- What Is a Chemical Restraint?
- 3 Types
- Medication List & Side Effects
What is chemical restraint?
Chemical restraint refers to the administration of certain medications to restrain agitated patients from behavior that is harmful to themselves or others, including the medical staff attending to them. The administration of a medication is considered a chemical restraint when used to sedate an agitated patient and not for direct therapeutic reasons.
Examples of chemical restraints
Three main classes of drugs are used as chemical restraints:
- Alcohol intoxication or withdrawal symptoms
- Seizure disorders or those at risk for seizures
- Agitation from unknown causes
Typical or classic antipsychotics
Butyrophenones and phenothiazines are the main classes of antipsychotic drugs used to control violence in patients with acute psychosis.
Atypical antipsychotic drugs are a relatively new type of chemical restraint and have a better side effect profile than benzodiazepines and typical antipsychotics. Studies indicate that atypical antipsychotic drugs are effective in controlling acute psychosis in patients with a known psychiatric disorder such as:
What are the three types of restraints?
The three types of restraints are:
- Physical: Limiting a person’s freedom of movement with physical devices such as waist belts, restraining vests, or hand mitts.
- Chemical: Use of medications to moderate behavior.
- Environmental: Restricting a person’s free access to the places or things in their environment, such as locking up a room or keeping an item in an inaccessible location.
Why and when is chemical restraint required?
A chemical restraint is most often administered in the emergency department when prompt action is required to avert violence or manage dangerous and uncontrollable behavior in an agitated patient.
A patient may be agitated due to a combination of several factors such as:
- Substance intoxication or withdrawal
- Significant physical illness
- Mental health crisis
- Confusion and anxiety
A chemical restraint medication is a last resort when less invasive options fail. Such less invasive options include verbal reasoning and involving trusted family members to calm the patient.
What are the important considerations before administration of chemical restraint?
A chemical restraint infringes on a patient’s freedom and dignity and has legal implications. Before administering a chemical bond, medical staff must carefully assess the following:
- If the patient can make rational decisions
- If the patient poses a serious threat to themselves or others, if restraint is not administered
- If the patient has any health condition that precludes the use of chemical control due to side effects
- If there are medical causes for agitation, such as
Other important considerations are:
- Legal Requirements
- Obtaining the patient’s consent if it is possible
- Obtaining the family member’s consent if the patient is not in a condition to comprehend, or is a minor
- Need for extreme caution in the use of chemical restraint and its dosage in a pregnant patient
- Use of appropriate medication and dosage in children
How is a chemical restraint administered?
Chemical restraints must ideally act rapidly with the most minor dosage and minimal side effects. Ease of administration is also an important consideration.
Chemical restraint may be administered in three ways:
- Oral medication: The first option is per oral (PO) administration if the patient is amenable and willing to take the medication. Oral solutions are better than tablets as they:
- work faster and
- help avoid the possibility of the patient hiding the tablet in their cheek.
- Intramuscular injection: In emergencies, intramuscular injections (IM) may be the best option because of ease of access and rapid action.
- Intravenous injection: Intravenous injections (IV) have the quickest onset time, but accessing the vein may be difficult in an acutely agitated patient.
The patient's vital signs must be carefully monitored for any serious side effects after the administration of chemical restraint.
What are the drugs used for chemical restraint?
Two benzodiazepine drugs are used for chemical restraint administered PO, IM, or IV:
Side effects include:
- Respiratory depression (shallow and ineffective breathing)
- Hypotension (low blood pressure)
- Extreme somnolence (sleepiness)
The two main antipsychotic drugs administered PO, IM or IV are:
Side effects include:
- Heart rhythm disorders (dysrhythmia)
- Extrapyramidal symptoms from movement disorders such as
- Tardive dyskinesia (jerky movements)
- Dystonia (muscle spasms and contractions)
- Akathisia (restlessness)
- Torticollis (twisted neck from neck muscle contraction)
- Drug-induced parkinsonism (tremors and muscle stiffness)
Three atypical antipsychotic drugs are available to administer PO or IM:
Side effects include:
A chemical restraint is a type of medication used to restrain agitated patients from behavior that is harmful to themselves or others, including the medical staff attending to them.
Multimedia: Slideshows, Images & Quizzes
What's Schizophrenia? Symptoms, Types, Causes, Treatment
What is the definition of schizophrenia? What is paranoid schizophrenia? Read about schizophrenia types and learn about...
Bipolar Disorder (Mania) Quiz
Who is at risk for developing bipolar disorder? Are you? Take this Bipolar Disorder Quiz to learn more about bipolar disorder, if...
Schizophrenia Quiz: What is Schizophrenia?
Schizophrenia is a complex psychiatric disorder. Learn more about the challenges of mental illness with the Schizophrenia Quiz.
Related Disease Conditions
Schizophrenia and Electroconvulsive Therapy (ECT)
Second Source article from WebMD
Schizophrenia is a disabling brain disorder that may cause hallucinations and delusions and affect a person's ability to communicate and pay attention. Symptoms of psychosis appear in men in their late teens and early 20s and in women in their mid-20s to early 30s. With treatment involving the use of antipsychotic medications and psychosocial treatment, schizophrenia patients can lead rewarding and meaningful lives.
Bipolar Disorder vs. Schizophrenia
Bipolar disorder and schizophrenia are mental illnesses that share some risk factors and treatments. Symptoms of bipolar disorder include mood changes and manic and depressive episodes. Symptoms of schizophrenia include unusual behavior, delusions, and hallucinations. Check out the center below for more medical references on mental illnesses, including multimedia (slideshows, images, and quizzes), related disease conditions, treatment and diagnosis, medications, and prevention or wellness.
Schizoaffective disorder is a mental illness that features schizophrenia and a mood disorder, either major depression or bipolar disorder. Symptoms include agitation, suicidal thoughts, little need for sleep, delusions, hallucinations, and poor motivation. Treatment may involve psychotherapy, medication, skills training, or hospitalization.
What Is Schizotypal Personality Disorder?
Schizotypal personality disorder is characterized by odd behaviors, feelings, perceptions, and ways of relating to others that interfere with one's ability to function. Medication and psychotherapy can help the sufferer to manage their symptoms.
What Are the Differences Between Mania and Hypomania?
Mania is an episode of irritable or euphoric mood and heightened energy that typically lasts a week and severely affects the sufferer's ability to function. Hypomania is a lesser form of mania that is less debilitating for the sufferer. Symptoms of mania last for seven days and include racing speech, decreased sleep, impulsivity, and grandiose ideas. Hypomania symptoms last at least four days and include trouble focusing, restlessness, and excessive spending. Treatments for both may incorporate psychotherapy, medications, and lifestyle changes.
Treatment & Diagnosis
- Schizophrenia FAQs
- Bipolar Disorder Mania FAQs
- Schizophrenia Predicted by a Gene Variant
- Can a Person Live a Normal Life with Schizophrenia?
- Can a Person Die from Schizophrenia?
- How Does Schizophrenia Start?
- Can You Prevent Schizophrenia?
- Who Is at Risk Developing Schizophrenia?
- What Is the Chemical Imbalance that Causes Schizophrenia?
- Is Schizophrenia a Genetic Disorder?
- What Is a Schizophrenic Person?
- Catherine Zeta-Jones: A Case of Bipolar II Disorder
Medications & Supplements
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.