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Unmet Needs in the Assessment and Treatment of Psychomotor Agitation

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New Directions in Psychiatry

Abstract

Agitation is described as a state of excessive psychomotor activity accompanied by increased tension and irritability. Agitation may be associated with psychiatric conditions, drug or alcohol withdrawal or intoxication, or several other medical conditions such as dementia, trauma, delirium, endocrine abnormalities, sepsis or infection, stroke, and many other illnesses, which need to be ruled out.

This chapter summarizes the epidemiology and pathophysiology of agitation and focuses on its assessment and management strategies, with special references to the evaluation, diagnosis and treatment of the most acute presentations. De-escalation and interviewing strategies, laboratory assessments, commonly used measurement scales and the most commonly used pharmacological interventions are reviewed and discussed.

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References

  1. Agency for Healthcare Research and Quality. Non-pharmacologic interventions for agitation and aggression in dementia. 2014. https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/dementia-agitation-aggression_research-protocol.pdf. Accessed 21 May 2019.

  2. Holloman GH Jr, Zeller SL. Overview of project BETA: best practices in evaluation and treatment of agitation. West J Emerg Med. 2012;13(1):1–2. https://doi.org/10.5811/westjem.2011.9.6865.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 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(1):26–34. https://doi.org/10.5811/westjem.2011.9.6866.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Siddiqui W, Huecker MR. Agitation. In: StatPearls. Treasure Island: StatPearls Publishing; 2019. https://www.ncbi.nlm.nih.gov/books/NBK493153/. Accessed 21 May 2019.

    Google Scholar 

  5. McNett M, Sarver W, Wilczewski P. The prevalence, treatment and outcomes of agitation among patients with brain injury admitted to acute care units. Brain Inj. 2012;26(9):1155–62. https://doi.org/10.3109/02699052.2012.667587.

    Article  PubMed  Google Scholar 

  6. San L, Marksteiner J, Zwanzger P, Figuero MA, Romero FT, Kyropoulos G, et al. State of acute agitation at psychiatric emergencies in Europe: the STAGE study. Clin Pract Epidemiol Ment Health. 2016;12:75–86. https://doi.org/10.2174/1745017901612010075.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mi W, Zhang S, Liu Q, Yang F, Wang Y, Li T, et al. Prevalence and risk factors of agitation in newly hospitalized schizophrenia patients in China: an observational survey. Psychiatry Res. 2017;253:401–6. https://doi.org/10.1016/j.psychres.2017.02.065.

    Article  PubMed  Google Scholar 

  8. Reddy MS. Suicide incidence and epidemiology. Indian J Psychol Med. 2010;32(2):77–82. https://doi.org/10.4103/0253-7176.78501.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Almeida TM, Azevedo LC, Nosé PM, Freitas FG, Machado FR. Risk factors for agitation in critically ill patients. Rev Bras Ter Intensiva. 2016;28(4):413–9. https://doi.org/10.5935/0103-507x.20160074.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Yudofsky SC, Kopecky HJ, Kunik M, Silver JM, Endicott J. The overt agitation severity scale for the objective rating of agitation. J Neuropsychiatry Clin Neurosci. 1997;9(4):541–8.

    Article  CAS  PubMed  Google Scholar 

  11. Gerken AT, Gross AF, Sanders KM. Aggression and violence. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, editors. Massachusetts general hospital comprehensive clinical psychiatry. 2nd ed. St. Louis: Elsevier; 2016. p. 709–17.

    Google Scholar 

  12. Lindenmayer JP. The pathophysiology of agitation. J Clin Psychiatry. 2000;61(14):5–10.

    CAS  PubMed  Google Scholar 

  13. Sheard MH, Marini JL, Bridges CI, Wagner E. The effect of lithium on impulsive aggressive behavior in man. Am J Psychiatry. 1976;133(12):1409–13.

    Article  CAS  PubMed  Google Scholar 

  14. Asberg M, Träskman L, Thorén P. 5-HIAA in the cerebrospinal fluid. A biochemical suicide predictor? Arch Gen Psychiatry. 1976;33(10):1193–7.

