Current practices in managing acutely disturbed patients at three hospitals in Rio de Janeiro-Brazil: a prevalence study.
BACKGROUND
The medical management of aggressive and violent behaviour is a critical situation for which there is little evidence. In order to prepare for a randomised trial, due to start in the psychiatric emergency rooms of Rio de Janeiro in 2001, a survey of current practice was necessary.


METHODS
A seven day survey of pharmacological management of aggressive people with psychosis in the emergency rooms of all four public psychiatric hospitals in Rio de Janeiro, Brazil.


RESULTS
In one hospital data were not available. Of the 764 people with psychosis attending these ERs, 74 were given IM medication for rapid tranquillisation (9.7%, 2.1/week/100,000). A haloperidol-promethazine mix (with or without other drugs) was used for the majority of patients (83%).


CONCLUSIONS
The haloperidol-promethazine mix, given intramuscularly for rapid tranquilization, is prevalent in Rio, where it is considered both safe and efficient. However, scientific evaluation of all pharmacological approaches to rapid tranquilization of psychotic people is inadequate or incomplete and a randomized trial of IM haloperidol-promethazine is overdue.
Huf
Gisele
G
Ministry of Health, Brazil. gisele@ensp.fiocruz.br
da Silva Freire Coutinho
Evandro
E
Fagundes
Hugo M
HM
Oliveira
Edmar S
ES
Lopez
Jose Ramon R A
JR
Gewandszajder
Marcio
M
da Luz Carvalho
Andreia
A
Keusen
Alexandre
A
Adams
Clive E
CE
D000374:Aggression / Q000187:drug effects / Q000523:psychology; D001569:Benzodiazepines / Q000627:therapeutic use; D001938:Brazil; D002985:Clinical Protocols; D004338:Drug Combinations; D004363:Drug Utilization; D004637:Emergency Services, Psychiatric / Q000458:organization & administration*; D006220:Haloperidol / Q000008:administration & dosage / Q000627:therapeutic use; D006778:Hospitals, Psychiatric / Q000458:organization & administration*; D006779:Hospitals, Public / Q000458:organization & administration; D006801:Humans; D007273:Injections, Intramuscular; D001523:Mental Disorders / Q000188:drug therapy* / Q000523:psychology; D011398:Promethazine / Q000008:administration & dosage / Q000627:therapeutic use; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012107:Research Design
D004338:Drug Combinations; D001569:Benzodiazepines; D011398:Promethazine; D006220:Haloperidol