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Assessment and management of agitation in psychiatry: Expert consensus

Lookup NU author(s): Professor Hamish McAllister-WilliamsORCiD, Professor Heinz Grunze


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Background Psychomotor agitation is associated with different psychiatric conditions and represents an important issue in psychiatry. Current recommendations on agitation in psychiatry are not univocal. Actually, an improper assessment and management may result in unnecessary coercive or sedative treatments. A thorough and balanced review plus an expert consensus can guide assessment and treatment decisions. Methods An expert task force iteratively developed consensus using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new, re-worded or re-rated items. Results Out of 2175 papers assessing psychomotor agitation, 124 were included in the review. Each component was assigned a level of evidence. Integrating the evidence and the experience of the task force members, a consensus was reached on 22 statements on this topic. Conclusions Recommendations on the assessment of agitation emphasise the importance of identifying any possible medical cause. For its management, experts agreed in considering verbal de-escalation and environmental modification techniques as first choice, considering physical restraint as a last resort strategy. Regarding pharmacological treatment, the ideal medication should calm without over-sedate. Generally, oral or inhaled formulations should be preferred over i.m. routes in mildly agitated patients. Intravenous treatments should be avoided.

Publication metadata

Author(s): Garriga M, Pacchiarotti I, Kasper S, Zeller SL, Allen MH, Vazquez G, Baldacara L, San L, McAllister-Williams RH, Fountoulakis KN, Courtet P, Naber D, Chan EW, Fagiolini A, Moller HJ, Grunze H, Llorca PM, Jaffe RL, Yatham LN, Hidalgo-Mazzei D, Passamar M, Messer T, Bernardo M, Vieta E

Publication type: Article

Publication status: Published

Journal: World Journal of Biological Psychiatry

Year: 2016

Volume: 17

Issue: 2

Pages: 86-128

Online publication date: 25/02/2016

Acceptance date: 01/12/2015

ISSN (print): 1562-2975

ISSN (electronic): 1814-1412

Publisher: Taylor & Francis


DOI: 10.3109/15622975.2015.1132007


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