Treatment of agitation in the general hospital setting

Agitation is a frequent and often complex clinical challenge to the hospital – based psychiatrist since it may lead to emergency hospitalization and can place patients and staff at risk. The first step in the evaluation is to identify whether a medical etiology for the agitation is present and to determine the general category of the disorder. Agitation can be seen in a number of different clinical conditions ranging from psychotic exacerbations in patients with schizophrenia to behavioral disturbances associated with organic factors. The determination of the aetiological factor of agitation and the diagnosis of the existent disorder are not always easy. The diagnosis is often unknown or provisional at best. So, agitation is an urgent situation in which the emergency team must operate immediately and, frequently, without complete diagnosis. Whenever possible patients should be offered choices in the selection of treatment. So there should always be attempts at trying to calm the patient by verbal means and trying to establish a cooperative relationship to reduce tension and to de-escalate the crisis before moving on to more intrusive strategies. If these interventions are not successful the use of emergency medication is desirable. The goals of a pharmaceutical intervention for this situation include rapid control of agitation, facilitation of therapeutic alliance and transition to longer-term treatment.