Evaluating and Managing the Agitated Patient

Abstract

This chapter describes all aspects of the evaluation and management of the agitated patient, one of the most common, and challenging, presentations encountered in psychiatric emergency care. Agitated behaviors range from restlessness to overt physical aggression and can escalate rapidly, placing both the patient and staff at risk of harm. Although early recognition and intervention are crucial for success, the wide variety of underlying etiologies of agitation present barriers to optimal care. This chapter will review how tailoring of treatment interventions has developed to more precisely and effectively target the behaviors while always keeping the safety of the patient and staff at the forefront of one’s mind. It will also review the rise of verbal de-escalation as a first line intervention for agitation management, as well as describing principles of pharmacologic management should verbal de-escalation be inadequate. Special population such as those with personality disorders, substance intoxication or withdrawal, and psychosis or mania, will be explored as each may have particularly effective interventions as well pitfalls to avoid. Finally, as a measure of last resort, guidelines around seclusion and/or restraint will be provided.