Rapid tranquillisation of the acutely disturbed patient

This is a substantial revision of a previous module by Dr Stephen Pereira, Dr Deepak Garg and Dr David Branford. The authors acknowledge their contribution.

Disturbed or violent behaviour by an individual in an in-patient psychiatric setting poses a serious risk to that individual, other patients and staff.

Immediate management of such situations is necessary to ensure the safety of other patients and staff and to reduce the patient’s level of distress.

Although non-pharmacological and oral pharmacological solutions should be attempted first, sometimes rapid tranquilisation (RT) is required.

NICE (2015) and BAP guidelines define rapid tranquillisation as 'the use of medication by the parenteral route if oral medication is not possible or appropriate and urgent sedation with medication is needed'.

The interventions used should be the minimum required to calm the patient.