1997) Psychotropic Drug Handbook.
USA: American Psychiatric Press.
Petersen, L.A. (2003). Process of care and outcome after acute myocardial
infarction for patients with mental illness in the VA health care system:
are there disparities. Health Services Research, Feb. Accessed 19th
April, 2007 from the FindArticles Website:
http://findarticles.com/p/articles/mi_m4149/is_1_38/ai_99290659/pri…
Petersen RC, Stevens JC, Ganguli M, Tangolos EG, Cummings JL &
DeKosky ST. (2001). Practice parameter: early detection of dementia.
Mild cognitive impairment (an evidence-based review): report of the
quality standards committee of the american academy of neurology.
Database of Abstracts of Reviews of Effects, 2007, 2.
Phelan, M. (2001). Physical health of people with severe mental illness: can
be improved if primary care and mental health professionals pay
attention to it-editorial. British Medical Journal, Feb 24. Accessed 19th
April 2007 from the Find Articles Website:
http://findarticles.com/p/articles/mi_m0999/is_7284_322/ai_71820691/pri…
Robinson, D.J. (1999). Sigmundoscopy: Medical-Psychiatric ConsultationLiaison: The Bases. USA: Rapid Psychler Press.
Rose SR, Ward KR & Giorgi-Guarnieri D. (2002). Pharmocotherapeutic
options for chemical restraint – emergency medicine update. Journal
of Critical Care, Nov, 1-4.
Shaw GM, Chase JG, Rudge AD, Starfinger C, Lam Z, Lee D, Wake GC,
Greefield K & Dove R. (2003). Rethinking sedation and agitation
management in critical illness. Critical Care and Resusitation, 5, 198206.
Shea, S. (1998). Psychiatric interviewing: The art of Understanding.2nd ED.
W.B.Saunders: Philadelphia.
Sir Charles Gairdner Hospital (2004). Emergency Department Guidelines:
Restraint of Patients. Perth: Sir Charles Gairdner Hospital.
24
Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
Soares, KVS & McGrath, JJ. (1997). Anticholinergic medication for
neuroleptic-induced tardive dyskinesia (review). Cochrane Database of
Systematic Reviews, Issue 2, Art No.:CD000204. DOI:
10.1002/14651858.CD000204.
Somprakit, P, Lertakyamanee J, Satraratanamai C, Wanicksamban S,
Silapadech A, Chainchop P & Muangsuay V. (2002) Mental state
change after general and regional anesthesia in adults and elderly
patients: a randomised clinical trial. The Cochrane Register of
Controlled Trials (CENTRAL), 2.
Stoner SC, Worrel JA & Jones MT. (2000). Pharmacist-designed and –
implemented pharmaceutical care plan for antipsychotic-induced
movement disorders. Pharmacotherapy, 20(5), 583-588.
Stuart GW & Sundeen SJ (eds). (1987). Principles and Practice of Psychiatric
Nursing (3rd Ed). USA: CV Mosby Company.
Swaffer T & Hollin, C. (2000). Anger and impulse control. In Newell, R &
Gournay, K (Eds) Mental Health Nursing: An Evidenced based
Approach. Churchill Livingstone: Edinburgh.
Sullivan, P. (1998). Care and control in mental health nursing. Nursing
Standard, 13(13-15), 42-45.
Therapeutic Guidelines Ltd. (2005). Psychotropic. North Melbourne: TGA.
Therapeutic Guidelines. (2000). Psychotropic. North Melbourne: TGA.
U. S. preventative Services. (2004). Screening for suicide risk:
recommendation and rationale. Annals of internal medicine, 140(10),
820-821.
Vos, E.T. & Begg, S.J. (1999). Victorian Burden of Disease Study: Mortality.
Melbourne: Epidemiology Section, Department of Human Services.
Vos, T. & Mathers,C.D. (2000). The burden of mental disorders: a comparison
of methods between the australian burden of disease studies and the
global burden of disease study. Bulletin of the World Health
Organisation, 78(4(: 427-438.
Waddell, M. Doherty, PJ & Schweitzer, I. (1996). The Australian Psychotropic
Pharmocopoeia. Melbourne: New Litho.
Wales, P. (1998). Solution-focused brief therapy in primary care. Nursing
Times, 94(5), 48-49.
Western Australian Drugs & Therapeutics Committee (2003). Acute Arousal:
25
Sir Charles Gairdner Hospital - Nurse Practitioner Mental Health Clinical Protocols
management in Schizophrenia and Related Psychosis: A Guide for
Medical Practitioners. Perth: Western Australian Drugs & Therapeutics
Committee.
Xeniditis, K. Russell, A & Murphy, D. (2001). Management of people with
challenging behaviour. Advances in Psychiatric Treatment, 7, 109-116.