Case history Written informed consent was given

by the patient for the articles production and publication. Oral lorazepam medication was offered to the patient each time before intramuscular clonazepam was given. Miss Z is a 14-year-old girl with a background of severe neglect and abuse admitted to our hospital due to significant agitation and distress when on remand in a secure children’s home. She presented with a high risk of harm to herself and to others. Her weight was approximately 45 kg on admission. Miss Z was on no regular medication on admission and had not previously been exposed to any psychotropic medication. Three weeks following admission Miss Z continued to exhibit significant self-harm Inhibitors,research,lifescience,medical behaviours, particularly in the form of head banging. She was also physically aggressive towards staff including attempting to kick and bite them during periods of control and restraint. This prompted the administration of 0.5 mg clonazepam intramuscularly (day 1, 22:20). Little effect was seen and arm holds or full restraint Inhibitors,research,lifescience,medical had to continue for 3 hours after the administration of the medication. The following day Miss Z was secluded due to ongoing aggressive behaviour to staff during a further period

of control and restraint. selleck Volasertib Whilst secluded she began to Inhibitors,research,lifescience,medical harm herself with a zipper and refused to hand it to staff, instead placing it in her mouth. Owing to the lack of efficacy of the 0.5 mg clonazepam that was administered the previous day, 1 mg clonazepam intramuscular was given (day 2, 17:15). This had a more significant effect, with Miss Z beginning to stagger

soon after administration Inhibitors,research,lifescience,medical and after less than 1 hour following the administration of the medication she fell asleep. Miss Z was Inhibitors,research,lifescience,medical awake soon afterwards and no respiratory difficulties were noted, although she was observed to remain drowsy. The following day Miss Z needed to be secluded again due to further aggression to staff. Whilst in seclusion she proceeded to bang her head on the Perspex window with varying force for just over 1 hour. She was given further medication with the aim of helping her calm down and reducing her self-harming behaviour. At this time 1 mg clonazepam was Dacomitinib administered intramuscularly (day 3, 14:20). This resulted in her again becoming sedated but no impairment in her physical observations (heart rate, blood pressure and respiratory rate) were noted. During that evening Miss Z was again agitated and required some physical restraint via arm holds. However, she accepted oral medication and was administered 1 mg lorazepam orally (day 3, 21:15). Miss Z was noted to be sedated and had a staggering gait for the remainder of the evening, but was observed to have regular respirations. Her respiratory rate was regularly monitored overnight and noted to range from 13 to 18 breaths per minute.