The role of physical restraint in the treatment of psychiatric illness.

Although physical restraint is a widely used and possibly hazardous form of treatment, few guidelines for its use appear in the recent psychiatric literature. An approach is described in which physical restraint is considered to be a specific therapeutic technique with definable indications, "dosages", contra-indications, and side effects. A method of initiating and terminating this treatment modality is presented and the indications for its use are discussed. These include the presence of violent behavior during a psychotic illness; the presence of agitation or confusion when the use of antipsychotic medication is limited by physical illness; the presence of severe psychotic symptoms in conjunction with severely regressed, socially aversive behavior; the need to reduce excessive external stimuli; and the request for restraint by the patient. Possible side effects and contra-indications are also discussed and criteria for evaluating the duration and effectiveness of the treatment are proposed.