Historically, psychiatry has been judged by its management of the ‘furiously mad’ (Turner 1996). In the current climate where inquiries into the care of patients are becoming increasingly common, considerable care has to be taken because of the risk of untoward incidents with acutely disturbed patients. On the one hand there is the necessity to protect the patient, their family, carers, the public and staff from the consequences of disturbed behaviour. On the other hand there is the risk that overzealous sedation with inappropriate medication regimens might lead to physical complications for the disturbed patient. Banerjee et al. (1995), reviewing eight cases of sudden death in detained patients, concluded that, ‘the risk of sudden cardiotoxic collapse in response to neuroleptic medication given during a period of high physiological arousal should be widely publicised’.

There is some evidence to suggest that the level of violence in society is rising (College Research Unit 1998) and that this is reflected in the increasing number of assaults on hospital staff. Psychiatric Intensive Care Unit (PICU) staff are frequently called upon to manage patients who are violent or potentially violent. It is vital that staff work together in an informed and supported environment to minimise the potential risks to themselves and others.

Acute behavioural disturbance requires urgent in-tervention. It usually manifests with mood, thought or behavioural signs and symptoms and can be transient, episodic or long lasting.