Overuse of Chemical Restraints for the Treatment of Aggressive Psychiatric Inpatients : A Clinical Report
Hajra Tariq, Mahnoor Irshad, Fahaddis Ahmed Rana, Sumira Alam, Nasar Sayeed KhanAims:
Aggression in psychiatric inpatients is a frequent challenge that threatens staff safety and patient well-being. Although guidelines recommend verbal de-escalation as the first-line approach, restrictive practices such as chemical and physical restraints are often overused.
Methods:
A retrospective review of patient records was conducted at the Services Hospital Lahore psychiatry ward (January–June 2022). Data were compared against NICE NG10 and Maudsley prescribing guidelines.
Results:
A total of 30 inpatients were included (66.7% male, mean age 35.4 ± 11.6 years). Diagnoses included substance-related disorders (50%), schizophrenia/psychosis (40%), mood disorders (10%), and dissociative disorders (10%). All patients (100%) were managed with chemical restraints as first-line intervention; 20% also required physical restraints. None received verbal de-escalation first. Reasons included fear of patient violence (40%), rapid availability of medication (40%), and lack of staff training (20%).
Conclusion:
There is systemic over-reliance on chemical restraints in this setting, with minimal use of evidence-based de-escalation. Staff training and guideline adherence are urgently required.