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Técnicas de desescalada para la agresión o la agitación inducida por la psicosis

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References

References to studies excluded from this review

Nijman 1997 {published data only}

Nijman HL, Merckelbach HL, Allertz WF, a Campo JM. Prevention of aggressive incidents on a closed psychiatric ward. Psychiatric Services 1997;48(5):694‐8. [MEDLINE: 9144826]CENTRAL

Additional references

Ahmed 2010

Ahmed U, Jones H, Adams CE. Chlorpromazine for psychosis‐induced aggression or agitation. Cochrane Database of Systematic Reviews 2010, Issue 4. [DOI: 10.1002/14651858.CD007445.pub2; PUBMED: 20393959]

Ahmed 2011

Ahmed U, Rehman F, Jones H, Adams CE. Risperidone for psychosis‐induced aggression or agitation. Cochrane Database of Systematic Reviews 2011, Issue 11. [DOI: 10.1002/14651858.CD009412]

Altman 1996

Altman DG, Bland JM. Detecting skewness from summary information. BMJ 1996;313(7066):1200.

Andrade 2007

Andrade C. Rapid Tranquillsation in emergency psychiatric settings. BMJ 2007;335:835.

Andreeva 2011

Andreeva V, Dartinet‐Chalmey V, Kloul A, Fromage B, Kadri N. "Snoezelen": Multisensorial stimulation effects on behavioural problems in elderly demented patients ["Snoezelen" ou les effets de la stimulation multisensorielle sur les troubles du comportement chez les personnes âgées démentes à un stade avancé]. NPG Neurologie ‐ Psychiatrie ‐ Geriatrie 2011;11(61):24‐9.

Belgamwar 2005

Belgamwar RB, Fenton M. Olanzapine IM or velotab for acutely disturbed/agitated people with suspected serious mental illnesses. Cochrane Database of Systematic Reviews 2005, Issue 2. [DOI: 10.1002/14651858.CD003729.pub2]

Berk 2004

Berk M, Rathbone J, Mandriota‐Carpenter SL. Clotiapine for acute psychotic illnesses. Cochrane Database of Systematic Reviews 2004, Issue 4. [DOI: 10.1002/14651858.CD002304.pub2]

Bland 1997

Bland JM. Trials randomised in clusters. BMJ 1997;315:600.

Boissel 1999

Boissel JP, Cucherat M, Li W, Chatellier G, Gueyffier F, Buyse M, et al. The problem of therapeutic efficacy indices. 3 Comparison of the indices and their use [Apercu sur la problematiquedes indices d'efficacite therapeutique 3: comparison des indices et utilisation. Groupe d'etude des indices d'efficacite]. Therapie 1999;54(4):405‐11.

Bourget 2002

Bourget D, El‐Guebaly N, Atkinson M. Assessing and managing violent patients. CPA Bulletin de l’APC2002:25‐7.

Bowers 2011

Bowers L, Stewart D, Papadopoulos C, Dack C, Ross J, Khanom D. Inpatient violence and aggression: A literature review. Report from the Conflict and Containment Reduction Research Programme. http://www.kcl.ac.uk/ioppn/depts/hspr/research/ciemh/mhn/projects/litreview/LitRevAgg.pdf 2011 [Accessed 06/02/2017].

Casby 1994

Casby JA, Holm MB. The effect of music on repetitive disruptive vocalizations of persons with dementia. American Journal of Occupational therapy 1994;48(10):883‐9.

CRAG 1996

Clinical Research and Audit Guidelines (CRAG) Working Group on Mental Illness. The prevention and management of aggression ‐ a good practice statement. Scottish Office, National Health Service in Scotland1996. [ISBN 0748031448, 9780748031443]

Deeks 2000

Deeks J. Issues in the selection for meta‐analyses of binary data. Proceedings of the 8th International Cochrane Colloquium; 2000 Oct 25‐28; Cape Town. Cape Town: The Cochrane Collaboration, 2000.

Divine 1992

Divine GW, Brown JT, Frazier LM. The unit of analysis error in studies about physicians' patient care behaviour. Journal of General Internal Medicine 1992;7(6):623‐9.

Donner 2002

Donner A, Klar N. Issues in the meta‐analysis of cluster randomised trials. Statistics in Medicine 2002;21:2971‐80.

Douglas‐Hall 2015

Douglas‐Hall P, Whicher EV. 'As required' medication regimens for seriously mentally ill people in hospital. Cochrane Database of Systematic Reviews 2015, Issue 12. [DOI: 10.1002/14651858.CD003441.pub3; CD003441]

Egger 1997

Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315:629‐34.

