Using de-escalation techniques  for people with psychosis induced aggression or agitation appears to be accepted as good clinical practice but is not supported by evidence from r and omised trials .
BACKGROUND Aggression is a disposition , a willingness to inflict harm , regardless of whether this is behaviourally or verbally expressed and regardless of whether physical harm is sustained .
De-escalation is a psychosocial intervention for managing people with disturbed or aggressive behaviour .
Secondary management strategies such as rapid tranquillisation , physical intervention and seclusion should only be considered once de-escalation and other strategies have failed to calm the service user .
OBJECTIVES To investigate the effects of de-escalation techniques in the short-term management of aggression or agitation  thought or likely to be due to psychosis .
It is unclear why it has remained such an under- research ed area .
A comparison of two treatments of agitated behavior in nursing home residents with dementia: simulated family presence and preferred music.
OBJECTIVE The objective of this study was to compare the effectiveness of two individualized psychosocial treatments in reducing the frequency of physically and verbally agitated behaviors in nursing home residents whose dementia was complicated by marked behavioral disturbance . METHODS Thirty nursing home residents with frequent , severe behavioral disturbances were observed by research staff before , during , and after multiple , r and omized , single-blind exposures to 15-minute audiotapes of simulated family presence ( a conversation prepared by a family member about positive experiences from the past ) , music preferred by the resident in earlier life , and a placebo condition of a reading from a horticultural text . Selected ( usually multiple ) physical and verbal behaviors were counted as present or absent at regular intervals . All three treatment conditions were compared with usual care . RESULTS Simulated presence and preferred music both proved effective in reducing counts of physically agitated behaviors .  Simulated presence , but not music , result ed in significantly reduced counts of verbally agitated behaviors . The placebo tape proved more effective than expected . Participants ' responses to simulated presence and music varied widely . Behavior counts fell by one-half or more in many cases . Other residents became more agitated . CONCLUSION Participants ' better-than-expected responses to the placebo tape suggest that even the simplest technology can improve the lives of confused , disturbed nursing home residents . Of the two psychosocial treatments , preferred music tapes were easier to make and were clearly helpful in many instances . By contrast , family members often struggled to recall enough happy memories to compile a simulated presence tape . Simulated presence might prove just as effective if relatives speak on topics of their own choosing . Although not all residents were helped by these treatments , adverse effects were mild and shortlived
Using de-escalation techniques  for people with psychosis induced aggression or agitation appears to be accepted as good clinical practice but is not supported by evidence from r and omised trials .
BACKGROUND Aggression is a disposition , a willingness to inflict harm , regardless of whether this is behaviourally or verbally expressed and regardless of whether physical harm is sustained .
De-escalation is a psychosocial intervention for managing people with disturbed or aggressive behaviour .
Secondary management strategies such as rapid tranquillisation , physical intervention and seclusion should only be considered once de-escalation and other strategies have failed to calm the service user .
OBJECTIVES To investigate the effects of de-escalation techniques in the short-term management of aggression or agitation  thought or likely to be due to psychosis .
It is unclear why it has remained such an under- research ed area .