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Chapter 14 - Psychomotor Agitation

Published online by Cambridge University Press:  02 January 2025

By
Olusegun Adebisi Popoola  and
Nidal Moukaddam
Edited by
Marsal Sanches  and
Jair C. Soares
Marsal Sanches
Affiliation:
McGovern Medical School, Texas
Jair C. Soares
Affiliation:
McGovern Medical School, Texas
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Summary

Agitation is an umbrella term for a spectrum of behaviors characterized by increased motor activity, restlessness, and emotional tension. Agitation is a cause of morbidity and complications during emergency center or hospital stays. The etiology of agitation states can be medical, psychiatric, substance or medication related, or as a result of delirium, and can be exacerbated by environmental factors. The goals of agitation assessment and management are (1) to ensure the safety of the patient and other individuals present, (2) the identification of risk factors (and cause, if possible) for psychomotor agitation, and (3) the implementation of the appropriate treatment in a timely and efficient manner. Pharmacological and nonpharmacological management strategies are needed for proper management, and teams should always start with verbal de-escalation and environmental modifications, followed by least-invasive means of administration of pharmacological agents, and potentially advancing to seclusion and restraints. Special considerations should be assessed in children, elderly, pregnant women, and those with medically unstable pictures who present with agitation, keeping in mind that delirium is underdiagnosed and goals of treatment must be customized.

Keywords

agitationdeliriumantipsychoticsverbal de-escalationrestraunts/seclusion
Type
Chapter
Information
Fundamentals of Clinical Psychiatry
A Practical Handbook
 , pp. 123 - 133
Publisher: Cambridge University Press
Print publication year: 2025

