Management of acute agitation in psychosis: an evidence-based approach in the USA

Abstract

SummaryAgitation in psychiatric settings, particularly in psychosis, presents a staggering challenge for clinicians, who must both manage the patient's acute symptoms and simultaneously make an accurate diagnosis. Too often, the management of the former confounds the latter. Patients are very often sedated medically, which masks their underlying condition, rendering accurate diagnosis delayed and inherently difficult. Significant data are available regarding both pharmacological and non-pharmacological interventions for agitation that maximise symptom control while minimising confounding side-effects. In this article, a review of the historical evolution of agitation management in psychotic illness is presented, followed by an evidence-based clinical guideline for managing agitation in psychosis in the USA.

Hospital Staff Nurse Perceptions of Competency to Care for Patients With Psychiatric or Behavioral Health Concerns

“…When de-escalation techniques are ineffective, patients experiencing acute agitation and loss of self-control may need rapid tranquilization to decrease dangerous behavior and allow treatment of the underlying psychiatric condition (Schleifer, 2011). Hospital nurses need to coordinate care effectively with physicians to identify and recommend needed medications.…”

Loxapine inhaler for psychosis-induced aggression or agitation

“…The main limitations of antipsychotic use in rapid tranquillisation include sedation, route of administration, speed of onset and adverse effect profile. Patients are very often sedated medically, rendering the accurate diagnosis delayed and inherently difficult (Schleifer 2011). The goal for rapid tranquillisation of the agitated patient is to allow for a reduction in agitation or aggression without sedation, allowing the service user to participate in further assessment or treatment (NICE 2002;Allen 2005).…”

A survey of caregiver burden in those providing informal care for patients with schizophrenia or bipolar disorder with agitation: results from a European study

“…Although agitation states from mild to severe and their characterization have been previously described, there has been a failure to reach a consensus on the definition of agitation [ 6 , 7 ] which has been recognised as one factor underlying the lack of epidemiological data in this area [ 8 ]. Previous studies that have reported on the prevalence of agitation focus on emergency hospital or clinic attendance; a European study found that 4.6% of psychiatric emergencies were attributed to acute agitation, of which half of the patients had a diagnosis of schizophrenia and a quarter had a diagnosis of bipolar disorder [ 9 ].…”