1st International Experts’ Meeting on Agitation: Conclusions Regarding the Current and Ideal Management Paradigm of Agitation

Abstract

Agitation is a heterogeneous concept without a uniformly accepted definition, however, it is generally considered as a state of cognitive and motor hyperactivity characterized by excessive or inappropriate motor or verbal activity with marked emotional arousal. Not only the definition but also other aspects of agitated patients’ care are still unsolved and need consensus and improvement. To help the discussion about agitation among experts and improve the identification, management, and treatment of agitation, the 1st International Experts’ Meeting on Agitation was held in October 2016 in Madrid. It was attended by 20 experts from Europe and Latin America with broad experience in the clinical management of agitated patients. The present document summarizes the key conclusions of this meeting and highlights the need for an updated protocol of agitation management and treatment, the promotion of education and training among healthcare professionals to improve the care of these patients and the necessity to generate clinical data of agitated episodes.

Variations in the care of agitated patients in Australia and New Zealand ambulance services

“…The key variations in the management of agitated patients in the pre‐hospital setting within Australia and New Zealand were differences in the use of validated scales to assess agitation and the effectiveness of sedation, the use of aetiology‐specific guidelines such as for methamphetamine‐affected patients and the variation in sedating agents and dosage. Based on this research, there is a need for epidemiological studies to examine the prevalence of pre‐hospital agitation and its causes, and the impact of differences in patient assessment and management on this heterogenous group of patients . Such research may support decision‐making around triage, clinical education and practice, mitigate the safety risk of paramedics and patients and streamline guidelines on the management of agitated patients …”

“…While some ambulance services have conducted internal evaluations of management regimes such as sedating agents, these do not capture the breadth of practices across services to make direct comparisons. Similar evaluations in the ED and psychiatric settings have provided important insights into areas for further research.…”

“…The cascade of care for agitated patients includes verbal de‐escalation, physical restraint, sedation and, in some cases, police escort . However, the assessment and management of acutely agitated patients may vary between ambulance services, partly because there are no standardised guidelines on the management of agitated patients . For example, conventional sedating agents include antipsychotics and benzodiazepines, although ketamine is becoming more widely used for its rapid onset and dissociative effect despite some studies reporting increased intubations .…”

Low-concentration sevoflurane inhalation in treating MK801-induced schizophrenia like disease in mice and a feasibility study of schizophrenia patients

“…Indeed, delayed treatments and poor treatment compliance are considered to be signi cant barriers for the effective management of psychiatric conditions and the establishment of therapeutic alliance between patients and healthcare providers. The consensus for schizophrenia treatment is that any ideal medication should have the properties of rapid onset of action, calmness without sedation, easy to administer, non-invasive, non-traumatic/non-coercive, with good safety pro le and favorable tolerability 9 . γ-aminobutyric acid type A receptors (GABA A R) are a family of ligand-gated ion channels essential for the regulation of synaptic inhibition in the brain 10 .…”

Recognition and Management of Agitation in Acute Mental Health Services: A Qualitative Evaluation of Staff Perceptions

“…Agitation among patients is a frequently cited behavioural problem across a variety of health settings [1]. While it is considered to be distinctly different to aggression [2], without timely assessment and management it can quickly escalate to a loss of personal control, aggression and violence [1] and result in injury to patients and staff [3,4]. Agitation can also lead to increased periods of hospitalisation [5] and episodes of readmission [6] resulting in increased health care costs [5,7].…”