Elbogen 2009

Elbogen EB, Johnson SC. The intricate link between violence and mental disorder:results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 2009;66:152‐61.

Elbourne 2002

Elbourne D, Altman DG, Higgins JPT, Curtina F, Worthingtond HV, Vaile A. Metah‐analyses involving cross‐over trials: methodological issues. International Journal of Epidemiology 2002;31(1):140‐9.

Fazel 2006

Fazel S, Grann M. The population impact of severe mental illness on violent crime. American Journal of Psychiatry 2006;163:1397‐403.

Furukawa 2006

Furukawa TA, Barbui C, Cipriani A, Brambilla P, Watanabe N. Imputing missing standard deviations in meta analyses can provide accurate results. Journal of Clinical Epidemiology 2006;59(7):7‐10.

Garland 2007

Garland K, Beer E, Eppingstall B, O'Connor DW. A comparison of two treatments of agitated behaviour in nursing home residents with dementia: Simulated family presence and preferred music. American Journal of Geriatric Psychiatry 2007;15(6):514‐21.

Gillies 2013

Gillies D, Sampson S, Beck A, Rathbone J. Benzodiazepines for psychosis‐induced aggression or agitation. Cochrane Database of Systematic Reviews 2013, Issue 4. [DOI: 10.1002/14651858.CD003079.pub3]

Gulliford 1999

Gulliford MC. Components of variance and intraclass correlations for the design of community‐based surveys and intervention studies: data from the Health Survey for England 1994. American Journal of Psychiatry 1978;135(3):325‐8.

Hawranik 2008

Hawranik P, Johnson P, Deatrich J. Therapeutic touch and agitation in individuals with Alzheimer's disease. Western Journal of Nursing Research 2008;30:417‐34.

Higgins 2003

Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327:557‐60.

Higgins 2011

Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Hockenhull 2012

Hockenhull JC, Whittington R, Leitner M, Barr W, McGuire J, Cherry MG, et al. A systematic review of prevention and intervention strategies for populations at high risk of engaging in violent behaviour:update 2002–8. Health Technology Assessment 2012;16(3):1‐152.

Huf 2016

Huf G, Alexander J, Gandhi P, Allen M. Haloperidol plus promethazine for psychosis‐induced aggression. Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 2016, issue 11. [DOI: 10.1002/14651858.CD005146.pub3; CD005146]

Jayakody 2012

Jayakody K, Gibson RC, Kumar A, Gunadasa S. Zuclopenthixol acetate for acute schizophrenia and similar serious mental illnesses. Cochrane Database of Systematic Reviews 2012, Issue 4. [DOI: 10.1002/14651858.CD000525.pub3]

Kaplan 1983

Kaplan S, Wheeler E. Survival skills for working with potentially violent clients. Social Casework 1983;64(6):339‐46.

Kay 1986

Kay SR, Opler LA, Fiszbein A. Positive and Negative Syndrome Scale (PANSS) Manual. North Tonawanda, NY: Multi‐Health Systems, 1986.

Khokhar 2016

Khokhar MA, Rathbone J. Droperidol for psychosis‐induced aggression or agitation. Cochrane Database of Systematic Reviews 2016, Issue 12. [DOI: 10.1002/14651858.CD002830.pub3]

Khushu 2016

Khushu A, Powney MJ. Haloperidol for long‐term aggression in psychosis. Cochrane Database of Systematic Reviews 2016, Issue 11. [DOI: 10.1002/14651858.CD009830.pub2]

Lee 2005

Lee SY. The effect of lavender aromatherapy on cognitive function, emotion, and aggressive behaviour of elderly with dementia. Taehan Kanho Hakhoe Chi 2005;35(2):303‐12.

Leucht 2005

Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel RR. What does the PANSS mean?. Schizophrenia Research 2005;79(2‐3):231‐8. [PUBMED: 15982856]

Leucht 2005a

Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel R. Clinical implications of brief psychiatric rating scale scores. British Journal of Psychiatry 2005;187:366‐71.

Leucht 2007

Leucht S, Engel RR, Bauml J, Davis JM. Is the superior efficacy of new generation antipsychotics an artefact of LOCF?. Schizophrenia Bulletin 2007;33(1):183‐91.

Levenson 2004

Levenson JL. American Psychiatric Publishing Book of Psychosomatic Medicine. American Psychiatric Association, 2004.

LYPFT 2013

Leeds and York Partnerships NHS Trust. Innovation Research and Development Newsletter2013; Vol. March, issue 13:1‐19.

Maguire 2007

Maguire J, Ryan D. Aggression and violence in mental health services: categorizing the experiences of Irish nurses. Journal of Psychiatric and Mental Health Nursing 2007;14:120‐7.