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References

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):1–11.CrossRefGoogle ScholarPubMed
Lindenmayer, J.-P. The pathophysiology of agitation. J Clin Psychiatry. 2000;61:5–10.Google ScholarPubMed
Pacciardi, B, Mauri, M, Cargioli, C, Belli, S, Cotugno, B, Di Paolo, L, et al. Issues in the management of acute agitation: how much current guidelines consider safety? Front Psychiatry. 2013;4:26.CrossRefGoogle ScholarPubMed
Mansutti, I, Venturini, M, Palese, A. Episodes of psychomotor agitation among medical patients: findings from a longitudinal multicentre study. Aging Clin Experiment Res. 2020;32:1101–1110.CrossRefGoogle ScholarPubMed
Jaber, S, Chanques, G, Altairac, C, Sebbane, M, Vergne, C, Perrigault, P-F, et al. A prospective study of agitation in a medical-surgical ICU: incidence, risk factors, and outcomes. Chest. 2005;128(4):2749–2757.CrossRefGoogle Scholar
Anand, A, Verhoeff, P, Seneca, N, Zoghbi, SS, Seibyl, JP, Charney, DS, et al. Brain SPECT imaging of amphetamine-induced dopamine release in euthymic bipolar disorder patients. Am J Psychiatry. 2000;157(7):1108–1114.CrossRefGoogle ScholarPubMed
Sanacora, G, Gueorguieva, R, Epperson, CN, Wu, Y-T, Appel, M, Rothman, DL, et al. Subtype-specific alterations of γ-aminobutyric acid and glutamatein patients with major depression. Archiv Gen Psychiatry. 2004;61(7):705–713.CrossRefGoogle Scholar
Hughes, DH. Emergency psychiatry: acute psychopharmacological management of the aggressive psychotic patient. Psychiatr Serv. 1999;50(9):1135–1137.CrossRefGoogle Scholar
Steinert, T. Prediction of inpatient violence. Acta Psychiatrica Scandinavica. 2002;106:133–141.CrossRefGoogle Scholar
Agüera-Ortiz, L, García-Ramos, R, Grandas Pérez, FJ, López-Álvarez, J, Montes Rodríguez, JM, Olazarán Rodríguez, FJ, et al. Depression in Alzheimer’s disease: a Delphi consensus on etiology, risk factors, and clinical management. Front Psychiatry. 2021;12:638–651.CrossRefGoogle ScholarPubMed
Angst, J, Gamma, A, Benazzi, F, Ajdacic, V, Rössler, W. Does psychomotor agitation in major depressive episodes indicate bipolarity? Evidence from the Zurich Study. Europ Archiv Psychiatry Clin Neurosci. 2009;259:55–63.CrossRefGoogle ScholarPubMed
Day, R. Psychomotor agitation: poorly defined and badly measured. J Affective Disorders. 1999;55(2–3):89–98.CrossRefGoogle ScholarPubMed
Iwanami, T, Maeshima, H, Baba, H, Satomura, E, Namekawa, Y, Shimano, T, et al. Psychomotor agitation in major depressive disorder is a predictive factor of mood-switching. J Affective Disorders. 2015;170:185–189.CrossRefGoogle ScholarPubMed
Childers, MK, Holland, D. Psychomotor agitation following gabapentin use in brain injury. Brain Injury. 1997;11(7):537–540.CrossRefGoogle ScholarPubMed
Woods, P, Almvik, R. The Brøset violence checklist (BVC). Acta Psychiatrica Scandinavica. 2002;106:103–105.CrossRefGoogle Scholar
Huber, CG, Lambert, M, Naber, D, Schacht, A, Hundemer, H-P, Wagner, TT, et al. Validation of a Clinical Global Impression Scale for Aggression (CGI-A) in a sample of 558 psychiatric patients. Schizophrenia Res. 2008;100(1–3):342–348.CrossRefGoogle Scholar
Kay, SR, Wolkenfeld, F, Murrill, LM. Profiles of aggression among psychiatric patients: I. Nature and prevalence. J Nerv Mental Dis. 1988;176(9):539–546.CrossRefGoogle Scholar
Zeller, SL, Rhoades, RW. Systematic reviews of assessment measures and pharmacologic treatments for agitation. Clin Therapeutics. 2010;32(3):403–425.CrossRefGoogle ScholarPubMed
Marder, SR. A review of agitation in mental illness: treatment guidelines and current therapies. J Clin Psychiatry. 2006;67(Suppl 10):13–21.Google ScholarPubMed
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.CrossRefGoogle Scholar
Citrome, L. New treatments for agitation. Psychiatric Quarterly. 2004;75:197–213.CrossRefGoogle ScholarPubMed
Kousgaard, SJ, Licht, RW, Nielsen, RE. Effects of intramuscular midazolam and lorazepam on acute agitation in non-Elderly Subjects: a systematic review. Pharmacopsychiatry. 2017;50(4):129–135.Google ScholarPubMed
Josiassen, RC, Shaughnessy, RA. IM aripiprazole for acute agitation. Curr Psychiatry. 2007;6(7):103–107.Google Scholar
Riddell, J, Tran, A, Bengiamin, R, Hendey, GW, Armenian, P. Ketamine as a first-line treatment for severely agitated emergency department patients. Am J Emerg Med. 2017;35(7):1000-1004.CrossRefGoogle ScholarPubMed
Hopper, AB, Vilke, GM, Castillo, EM, Campillo, A, Davie, T, Wilson, MP. Ketamine use for acute agitation in the emergency department. J Emerg Med. 2015;48(6):712–719.CrossRefGoogle ScholarPubMed
Allen, MH, Currier, GW, Carpenter, D, Ross, RW, Docherty, JP. The expert consensus guideline series: treatment of behavioral emergencies 2005. J Psychiatric Pract. 2005;11:5–108.CrossRefGoogle ScholarPubMed
Jeffers, T, Darling, B, Edwards, C, Vadiei, N. Efficacy of combination haloperidol, lorazepam, and diphenhydramine vs. combination haloperidol and lorazepam in the treatment of acute agitation: a multicenter retrospective cohort study. J Emerg Med. 2022;62(4):516–523.CrossRefGoogle ScholarPubMed
Hamers, JP, Huizing, AR. Why do we use physical restraints in the elderly? Zeitschrift für Gerontologie und Geriatrie. 2005;38(1):19–25.CrossRefGoogle ScholarPubMed

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