Agitation

Excerpt

Agitation is a feeling of irritability or severe restlessness. It is a common sight in psychiatry units, emergency departments, and long-term care facilities, and it is managed differently depending on the setting and the person addressing it. The United States (US) Food and Drug Administration Center for Drug Evaluation and Research has highlighted that the various definitions of agitation include the presence of “exceeding restlessness associated with mental distress” and “excessive motor activity associated with a feeling of inner tension.” There are many reasons for aggression, and to some degree, it can be a normal physiological process. Traditionally, agitated patients were restrained, secluded, or given high doses of antipsychotics to sedate them; however, over time, less restrictive methods have been used and have shown to be superior while maintaining therapeutic support. Noncoercive methods are most likely to de-escalate situations, but there are times when agitation is so severe that medications must be used voluntarily or involuntarily for safety concerns. Recent recommendations from psychiatry experts are still ambiguous and often confounded by observer bias. Aggression can be verbal or physical and is directed at objects and other people, and sometimes may manifest as self-mutilation. Suicide attempts or gestures are considered a sign of aggression as well. This activity reviews different causes of behavioral disturbances, diagnostic cues, and management protocols in different settings.