    Article  CAS  PubMed  Google Scholar 

  15. Beitchman JH, Baldassarra L, Mik H, De Luca V, King N, Bender D, et al. Serotonin transporter polymorphisms and persistent, pervasive childhood aggression. Am J Psychiatry. 2006;163(6):1103–5.

    Article  PubMed  Google Scholar 

  16. Cummings J, Mintzer J, Brodaty H, Sano M, Banerjee S, Devanand DP, et al. Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition. Int Psychogeriatr. 2015;27(1):7–17. https://doi.org/10.1017/S1041610214001963.

    Article  PubMed  Google Scholar 

  17. Richmond JS, Berlin JS, Fishkind AB, Holloman GH Jr, Zeller SL, Wilson MP, et al. Verbal de-escalation of the agitated patient: consensus statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. West J Emerg Med. 2012;13(1):17–25. https://doi.org/10.5811/westjem.2011.9.6864.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Fishkind A. Calming agitation with words, not drugs: 10 commandments for safety. Curr Psychol. 2002;1(4):32–9.

    Google Scholar 

  19. Baumgardt J, Jackel D, Helber-Bohlen H, Stiehm N, Morgenstern K, Voight A, et al. Preventing and reducing coercive measures—an evaluation of the implementation of the Safewards model in two locked wards in Germany. Front Psych. 2019;10:340. https://doi.org/10.3389/fpsyt.2019.00340.

    Article  Google Scholar 

  20. Garriga M, Pacchiarotti I, Kasper S, Zeller SL, Allen MH, Vázquez G, et al. Assessment and management of agitation in psychiatry: expert consensus. World J Biol Psychiatry. 2016;17(2):86–128. https://doi.org/10.3109/15622975.2015.1132007.

    Article  PubMed  Google Scholar 

  21. Mantovani C, Nobre Migon M, Valdozende Alheira F, Del-Ben CM. Managing agitated or aggressive patients. Rev Bras Psiquiatr. 2010;32(2):S96–S103.

    Article  PubMed  Google Scholar 

  22. Ulrich R, Bogren L, Gardiner SK, Lundin S. Psychiatric ward design can reduce aggressive behavior. J Environ Psychol. 2018;57:53–66. https://doi.org/10.1016/j.jenvp.2018.05.002.

    Article  Google Scholar 

  23. Stowell KR, Florence P, Harman HJ, Glick RL. Psychiatric evaluation of the agitated patient: consensus statement of the American Association for Emergency Psychiatry Project Beta Psychiatric Evaluation Workgroup. West J Emerg Med. 2012;13(1):11–6. https://doi.org/10.5811/westjem.2011.9.6868.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Nordstrom K, Zun LS, Wilson MP, Stiebel V, Ng AT, Bregman B, et al. Medical evaluation and triage of the agitated patient: consensus statement of the American Association for Emergency Psychiatry Project Beta Medical Evaluation Workgroup. West J Emerg Med. 2012;13(1):3–10. https://doi.org/10.5811/westjem.2011.9.6863.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Vieta E, Garriga M, Cardete L, Bernardo M, Lombraña M, Blanch J, et al. Protocol for the management of psychiatric patients with psychomotor agitation. BMC Psychiatry. 2017;17(1):328. https://doi.org/10.1186/s12888-017-1490-0.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Anderson KK, Jenson CE. Violence risk-assessment screening tools for acute care mental health settings: literature review. Arch Psychiatr Nurs. 2019;33(1):112–9. https://doi.org/10.1016/j.apnu.2018.08.012.

    Article  PubMed  Google Scholar 

  27. Smith FA, Hogan CH. Laboratory tests and diagnostic procedures. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, editors. Massachusetts general hospital comprehensive clinical psychiatry. 2nd ed. St. Louis: Elsevier; 2016. p. 20–38.

    Google Scholar 

  28. Baker SN. Management of acute agitation in the emergency department. Adv Emerg Nurs J. 2012;34(4):306–18. https://doi.org/10.1097/TME.0b013e31826f12d6.

