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Emergency Management of Acute Psychosis

  • Oliver Freudenreich
Chapter
Part of the Current Clinical Psychiatry book series (CCPSY)

Abstract

The competent management of an acutely psychotic patient who is agitated requires skill and experience. This chapter describes the clinical approach to agitation in acute settings, particularly the importance of non-pharmacological interventions such as verbal de-escalation and early use of oral medications in order to avoid behavioral escalation and prevent injury to patients and staff. To achieve the goal of a calm patient who can be evaluated, clinicians can chose from a variety of medications to treat agitation rapidly and effectively, including second-generation antipsychotics and inhaled loxapine. The chapter ends with a discussion of patient disposition including discharge from the acute setting.

Keywords

Agitation Diagnosis Symptomatic treatment Verbal de-escalation Restraint Project BETA Psychopharmacology Antipsychotics Benzodiazepines Inhaled loxapine Disposition 

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Additional Resources

    Articles

    1. Holloman GH Jr, Zeller SL. Overview of Project BETA: best practices in evaluation and treatment of agitation. West J Emerg Med. 2012;13:1–2. – Introduction to the Project BETA from the American Association for Emergency Psychiatry (AAEP) who, in October 2010, embarked on developing guidelines for the assessment and management of agitation in acute care settings. (BETA stands for Best practices in Evaluation and Treatment of Agitation). Working groups tackled several topics (medical evaluation and triage, psychiatric evaluation, verbal de-escalation, psychopharmacology, use and avoidance of seclusion and restraint), all published in the Western Journal of Emergency Medicine.Google Scholar
    2. Wilson MP, Pepper D, Currier GW, Holloman GH Jr, Feifel D. The psychopharmacology of agitation: consensus statement of the American Association for Emergency Psychiatry Project Beta psychopharmacology workgroup. West J Emerg Med. 2012;13:26–34. – The psychopharmacology recommendations from Project BETA.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Oliver Freudenreich
    • 1
  1. 1.Department of PsychiatryMassachusetts General HospitalBostonUSA

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