Issues on sedating mental patients

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NICE clinical guideline on violence advises that rapid tranquillisation, physical intervention and seclusion are not primary treatment techniques and should only be considered if de-escalation and other strategies have failed to calm the person.

When determining which interventions to use, it is advised that clinical need, safety of the individual and others, and, where possible, advance directives should be taken into account.

The importance of assessment of mental health status is equally important to the delivery of health care including dental care.

Indeed, if certain mental health issues are present, the patient may lack the ability to provide consent for the procedure, or medications being used to manage the mental health problem may interact with those used during dental treatment.

Again, for the cardiovascular system, questions on exercise tolerance, episodes of dyspnea, energy levels and edema, to provide a few will often provide a good estimate of cardiovascular health.

In the event that questions remain, or the disease process needs to be further categorized, there are a number of tests available to assist in the diagnostic process.

Lorazepam has a short half-life, which limits the risk of excessive sedation.

If benzodiazepines are contraindicated or have previously been ineffective, antipsychotics are commonly considered; however, they can cause adverse extrapyramidal and cardiovascular adverse effects.

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It is available as oral and injectable formulations.

Using a combination of a benzodiazepine and an antipsychotic can allow a lower dose of antipsychotic to be used (see the NICE full guideline on violence).

The NICE clinical guideline on violence advises that oral medication should be offered for rapid tranquillisation whenever possible.

The NICE full guideline on violence defines rapid tranquillisation as the use of medication to calm or lightly sedate the person and reduce the risk to self and others.

The aim is to control severe mental and behavioural disturbance (including aggression associated with schizophrenia, mania and other psychiatric conditions) to allow a thorough psychiatric evaluation to take place, while allowing comprehension and response to spoken messages throughout.

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