Técnicas de desescalada para la agresión o la agitación inducida por la psicosis
Información
- DOI:
- https://doi.org/10.1002/14651858.CD009922.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 03 abril 2017see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Esquizofrenia
- Copyright:
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- Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
HR and MJ devised the protocol for the study.
HR and WY reviewed the abstracts of the studies obtained from the search.
MJ reviewed the abstracts of a random sample of the search studies.
MD, SY, WS and HR completed the first draft of this review manuscript.
MD and SZ revised the review manuscript.
XM and JX reviewed and final proofed the manuscript.
Sources of support
Internal sources
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Leeds PFT, UK.
External sources
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Inner Mongolia Medical University, Inner Mongolia, China.
One million projects of Science and Technology. Project code: YKD2013KJBW006
Declarations of interest
All review authors have no known conflicts of interest.
Review authors JX and SZ work for Systematic Review Solutions which is an independent health care research company.
Acknowledgements
The Cochrane Schizophrenia Group Editorial Base in Nottingham produces and maintains standard text for use in the Methods section of their reviews. We have used this text as the basis of what appears here and adapted it as required.
The search terms for the protocol were developed, in collaboration with the review authors, by the Information Specialist of the Cochrane Schizophrenia Group, Samantha Roberts. We would like to thank Mohamed Gomaa and Seyed Mazloomi for peer reviewing this version of the review.
Version history
| Published | Title | Stage | Authors | Version |
| 2017 Apr 03 | De‐escalation techniques for psychosis‐induced aggression or agitation | Review | Maolin Du, Xuemei Wang, Shaohua Yin, Wei Shu, Ruiqi Hao, Sai Zhao, Harish Rao, Wan‐Ley Yeung, Mahesh B Jayaram, Jun Xia | |
| 2012 Jul 11 | De‐escalation techniques for psychosis‐induced aggression or agitation | Protocol | Harish Rao, Wan‐Ley Yeung, Mahesh B Jayaram | |
Differences between protocol and review
We have amended the objective of the review and description of participants to reflect our title more accurately, that is, to investigate effects of de‐escalation techniques in the management of aggression due to psychosis. We have stated the age of participants more clearly.
We have also updated Types of interventions to clarify the description of de‐escalation techniques.
For Types of outcome measures, we added adverse events as a primary outcome and an outcome of interest for the 'Summary of findings' table.
A new team of authors joined the original review authors of the protocol and helped to complete the review.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Humans;
PICO
Study flow diagram.
| 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 2.4 Recurrance of aggression 3. Adverse effects 3.1 Physical 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. |
| Patient or population: people who are aggressive secondary to serious mental illness | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of Participants | Quality of the evidence | 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). | ||||||
| GRADE Working Group grades of evidence | ||||||
| Focus of review | Reference |
| Completed and maintained reviews | |
| 'As required' medication regimens for seriously mentally ill people in hospital | |
| Benzodiazepines for psychosis‐induced aggression or agitation | |
| Chlorpromazine for psychosis‐induced aggression or agitation | |
| Clotiapine for acute psychotic illnesses | |
| Containment strategies for people with serious mental illness | |
| Droperidol for acute psychosis | |
| Haloperidol for psychosis‐induced aggression or agitation (rapid tranquillisation) | |
| Haloperidol plus promethazine for psychosis‐induced aggression | |
| Olanzapine IM or velotab for acutely disturbed/agitated people with suspected serious mental illnesses | |
| Seclusion and restraint for serious mental illnesses | |
| Zuclopenthixol acetate for acute schizophrenia and similar serious mental illnesses | |
| Reviews in the process of being completed | |
| Clozapine for people with schizophrenia and recurrent physical aggression | |
| De‐escalation techniques for managing aggression | |
| Haloperidol for long‐term aggression in psychosis | |
| Loxapine inhaler for psychosis‐induced aggression | |
| Quetiapine for psychosis‐induced aggression or agitation | |
| Risperidone for psychosis‐induced aggression or agitation | |