    Article  PubMed  Google Scholar 

  29. Ng AT, Zeller SL, Rhoades RW. Clinical challenges in the pharmacologic management of agitation. Prim Psychiatry. 2010;17(8):46–52.

    Google Scholar 

  30. Pacciardi B, Mauri M, Cargioli C, Belli S, Cutugno B, Di Paolo L, et al. Issues in the management of acute agitation: how much current guidelines consider safety? Front Psych. 2013;4:26. https://doi.org/10.3389/fpsyt.2013.00026.

    Article  Google Scholar 

  31. Kattimani S, Bharadwaj B. Clinical management of alcohol withdrawal: a systematic review. Ind Psychiatry J. 2013;22(2):100–8. https://doi.org/10.4103/0972-6748.132914.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Taylor DM, Barnes TRE, Young AH. The Maudsley prescribing guidelines in psychiatry. 13th ed. New Jersey: Wiley-Blackwell; 2018.

    Google Scholar 

  33. Battaglia J. Pharmacological management of acute agitation. Drugs. 2005;65(9):1207–22.

    Article  CAS  PubMed  Google Scholar 

  34. Jones KA, Nielsen S, Bruno R, Frei M, Lubman DI. Benzodiazepines - their role in aggression and why GPs should prescribe with caution. Aust Fam Physician. 2011;40(11):862–5.

    PubMed  Google Scholar 

  35. Richards JR, Schneir AB. Droperidol in the emergency department: is it safe? J Emerg Med. 2003;24:441–7.

    Article  PubMed  Google Scholar 

  36. Ziaei M, Massoudifar A, Rajabpour-Sanati A, Pourbagher-Shahri AM, Abdolrazaghnejad A. Management of violence and aggression in emergency environment; a narrative review of 200 related articles. Adv J Emerg Med. 2018;3(1):e7. https://doi.org/10.22114/AJEM.v0i0.117.

    Article  PubMed  PubMed Central  Google Scholar 

  37. ADASUVE™ (loxapine) inhalation powder [package insert]. Souderton: Galen US; 2017. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/022549s006lbl.pdf. Accessed 4 Aug 2019.

  38. Hsu WY, Huang SS, Lee BS, Chiu NY. Comparison of intramuscular olanzapine, orally disintegrating olanzapine tablets, oral risperidone solution, and intramuscular haloperidol in the management of acute agitation in an acute care psychiatric ward in Taiwan. J Clin Psychopharmacol. 2010;30(3):230–4.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Molecular Medicine, Division of Psychiatry, University of Siena, Siena, Italy

    Alessandro Cuomo, Simone Bolognesi, Arianna Goracci, Pier Francesco Laurenzi & Andrea Fagiolini

  2. Department of Mental Health, Division of Psychiatry, Lombardy Health System, Mantova, Italy

    Alessandro Cuomo & Despoina Koukouna

Authors
  1. Alessandro Cuomo
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  2. Simone Bolognesi
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  3. Arianna Goracci
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  4. Despoina Koukouna
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  5. Pier Francesco Laurenzi
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  6. Andrea Fagiolini
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Editor information

Editors and Affiliations

  1. Department of Neurosciences Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy

    Maurizio Pompili

  2. University Health Network, University of Toronto, Toronto, ON, Canada

    Roger McIntyre

  3. Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy

    Andrea Fiorillo

  4. Association for the Improvement of Mental Health Programmes (AMH), Geneva, Geneve, Switzerland

    Norman Sartorius

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Cuomo, A., Bolognesi, S., Goracci, A., Koukouna, D., Laurenzi, P.F., Fagiolini, A. (2020). Unmet Needs in the Assessment and Treatment of Psychomotor Agitation. In: Pompili, M., McIntyre, R., Fiorillo, A., Sartorius, N. (eds) New Directions in Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-030-42637-8_7

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  • DOI: https://doi.org/10.1007/978-3-030-42637-8_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-42636-1

  • Online ISBN: 978-3-030-42637-8

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