Agitation


Agitation is a serious, disruptive and pathological complication of many chronic psychological disorders, such as schizophrenia and mania. There are approximately five million adults in Europe afflicted by psychotic disorders. Agitation is defined by the “Diagnostic and Statistical Manual of Mental Disorders” as an “excessive motor activity associated with a feeling of inner tension.”

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    Cause & Symptoms
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    Diagnosis & Therapy
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    Everyday life

Diagnosis

Agitation (states of irritability, restlessness and tensions) is an acute, severe and pathological complication of many chronic psychiatric disorders, including schizophrenia and mania. Psychomotor agitation is defined as excess motor activity coupled with a feeling of inner anxiety.

Patients describe agitation as a feeling of inner distress (they feel nervous, restless, overwhelmed, out of control, in fear, in panic). It leads to an externally recognised dysfunctional state and manifests itself in swearing, hostility, lack of impulse controls, uncooperative behaviour and a greater propensity to violence.

Acute agitation in psychiatric disorders contributes significantly to the continued stigmatisation of psychiatric disorders.

Treatment

If a patient demonstrates signs of acute agitation or openly aggressive behaviour, the first step is to take the necessary precautions to ensure the safety of the people present: 

  • Ensure that the patient does not feel physically uncomfortable.
  • Reduce external agitation by means of relative isolation (a quiet room or separate examination room).
  • Minimise waiting times.
  • Remove any potentially dangerous objects.

The first line of treatment for the agitated person generally involves verbal de-escalation (“defuse” or “appease”). Staff must behave in a calm and controlled manner, at the same time demonstrate empathy and professional concern for the well-being of the patient as well as conveying the impression that the patient is safe.

If the agitation of a patient worsens to such an extent that there is a clear and present danger of self-injury or injury to other people, treatment must first and foremost focus on taking all necessary steps to ensure the safety of the patient and other people.

Means of coercion are used temporarily (two to four hours). This should be used to enable treatment to begin, as well as to be able to conduct initial physical, instrumental and laboratory examinations.

Once the patient has calmed down, there should be several indicators about the  problem afflicting the patient.

If medication continues to be necessary, attempts should be made by verbal means to calm the patient as much as possible so that they will voluntary accept oral administration, avoiding the need to administer medication forcibly via an intramuscular injection.

The patient generally calms down within half an hour or an hour if medication is administered repeatedly at short intervals.

A holistic treatment  approach should be applied. In addition to the unavoidable treatment with medication, non-pharmacological measures, including behavioural and environment-related measures, are taken in cases of acute agitation.