Acute Agitation

Introduction

Treatment of overtly agitated, violent, or psychotic patients in the emergency department is challenging as clinicians often lack information about patients’ past medical and psychiatric history. Further, an agitated patient’s behavior may hinder the ability to perform a clinical examination. When presented with this scenario, verbal de-escalation should be trialed along with easy-to-administer oral medications.1 However, when these low-risk strategies fail, more potent pharmacologic sedation and physical restraints may be required.2 The ultimate decision to pursue pharmacologic sedation is a clinical one with the goal of calming the patient without oversedation so that he/she can take part in the plan of care without compromising diagnostic efforts or causing harm. This Capsules module will discuss the pharmacologic background of various agents used in the treatment of the agitated patient.

Learning Objectives

  1. Describe pharmacokinetic properties of medications routinely used to treat acute agitation
  2. Identify potential adverse effects associated with first- and second-generation antipsychotics
  3. Evaluate the comparative efficacy between various pharmacologic agents for treatment of acute agitation
  4. Recognize potential challenges of pharmacologic sedation in special populations
Authors Affiliation Twitter
Jenny Koehl, PharmD, BCPS Emergency Medicine Clinical Pharmacist, Massachusetts General Hospital @jlkoehl
Kyle DeWitt, PharmD, BCPS Emergency Medicine Clinical Pharmacist, University of Vermont Medical Center @EmergPharm
Gabrielle L. Procopio, PharmD, BCPS Emergency Medicine Clinical Pharmacist, Hackensack University Medical Center @gppharmed
Zlatan Coralic, PharmD, BCPS Emergency Medicine Clinical Pharmacist, University of California – San Francisco @ZEDpharm

 

Editors Affiliation Twitter
Emily Wiener, PharmD Emergency Medicine Clinical Pharmacist, Baltimore Washington Medical Center @PharmdEMily
Xander Miller, PharmD PGY-1 Pharmacy Resident, Massachusetts General Hospital @XanderBOS
Lead Editor: Bryan Hayes, PharmD, FAACT, FASHP Emergency Medicine Clinical Pharmacist, Massachusetts General Hospital @PharmERToxGuy

 

1.
Gilligan J, Lee B. The psychopharmacologic treatment of violent youth. Ann N Y Acad Sci. 2004;1036:356-381. [PubMed]
2.
Downes M, Healy P, Page C, Bryant J, Isbister G. Structured team approach to the agitated patient in the emergency department. Emerg Med Australas. 2009;21(3):196-202. [PubMed]