Marshall 2000

Marshall M, Lockwood A, Bradley C, Joy C, Fenton M. Unpublished rating scales ‐ a major source of bias in randomised controlled trials of treatments for schizophrenia. British Journal of Psychiatry 2000;176:249‐52.

Muralidharan 2006

Muralidharan S, Fenton M. Containment strategies for people with serious mental illness. Cochrane Database of Systematic Reviews 2006, Issue 3. [DOI: 10.1002/14651858.CD002084.pub2]

NHS Protect 2013

NHS Protect. Reported physical assaults on NHS staff figures (2012‐2013). Available from: http://www.nhscounterfraud.nhs.uk/2012‐13%20Reported%20physical%20assaults%20on%20NHS%20staff%20NO%20PCT%20&%20SHA%20v2%20PCC.pdf. London: NHS Security Management Services2013.

NICE 2015

Violence and aggression: short‐term management in mental health, health and community settings. NICE guidelines [NG10]May 2015.

Overall 1962

Overall JE, Gorham DR. The brief psychiatric rating scale. Psychological Reports 1962;10:799‐812.

Paterson 1997

Paterson B, Leadbetter D. McComish A. De escalation in the short term management of violence ‐ A process based approach. Nursing Times 1997;93(36):58‐61.

Powney 2012

Powney MJ, Adams CE, Jones H. Haloperidol for psychosis‐induced aggression or agitation (rapid tranquillisation). Cochrane Database of Systematic Reviews 2012, Issue 11. [DOI: 10.1002/14651858.CD009377.pub2; PUBMED: 23152276]

Rao 1992

Rao JNK, Scott AJ. A simple method for the analysis of clustered binary data.. Biometrics 1992;48:577‐85.

Rao 2013

Rao H. Survey of management techniques among staff in acute inpatient mental health units in LYPFT. MSc Psychiatry Dissertation2013.

Rix 2001

Rix R. De‐escalation techniques. In: Beer MD, Pereira SM, Paton C editor(s). Psychiatric Intensive Care. GreenwichMedical Media Limited, 2001.

Sailas 2000

Sailas E, Fenton M. Seclusion and restraint for people with serious mental illnesses. Cochrane Database of Systematic Reviews 2000, Issue 2. [DOI: 10.1002/14651858.CD001163]

Schünemann 2008

Schünemann HJ, Oxman AD, Vist GE, Higgins JPT, Deeks JJ, Glasziou P, et al. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration, 2008:359‐83.

Spencer 2016

Spencer S, Johnson P. De‐escalation techniques for managing aggression. Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 2016, issue 1. [DOI: 10.1002/14651858.CD012034; CD012034]

Stefan 2002

Stefan S. Legal and regulatory aspects of seclusion and restraint in mental health settings. Special edition: Violence and Coercion in Mental Health Settings: Eliminating the Use of Seclusion and Restraint. NTAC Networks.2002;Summmer/Fall; Vol. 3.

Toal 2012

Toal F, Roberts K. Clozapine for people with schizophrenia and recurrent physical aggression. Cochrane Database of Systematic Reviews.

Ukomunne 1999

Ukoumunne OC, Gulliford MC, Chinn S, Sterne JA, Burney PG. Methods for evaluating area‐wide and organisation‐based interventions in health and health care: a systematic review [Methods for evaluating area‐wide and organisation‐based interventions in health and health care: a systematic review]. Health Technology Assessment 1999;3:5.

van Dorn 2012

van Dorn R, Volavka J, Johnson N. Mental disorder and violence: is there arelationship beyond substance use?. Social Psychiatry and Psychiatric Epidemiology 2012;47:487‐503.

Vangala 2012

Vangala R, Ahmed U, Ahmed R. Loxapine inhaler for psychosis‐induced aggression or agitation. Cochrane Database of Systematic Reviews 2012, Issue 11. [DOI: 10.1002/14651858.CD010190]

Weiss 1998

Weiss EM. Deadly restraint: a Hartford Courant investigative report. Hartford Courant. October 1998;Section A.1:11‐5.

Wilkie 2012

Wilkie F, Fenton M. Quetiapine for psychosis‐induced aggression or agitation. Cochrane Database of Systematic Reviews 2012, Issue 4. [DOI: 10.1002/14651858.CD009801]

Xia 2009

Xia J, Adams CE, Bhagat N, Bhagat V, Bhoopathi P, El‐Sayeh H, et al. Loss to outcomes stakeholder survey: the LOSS study. Psychiatric Bulletin 2009;33(7):254‐7.

Yeung 2009

Yeung W‐L, Jayaram M, Kotha S, Adams CE. Is NICE nice?. RCGP Annual National Primary Care Conference, Excellence in Practice: winning ways for primary care; 2009 Nov 5‐7; Glasgow. 2009.

