Intramuscular Ketamine Protocol as an Alternative to Physical Restraints for Electroconvulsive Therapy Administration in a Psychotic Patient

Acute psychosis can be a true emergency, and the primary goal in the evaluation of an acutely psychotic patient should be to maintain safety and prevent harm to the patient and staff. The defining symptoms of psychosis include hallucinations, delusions, disorganized thought or speech, abnormal motor behavior, and negative symptoms. This review covers the approach to the patient, and definitive treatment, disposition and outcomes for patients experiencing acute psychosis. The figure shows an interview setting in a triangular arrangement, allowing for safe egress. Tables list goals in the evaluation of the acutely psychotic patient; causes of secondary psychosis; common medication classes causing mental status change; four key questions for assessing psychotic behavior; screening assessment for psychosis; clinical features of dementia, delirium, and psychiatric illness; brief mental status examination; common medications for the treatment of acute psychosis and chemical sedation; QT-prolonging effects of commonly used antipsychotic medications; and documentation required in the use of chemical and/or physical restraints. This review contains 1 highly rendered figure, 10 tables, and 57 references.

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Acute Psychosis

10.2310/em.4374 ◽

2015 ◽

Author(s):

James Kimo Takayesu ◽

Suzanne Bird

Keyword(s):

Mental Status ◽

Negative Symptoms ◽

Motor Behavior ◽

Psychotic Patient ◽

Definitive Treatment ◽

Acute Psychosis ◽

Physical Restraints ◽

Status Change ◽

Screening Assessment ◽

Psychotic Behavior

Acute psychosis can be a true emergency, and the primary goal in the evaluation of an acutely psychotic patient should be to maintain safety and prevent harm to the patient and staff. The defining symptoms of psychosis include hallucinations, delusions, disorganized thought or speech, abnormal motor behavior, and negative symptoms. This review covers the approach to the patient, and definitive treatment, disposition and outcomes for patients experiencing acute psychosis. The figure shows an interview setting in a triangular arrangement, allowing for safe egress. Tables list goals in the evaluation of the acutely psychotic patient; causes of secondary psychosis; common medication classes causing mental status change; four key questions for assessing psychotic behavior; screening assessment for psychosis; clinical features of dementia, delirium, and psychiatric illness; brief mental status examination; common medications for the treatment of acute psychosis and chemical sedation; QT-prolonging effects of commonly used antipsychotic medications; and documentation required in the use of chemical and/or physical restraints. This review contains 1 highly rendered figure, 10 tables, and 57 references.

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Acute Psychosis

10.2310/im.4374 ◽

2015 ◽

Author(s):

James Kimo Takayesu ◽

Suzanne Bird

Keyword(s):

Mental Status ◽

Negative Symptoms ◽

Motor Behavior ◽

Psychotic Patient ◽

Definitive Treatment ◽

Acute Psychosis ◽

Physical Restraints ◽

Status Change ◽

Screening Assessment ◽

Psychotic Behavior

Acute psychosis can be a true emergency, and the primary goal in the evaluation of an acutely psychotic patient should be to maintain safety and prevent harm to the patient and staff. The defining symptoms of psychosis include hallucinations, delusions, disorganized thought or speech, abnormal motor behavior, and negative symptoms. This review covers the approach to the patient, and definitive treatment, disposition and outcomes for patients experiencing acute psychosis. The figure shows an interview setting in a triangular arrangement, allowing for safe egress. Tables list goals in the evaluation of the acutely psychotic patient; causes of secondary psychosis; common medication classes causing mental status change; four key questions for assessing psychotic behavior; screening assessment for psychosis; clinical features of dementia, delirium, and psychiatric illness; brief mental status examination; common medications for the treatment of acute psychosis and chemical sedation; QT-prolonging effects of commonly used antipsychotic medications; and documentation required in the use of chemical and/or physical restraints. This review contains 1 highly rendered figure, 10 tables, and 57 references.

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Nursing professionals’ attitudes toward use of physical restraints in Styrian nursing homes Austria

Pflege ◽

10.1024/1012-5302/a000649 ◽

2019 ◽

Vol 32 (1) ◽

pp. 57-63

Author(s):

Hannes Mayerl ◽

Tanja Trummer ◽

Erwin Stolz ◽

Éva Rásky ◽

Wolfgang Freidl

Keyword(s):

Nursing Homes ◽

Large Scale ◽

Critical Role ◽

Physical Restraint ◽

Care Practice ◽

Physical Restraints ◽

Convenience Sample ◽

Restraint Use ◽

Positive Attitudes ◽

Nursing Professionals

Abstract. Background: Given that nursing staff play a critical role in the decision regarding use of physical restraints, research has examined nursing professionals’ attitudes toward this practice. Aim: Since nursing professionals’ views on physical restraint use have not yet been examined in Austria to date, we aimed to explore nursing professionals’ attitudes concerning use of physical restraints in nursing homes of Styria (Austria). Method: Data were collected from a convenience sample of nursing professionals (N = 355) within 19 Styrian nursing homes, based on a cross-sectional study design. Attitudes toward the practice of restraint use were assessed by means of the Maastricht Attitude Questionnaire in the German version. Results: The overall results showed rather positive attitudes toward the use of physical restraints, yet the findings regarding the sub-dimensions of the questionnaire were mixed. Although nursing professionals tended to deny “good reasons” for using physical restraints, they evaluated the consequences of physical restraint use rather positive and considered restraint use as an appropriate health care practice. Nursing professionals’ views regarding the consequences of using specific physical restraints further showed that belts were considered as the most restricting and discomforting devices. Conclusions: Overall, Austrian nursing professionals seemed to hold more positive attitudes toward the use of physical restraints than counterparts in other Western European countries. Future nationwide large-scale surveys will be needed to confirm our findings.

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A Case of Catatonia in a 14-Year-Old Girl with Schizophrenia Treated with Electroconvulsive Therapy

Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie ◽

10.1024/1422-4917/a000211 ◽

2013 ◽

Vol 41 (1) ◽

pp. 69-74 ◽

Cited By ~ 10

Author(s):

Frank Häßler ◽

Olaf Reis ◽

Steffen Weirich ◽

Jacqueline Höppner ◽

Birgit Pohl ◽

...

Keyword(s):

Case Report ◽

Treatment Response ◽

Electroconvulsive Therapy ◽

Rating Scale ◽

Combined Treatment ◽

Adolescent Patient

This article presents a case of a 14-year-old female twin with schizophrenia who developed severe catatonia following treatment with olanzapine. Under a combined treatment with amantadine, electroconvulsive therapy (ECT), and (currently) ziprasidone alone she improved markedly. Severity and course of catatonia including treatment response were evaluated with the Bush-Francis Catatonia Rating Scale (BFCRS). This case report emphasizes the benefit of ECT in the treatment of catatonic symptoms in an adolescent patient with schizophrenic illness.

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