{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T01:28:53Z","timestamp":1777858133710,"version":"3.51.4"},"reference-count":33,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2018,12,19]],"date-time":"2018-12-19T00:00:00Z","timestamp":1545177600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Psychopharmacol"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>A quality improvement programme addressing prescribing practice for acutely disturbed behaviour was initiated by the Prescribing Observatory for Mental Health.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>This study analysed data from a baseline clinical audit conducted in inpatient mental health services in member trusts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Fifty-eight mental health services submitted data on 2172 episodes of acutely disturbed behaviour. A benzodiazepine alone was administered in 60% of the 1091 episodes where oral medication only was used and in 39% of the 1081 episodes where parenteral medication (rapid tranquillisation) was used. Haloperidol was combined with lorazepam in 22% of rapid tranquillisation episodes and with promethazine in 3%. Physical violence towards others was strongly associated with receiving rapid tranquillisation in men (odds ratio 1.74, 1.25\u20132.44; p&lt;0.001) as was actual or attempted self-harm in women (odds ratio 1.87, 1.19\u20132.94; p=0.007). Where physical violence towards others was exhibited, a benzodiazepine and antipsychotic was more likely to be prescribed than a benzodiazepine alone (odds ratio 1.39, 1.00\u20131.92; p=0.05). The data suggested that 25% of patients were at least \u2018extremely or continuously active\u2019 in the hour after rapid tranquillisation was administered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The current management of acutely disturbed behaviour with parenteral medication may fail to achieve a calming effect in up to a quarter of episodes. The most common rapid tranquillisation combination used was lorazepam and haloperidol, for which the randomised controlled trial evidence is very limited. Rapid tranquillisation prescribing practice was not wholly consistent with the relevant National Institute for Health and Care Excellence guideline, which recommends intramuscular lorazepam on its own or intramuscular haloperidol combined with intramuscular promethazine. Clinical factors prompting the use of rapid tranquillisation rather than oral medication may differ between the genders.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0269881118817170","type":"journal-article","created":{"date-parts":[[2018,12,19]],"date-time":"2018-12-19T08:19:47Z","timestamp":1545207587000},"page":"472-481","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["The pharmacological management of acute behavioural disturbance: Data from a clinical audit conducted in UK mental health services"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7756-1031","authenticated-orcid":false,"given":"Carol","family":"Paton","sequence":"first","affiliation":[{"name":"Royal College of Psychiatrists, Centre for Quality Improvement, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clive E","family":"Adams","sequence":"additional","affiliation":[{"name":"Institute of Mental Health, University of Nottingham, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Dye","sequence":"additional","affiliation":[{"name":"Ipswich Access and Treatment Team, Norfolk and Suffolk NHS Foundation Trust, Ipswich, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Fagan","sequence":"additional","affiliation":[{"name":"Royal College of Psychiatrists, Centre for Quality Improvement, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chike","family":"Okocha","sequence":"additional","affiliation":[{"name":"Oxleas NHS Foundation Trust, Dartford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas RE","family":"Barnes","sequence":"additional","affiliation":[{"name":"Royal College of Psychiatrists, Centre for Quality Improvement, London, UK"},{"name":"Centre for Psychiatry, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,12,19]]},"reference":[{"key":"bibr1-0269881118817170","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.185.1.63"},{"key":"bibr2-0269881118817170","doi-asserted-by":"publisher","DOI":"10.1590\/S1516-44462011000100008"},{"key":"bibr3-0269881118817170","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1176\/ajp.149.4.506","volume":"149","author":"Barbee J","year":"1992","journal-title":"Am J Psychiatry"},{"key":"bibr4-0269881118817170","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-6757(97)90119-4"},{"key":"bibr5-0269881118817170","doi-asserted-by":"publisher","DOI":"10.1186\/1471-244X-13-225"},{"key":"bibr6-0269881118817170","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v68n1207"},{"key":"bibr7-0269881118817170","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.9101tx6c"},{"key":"bibr8-0269881118817170","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v65n0315"},{"key":"bibr9-0269881118817170","first-page":"CD003441","volume":"3","author":"Douglas-Hall P","year":"2015","journal-title":"Cochrane Database of Syst Rev"},{"key":"bibr10-0269881118817170","unstructured":"Electronic Medicines Compendium (2018) Available at: www.medicines.org.uk (accessed May 2018)."},{"key":"bibr11-0269881118817170","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000120"},{"key":"bibr12-0269881118817170","unstructured":"Formic Software (2016) Available at: http:\/\/www.formic.com\/survey-software\/"},{"key":"bibr13-0269881118817170","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp068229"},{"key":"bibr14-0269881118817170","doi-asserted-by":"publisher","DOI":"10.3109\/15622975.2015.1132007"},{"key":"bibr15-0269881118817170","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.321.7273.1371"},{"key":"bibr16-0269881118817170","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1614.2002.01069.x"},{"key":"bibr17-0269881118817170","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2011.9.6865"},{"key":"bibr18-0269881118817170","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39339.448819.AE"},{"key":"bibr19-0269881118817170","volume-title":"SPSS Statistics Version 21","author":"IBM","year":"2017"},{"key":"bibr20-0269881118817170","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2015.07.005"},{"key":"bibr21-0269881118817170","first-page":"43","volume":"61","author":"Masand PS","year":"2000","journal-title":"J Clin Psychiatry"},{"key":"bibr22-0269881118817170","unstructured":"National Institute for Health and Care Excellence (2009) Borderline Personality Disorder: Recognition and Management. CG 78. London: National Institute for Health and Care Excellence. Available at: www.nice.org.uk\/guidance\/cg78."},{"key":"bibr23-0269881118817170","unstructured":"National Institute for Health and Care Excellence (2015) Violence and Aggression: Short-Term Management in Mental Health, Health and Community Settings. NG 10. Available at: https:\/\/www.nice.org.uk\/guidance\/ng10"},{"key":"bibr24-0269881118817170","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S118438"},{"key":"bibr25-0269881118817170","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.160.6.831"},{"key":"bibr26-0269881118817170","doi-asserted-by":"publisher","DOI":"10.2165\/00002018-200225020-00004"},{"key":"bibr27-0269881118817170","first-page":"CD009377","volume":"11","author":"Powney MJ","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr28-0269881118817170","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39341.608519.BE"},{"key":"bibr29-0269881118817170","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02035-3"},{"key":"bibr30-0269881118817170","unstructured":"Royal College of Psychiatrists (2014) Consensus statement on high-dose antipsychotic medication. CR190. London: Royal College of Psychiatrists. Available at: http:\/\/www.rcpsych.ac.uk\/files\/pdfversion\/CR190.pdf"},{"key":"bibr31-0269881118817170","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3956(01)00052-8"},{"key":"bibr32-0269881118817170","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7417.708"},{"key":"bibr33-0269881118817170","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2008.01797.x"}],"container-title":["Journal of Psychopharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0269881118817170","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0269881118817170","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0269881118817170","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:08:09Z","timestamp":1777507689000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0269881118817170"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,19]]},"references-count":33,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1177\/0269881118817170"],"URL":"https:\/\/doi.org\/10.1177\/0269881118817170","relation":{},"ISSN":["0269-8811","1461-7285"],"issn-type":[{"value":"0269-8811","type":"print"},{"value":"1461-7285","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12,19]]}}}