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Specialist ServicesSecure Adolescent Inpatient
Published in Cathy Laver-Bradbury, Margaret J.J. Thompson, Christopher Gale, Christine M. Hooper, Child and Adolescent Mental Health, 2021
All three of the following must apply: The young person is under 18 years of age at the time of referral. The young person admitted to an Adolescent PICU will be subject to an order within part 2 of the Mental Health Act. An Adolescent PICU setting will not be appropriate for young people subject to hospital admission under part 3 of the Mental Health Act (this includes admissions for assessment under sections 35 and 36). The young person cannot be appropriately and safely managed in an open inpatient or community environment. This means that the young person will either present a risk of harm to others or themselves and suffers from an acute behavioural disturbance as a result of a mental disorder that requires intensive and acute inpatient care, specialist risk management procedures and a specialist treatment intervention. (Young people may be accepted with pending criminal charges if subject to part 2 of the Mental Health Act.)
Police custodial healthcare
Published in Jason Payne-James, Richard Jones, Simpson's Forensic Medicine, 2019
Jason Payne-James, Richard Jones
The key practical element in care of the detained (or about to be detained) individual is to differentiate between an aggressive individual who is trying to avoid arrest, and an individual with ExDS (or an acute behavioural disturbance). Such an individual represents a medical emergency and requires immediate transport to a medical facility with full resuscitation and life support capability. A Special Panel Review of Excited Delirium produced a simple ‘aide memoire’ to assist in making this crucial diagnosis (Figure 16.5). The UK Faculty of Forensic and Legal Medicine and the Royal College of Emergency Medicine have produced guidelines on management in police custody of acute behavioural disturbance.
A Prospective Study of the Safety and Effectiveness of Droperidol in Children for Prehospital Acute Behavioral Disturbance
Published in Prehospital Emergency Care, 2019
Colin B. Page, Lachlan E. Parker, Stephen J. Rashford, Katherine Z. Isoardi, Geoffrey K. Isbister
Acute behavioral disturbance is a common and increasing problem for health care workers both in the emergency department (1) (ED) and in the prehospital environment (2, 3). The pharmacological management of acute behavioral disturbance in adults has been well studied in the ED setting. There are studies investigating benzodiazepines (4), antipsychotics (5), and ketamine (6), as well as comparisons of different drugs (7–9) and different routes of administration (10). In the prehospital setting, there are a small number of studies of midazolam, droperidol and haloperidol in adults to guide management (11–15). In a before and after study of midazolam and droperidol, we showed that intramuscular (IM) droperidol was safer and more effective than midazolam for the management of adults (≥16 years) with acute behavioral disturbance (14). Prehospital ketamine has also been studied (16), but there are concerns about its adverse effect profile when used as a first line agent (15, 17–19).
A Prospective Before and After Study of Droperidol for Prehospital Acute Behavioral Disturbance
Published in Prehospital Emergency Care, 2018
Colin B. Page, Lachlan E. Parker, Stephen J. Rashford, Emma Bosley, Katherine Z. Isoardi, Frances E. Williamson, Geoffrey K. Isbister
A limitation of studies that investigate sedative agents used in acute behavioral disturbance is the difference in the etiology of the behavioral disturbance between study groups, which can cause confounding. Some causes of acute behavioral disturbance may be more prone than others to respond differently and/or have a higher frequency of adverse events. The combination of alcohol and benzodiazepines may predispose to a higher rate of adverse events from over sedation (7). In this study, as in ED studies (7, 10, 11), alcohol was the most common cause of acute behavioral disturbance in both the midazolam and droperidol groups. The proportion of patients with alcohol as a cause of acute behavioral disturbance was similar in both groups as were other causes of acute behavioral disturbance. This may result in more patients being over-sedated in the midazolam group due to the combination of a benzodiazepine and alcohol. However, this further highlights the increased risk with the use of midazolam in this subgroup of patients.