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Guidelines for Behavioral Emergencies

The Expert Consensus Guidelines on behavioral emergencies that were published in 2001 (2) provided a needed starting point for standardization of treatment in this area—treatment that is based on empirical evidence. However, more data on strategies in use and their outcomes need to be gathered before a more definitive, evidence-based approach can be developed. One of the areas of study recommended by the expert panel is the influence of race, ethnicity, and culture. Our group attempted to shed some light on this area by assembling two additional expert panels from outside North America, one from Italy and one from countries of the former Soviet Union.

In order to maximize the value and comparability of our data, we attempted to follow the methods used by the North American expert panel. We used the same questionnaire (translated into Italian and Russian) and mailed it to recognized experts in emergency psychiatry. A comparison of the three different sets of consensus guidelines reveals some similarities, which help legitimize some aspects of the original guidelines.

Treatment approaches on which all panels agreed form a core of practices on which psychiatrists who manage behavioral emergencies can rely, because they are embraced (and therefore presumed effective) by three expert panels operating in very diverse settings. One of the strategies on which all three panels agreed unanimously was the preference for intravenous formulations of antipsychotics and benzodiazepines because of the rapidity of onset. They also agreed that the first choice among intramuscular formulations should be a second-generation antipsychotic, because of its superior efficacy and safety profile compared with first-generation antipsychotics and benzodiazepines.

However, some differences between the guidelines are thought provoking and may ultimately spark discussion that leads to more refined practice in this area of psychiatric care. In defining the short- and long-term goals of intervention in an acute crisis, the Italian and North American panels cited the control of aggressive behavior as the primary goal. However, the panel from the former Soviet Union countries felt that cooperation with the patient should be the primary goal of any intervention

More analysis is needed in the areas of disagreement to ascertain the reasons for these differences and to determine which strategy is indeed optimal in a given setting. Our hope is that these results will carry forward the impetus that began with the publication of the original North American guidelines in 2001 and that more administrators and clinicians will allocate the time and resources needed to further refine evidence-based protocols for managing behavioral emergencies. More information on the Italian and former Soviet Union panels is available at www.psyter.org.

Mario Di Fiorino, M.D., Arman Danielyan, M.D. and Alfredo Gemignani, M.D.

Footnotes

Dr. Di Fiorino and Dr. Gemignani are affiliated with the department of psychiatry at Versilia General Hospital in Lido di Camaiore, Italy. Dr Danielyan is affiliated with the National Institute of Mental Health in Yerevan, Armenia.

Reference

1. Di Fiorino M, Danielyan A, Yevchuk S, et al: The clinical management of the aggressive patient in behavioural emergency: some differences between Italy, North America, and former Soviet Union. Bridging Eastern and Western Psychiatry 3:16–23,2005. Available at www.psyter.org
2. Allen MH, Currier GW, Hughes DH, et al: The Expert Consensus Guideline Series: treatment of behavioral emergencies. Postgraduate Medicine 110(special no):1–88,2001

Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by Di Fiorino, M. Articles by Gemignani, A. Search for Related Content PubMed Citation Articles by Di Fiorino, M. Articles by Gemignani, A. General Topics in Psychiatry Chronically Mentally Ill Patients Patient Advocacy Patient Satisfaction, Quality of Life Crisis and Emergency Treatment Hospitals, Hospital Treatment Quality of Care, Practice Guidelines Service Utilization Other Health Services Issues Research Design, Methodology Other Violence/Aggression

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