Algorithm-based protocol for the identification, management and treatment of psychiatric patients with acute psychomotor agitation

Abstract

Introduction

Psychomotor agitation is the most common behavioural disorder observed in emergency and psychiatry departments. This syndrome is characterized by excessive or inappropriate motor or verbal activity and important emotional tension. Psychomotor agitation may be associated with medical conditions, substance intoxication/withdrawal and in a significant number of cases with schizophrenia or bipolar I disorder.

Objectives

The objective of this protocol was to provide up-to-date guidance to identify, manage and treat patients with an episode of acute agitation, considering the consensus clinical knowledge, current ethical standards and available therapies. This protocol is aimed to be a patient-centric tool helping to anticipate and prevent the escalation of agitation symptoms.

Methods

The method followed to elaborate this document was through a combination of comprehensive bibliographical review (complied in the article “Assessment and management of agitation in psychiatry: expert consensus” by Garriga M. et al. (World J Biol Psychiatry, 2016), interaction with patients, and the clinical experience in our centre.

Results

The elaboration of this protocol resulted in a document that contains guidelines to identify, manage and treat patients efficiently, ethically and safely. One of the novelties of the protocol is the addition of dichotomies based on the patients’ willingness to cooperate. The information is summarized in easy-to-use algorithms for non-specialized healthcare professionals.

Conclusions

This protocol may provide the basis of a new standardized treatment paradigm for psychomotor agitation which may help improve the patient's experience and therapeutic alliance with the healthcare professional and optimize resources in healthcare centres.

Disclosure of interest

COI: The preparation of the protocol was funded by an unrestricted grant from Ferrer International. The company had no say on protocol content. Dr Vieta has received funding for research projects and/or honoraria as a consultant or speaker for from the following companies and institutions: AB-Biotics, Allergan, AstraZeneca, Bial, Bristol-Myers Squibb, Dainippon Sumitomo Pharma, Elan, Eli Lilly, Farmaindustria, Ferrer, Forest Research Institute, Gedeon Richter, Glaxo-Smith-Kline, Janssen, Lundbeck, Otsuka, Pfizer, Roche, Sanofi-Aventis, Servier, Shire, Solvay, Sunovion, Takeda, Telefónica, Institute of Health Carlos III [Instituto de Salud Carlos III], Séptimo Programa Marco (ENBREC), Brain and Behaviour Foundation (NARSAD) and Stanley Medical Research Institute.