Empathy, Normalization and De-escalation : Management of the Agitated Patient in Emergency and Critical Situations

This book describes theory and techniques of empathic communication, normalization and de-escalation procedures for the management of aggressive or violent patients in clinical critical settings'. Consisting of 9 chapters, it discusses in detail the self-regulation of empathy in potential dangerous interactions, as well as common mistakes and nonprofessional reactions. It also explores the basic concept of neurobiology of violence and aggression behaviour, such as brain circuitry and neuromodulators, and other rapid tranquillization guidelines. The final chapter focuses on the crucial topics of post-aggression debriefing. Based on the clinical experience of the editors and authors, who work in emergency psychiatry settings, the book offers practical key expressions to promote a normalization talk, to calm agitated individuals, and to prevent crises both for psychiatric patients and people without mental disorders. It is a useful tool to help readers gain confidence as mediators in critical circumstances and will be of interest for a wide range of practitioners in healthcare settings, from psychiatrists and psychologists, to nurses and other healthcare workers. Preface Introduction: Meaning of the END Methods Contents 1: Psychomotor Agitation and Aggression 1.1 Introduction and Definition 1.2 Epidemiology 1.3 Clinical Conditions of Agitation and Aggression 1.4 Neurobiology 1.5 Agitation and Aggression: Settings and Clinical Implications 1.5.1 Agitation and Aggression in Psychiatric Emergency Service: Introduction and Methods 1.5.2 Primary Reason of Psychiatric in Emergency Room 1.5.3 Dimensional Approach to Agitation and Aggression and Psychopathological Clusters in ER 1.5.4 Overall Considerations 1.6 Agitation and Aggression in Psychiatric Intensive Care Unit 1.7 Conclusions References 2: Neurobiology of Aggression and Violence 2.1 Introduction 2.2 Genetic and Molecular Underpinnings of Human Aggression 2.3 Neurophysiological Underpinnings of Human Aggression 2.4 Conclusion References 3: Empathy Regulation in Crisis Scenario 3.1 Introduction 3.2 Definition 3.3 Neural Bases of Empathy 3.4 Empathic Communication and Its Mechanism of Action 3.5 Is Empathy a Skill for Everyone? 3.6 Summary References 4: The End Method: Normalization 4.1 Introduction to the Concept 4.2 Normalization in the Clinical Management of Severe Mental Disorders and other Medical Conditions References 5: De-escalation Techniques in Various Settings 5.1 Introduction 5.2 Definition and Concept Evolution 5.3 Neurobiological Correlates 5.4 Techniques and Methods 5.4.1 Risk Assessment 5.5 Clinical Examples 5.5.1 The Disorganized Patient 5.5.2 The Psychotic Patient 5.5.2.1 Clinical Example 5.5.3 The Manic Patient 5.5.3.1 Clinical Example 5.5.4 The Angry Patient 5.5.5 The Patient with Suicidal Ideation 5.5.5.1 Clinical Example 5.5.6 The Patient Suffering Severe Withdrawal from Intoxicating Substances 5.6 Conclusions References 6: Rapid Tranquillisation 6.1 Introduction and Overview 6.2 Aims of Rapid Tranquillisation 6.3 General Principles to Follow When Treating an Agitated Patient 6.4 Assessment. Aetiology and Differential Diagnosis 6.5 Assessing Agitated Behaviour 6.6 Reduced Agitated Behaviour and Meta-analytic Findings 6.7 Proportion of Patients Reaching Calmness 6.7.1 Benzodiazepines 6.7.2 Antipsychotics (With or Without Additional Medication) 6.8 Time Needed to Reach Calmness 6.9 Adverse Events 6.9.1 Oversedation 6.9.2 Movement Disorders 6.9.2.1 Benzodiazepines 6.9.2.2 Antipsychotics 6.9.3 Cardiovascular Adverse Effects 6.9.3.1 Benzodiazepines 6.9.3.2 Antipsychotics 6.9.4 Alterations in Blood Pressure 6.9.5 Hypoventilation and Respiratory Depression 6.9.6 Throat Irritation 6.10 Suggestions from Treatment Guidelines and Clinical Experience 6.11 Conclusions References 7: Communication in Psychiatric Coercive Treatment and Patients’ Decisional Capacity to Consent 7.1 Introduction 7.2 Patients’ Decisional Capacity to Consent to Medical Treatment 7.3 Informed Consent in Involuntary Psychiatric Treatment 7.4 Doctor-Patient Communication in Coercive Medical Settings 7.5 Involuntary Psychiatric Hospitalization 7.6 Improving Medical Communication 7.7 Conclusion References 8: Post-aggression Debrief 8.1 Introduction 8.2 Debriefing: Definition and Historical Background 8.3 Post-aggression Debrief in Mental Health 8.3.1 Staff-Focused Post-aggression Debrief 8.3.1.1 Summary of Evidence 8.3.1.2 Participants 8.3.1.3 Time Frame 8.3.1.4 How to Lead a Debriefing 8.3.1.5 Debriefing Technique 8.3.2 Patient-Focused Post-aggression Debrief 8.3.2.1 Summary of Evidence 8.3.2.2 Participants 8.3.2.3 Time Frame 8.3.2.4 Debriefing Technique 8.4 Discussion References