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2 results

  • Chapter 14 - Psychomotor Agitation

  • Edited by Marsal Sanches, McGovern Medical School, Texas, Jair C. Soares, McGovern Medical School, Texas
  • Book:
    Fundamentals of Clinical Psychiatry
    Published online:
    02 January 2025
    Print publication:
    16 January 2025, pp 123-133

  • 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.

  • Use of verbal de-escalation in reducing need for mechanical restraint in patients with psychotic disorders during non-voluntary transfers from home to the psychiatric emergency department

  • E. Miranda Ruiz, A. Gonzalez, P. Samos, M. Bellsola, A. Sabate, J. Leon, M.A. Jerónimo, V. Pérez-Solà, L.M. Martin, D. Corcoles
  • Journal:
    European Psychiatry / Volume 65 / Issue S1 / June 2022
    Published online by Cambridge University Press:
    01 September 2022, p. S589
    • Article
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      • Open access
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  • Introduction

    Little is known about the need for mechanical restraint during non-voluntary transfers from patient’s homes to the psychiatric emergency department in patients diagnosed with Paranoid Schizophrenia. Although there is no evidence of its efficacy, one of the main tools used for the reduction of mechanical restraints is verbal de-escalation training.

    Objectives

    The aim is to describe which symptoms predispose to mechanical restrain in patients with Paranoid Schizophrenia transferred in a non-voluntary manner from home to the psychiatric emergency department, and the effect on reducing mechanical restraints after receiving verbal de-escalation training.

    Methods

    All patients with Paranoid Schizophrenia who, after being visited by a home psychiatry team, have required non-voluntary transfer from their homes to the psychiatric emergency department were selected (N = 442).

    Results

    Young age, being male, having a poor adherence to treatment, higher scores for de following variables; Excitement, Grandiosity, Suspiciousness, Hostility, Abstract thinking, Motor tension, Uncooperativeness, Poor attention, Lack of insight and Poor impulse control as well as lower scores in motor retardation on the PANSS, are related to a higher frequency of mechanical restrain (P<0,005). Before the verbal de-escalation training, 43.9% of the transferred patients required mechanical restraint, after the training, the need for restraints was reduced to 25.5% (P<0.001).

    Conclusions

    Training in verbal de-escalation has allowed an important reduction in mechanical restraints in patients with schizophrenia who have required non-voluntary transfers from home to the psychiatric emergency department.

    Disclosure

    No significant relationships.