References to other published versions of this review

Rao 2012

Rao H, Yeung WL, Jayaram MB. De‐escalation techniques for psychosis‐induced aggression or agitation. Cochrane Database of Systematic Reviews 2012, Issue 7. [DOI: 10.1002/14651858.CD009922]

Characteristics of studies

Characteristics of excluded studies [ordered by study ID]

Study

Reason for exclusion

Nijman 1997

Allocation: not randomised.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Table 2. Outline design for a randomised trial of de‐escalation technique

Methods

Allocation: cluster‐randomised, clearly described, with researched and recorded intra‐class correlation coefficient (ICC) reported.

Blinding: none.

Duration: 2 weeks.

Setting: any psychiatric ward with high rate of aggression.

Participants

Diagnosis: any.

History: people admitted or, or getting admitted to psychiatric ward.

N =*.

Age: adult.

Sex: men or women.

Exclude: those already randomised.

Interventions

1. De‐escalation technique training.

2. Waiting list for training.

The de‐escalation technique training could involve refining of: a. Verbal communication techniques; b. Use of body language; c. Prevention and recognition strategies (risk assessment tools); d. Staff attitudes, knowledge and skills; e. Setting of limits for patients to follow; f. Environmental controls (such as minimising light, noise, conversations and so on) used for the management of aggression ‐ or any combination of these.

Outcomes

Primarily routinely‐recorded binary outcomes.

1. Clinically important changes in global state (short‐term outcomes)

2. Aggression

2.1 Improved to an important extent
2.2 Deterioration: incidence of violence to self or others (harm)
2.3 Changes in aggression as recorded by any other outcomes

2.4 Recurrance of aggression

3. Adverse effects

3.1 Physical adverse effects
3.2 Death, suicide or natural causes
3.3 Psycological adverse effects

4. Service outcomes

4.1 Time in hospital

5. Acceptability

5.1 To staff

5.2 To patients

6. Cost

Notes

* We are unclear of power calculations at this point. It is likely that the sample of people will have to total at least 300 to gain sufficient power to find clear outcomes that are likely to effect clinical practice, but this figure would have to be modified depending on a well‐researched (not imputed) ICC.

Figures and Tables -
Table 2. Outline design for a randomised trial of de‐escalation technique
Summary of findings for the main comparison. De‐escalation for aggression thought to be due to psychosis versus standard care

Patient or population: people who are aggressive secondary to serious mental illness
Settings: anywhere
Intervention: de‐escalation versus standard care

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Standard care control

De‐escalation technique

Clinically important changes in global state

We identified no relevant studies.

Aggression ‐ Improved to an important extent

Aggression ‐ deterioration: incidence of violence to self or others

Aggression ‐ changes in aggression as recorded by any other outcomes

Adverse effects ‐

physical adverse effects

Adverse effects ‐ death, suicide or natural causes

Adverse effects ‐ psychological adverse effects

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

Figures and Tables -
Summary of findings for the main comparison. De‐escalation for aggression thought to be due to psychosis versus standard care
Table 1. Other relevant Cochrane reviews

Focus of review

Reference

Completed and maintained reviews

'As required' medication regimens for seriously mentally ill people in hospital

Douglas‐Hall 2015

Benzodiazepines for psychosis‐induced aggression or agitation

Gillies 2013

Chlorpromazine for psychosis‐induced aggression or agitation

Ahmed 2010

Clotiapine for acute psychotic illnesses

Berk 2004

Containment strategies for people with serious mental illness

Muralidharan 2006

Droperidol for acute psychosis

Khokhar 2016

Haloperidol for psychosis‐induced aggression or agitation (rapid tranquillisation)

Powney 2012

Haloperidol plus promethazine for psychosis‐induced aggression

Huf 2016

Olanzapine IM or velotab for acutely disturbed/agitated people with suspected serious mental illnesses

Belgamwar 2005

Seclusion and restraint for serious mental illnesses

Sailas 2000

Zuclopenthixol acetate for acute schizophrenia and similar serious mental illnesses

Jayakody 2012

Reviews in the process of being completed

Clozapine for people with schizophrenia and recurrent physical aggression

Toal 2012

De‐escalation techniques for managing aggression

Spencer 2016

Haloperidol for long‐term aggression in psychosis

Khushu 2016

Loxapine inhaler for psychosis‐induced aggression

Vangala 2012

Quetiapine for psychosis‐induced aggression or agitation

Wilkie 2012

Risperidone for psychosis‐induced aggression or agitation

Ahmed 2011

Figures and Tables -
Table 1. Other relevant Cochrane reviews