The Diagnosis and Management of Agitation

A common symptom of psychiatric and medical disorders, agitation often appears in a variety of medical environments. This practical guide explores the origins of the condition and the differing approaches and treatments available. The biology of agitation is discussed, followed by specific chapters on substance abuse, medical causes, personality disorders, and treatment in pediatrics and the elderly. Treatment options including psychiatric work-ups, medical work-ups, psychopharmacology, de-escalation, and calming techniques are provided. The complexities of legal issues, patients' rights, and prehospital settings are also addressed, providing physicians, nurses, and mental health workers with a comprehensive resource in providing safe, focused, and effective treatment.

1. Agitation: where we're going, where we've been Scott L. Zeller; 2. The biology of agitation Scott A. Simpson; 3. Medical evaluation of the agitated patient Seth Thomas and Nathan Beckerman; 4. Agitation due to substance use, abuse, and withdrawal Alexander Schorb and Heinz Grunze; 5. Medical causes of patients with agitation: systemic illness Sandra Schneider; 6. Special populations: agitation in elderly patients Eric L. Anderson; 7. The psychiatric evaluation of patients with agitation Joachim Scharfetter; 8. Psychiatric causes of agitation: exacerbation of personality disorders Paul R. Borghesani, Sharon Romm and Jagoda Pasic; 9. Psychiatric causes of agitation: exacerbation of mood and psychotic disorders Marina Garriga, Isabella Pacchiarotti, Miquel Bernardo and Eduard Vieta; 10. Collaborative de-escalation Jon S. Berlin; 11. Agitation in field settings: emergency medical providers and law enforcement Thom Dunn and Charles Dempsey; 12. Use of force in the prehospital environment Yuko Nakajima and Gary M. Vilke; 13. Appropriate use of restraint and seclusion Naomi Schmelzer; 14. Pharmacologic treatment of agitation Leslie Citrome; 15. Understanding the environmental, social, familial, and cultural context of agitation Julien J. Cavanagh de Carvalho; 16. The ethics of agitation: when is an agitated patient decisionally capable? David Pepper and Michael P. Wilson; 17. Patient rights, patient and family perspectives on agitation Phyllis Foxworth; 18. Diagnosis and management of agitation in children and adolescents John S. Rozel, Keith R. Stowell and Gregory D. Thorkelson.

Scott L. Zeller is Vice President for Psychiatry, CEP America and Assistant Clinical Professor of Psychiatry, University of California, Riverside. He has designed and developed emergency psychiatry programs across the USA, and he was a lead author on both the USA and International Best Practices guidelines publications for the treatment and evaluation of agitation. His work to improve care for agitated patients led to him being named the 2015 USA 'Doctor of the Year' by the National Council for Behavioral Health.
Kimberly D. Nordstrom is Medical Director, Office of Behavioral Health, State of Colorado and Emergency Psychiatrist, Denver Health Medical Center and Associate Professor at the University of Colorado Department of Psychiatry. She is the Immediate Past President of American Association for Emergency Psychiatry and a Distinguished Fellow of the American Psychiatric Association.
Michael P. Wilson is practicing emergency physician and Director of Emergency Psychiatry Research for the American Association for Emergency Psychiatry, Medical Director of Aeromedevac Air Ambulance, and Director of the Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab at the University of California, San Diego.