Agitation and Psychiatric Disease
Best Practices for Emergency Care
Meeting Slides
Clinical Assessment Tools
Behavioral Activity Rating Scale (BARS)
The BARS allows for a quick assessment of agitation via a numerical rating score of 1 to 7.
Overt Agitation Severity Scale (OASS)
Designed to assess agitation, this comprehensive evaluation scale relies on the observation of specific agitation-related behaviors and the frequencies at which they manifest.
Positive and Negative Syndrome Scale, Excited Component (PANSS-EC)
This subscale of the Positive and Negative Syndrome Scale specifically evaluates excited states by assessing patients for 5 items: poor impulse control, tension, hostility, uncooperativeness, and excitement.
American Association for Emergency Psychiatry Project BETA Guidelines:
Use and avoidance of seclusion and restraint: consensus statement of the American Association for Emergency Psychiatry Project BETA Seclusion and Restraint Workgroup.
Knox DK, Holloman GH, Jr. West J Emerg Med. 2012;13(1)35-40.
Medical evaluation and triage of the agitated patient: consensus statement of the American Association for Emergency Psychiatry Project BETA Medical Evaluation Workgroup.
Nordstrom K, et al. West J Emerg Med. 2012;13(1):3-10.
Verbal de-escalation of the agitated patient: consensus statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup.
Richmond JS, et al. West J Emerg Med. 2012;13(1):17-25.
Psychiatric evaluation of the agitated patient: consensus statement of the American Association for Emergency Psychiatry Project BETA Psychiatric Evaluation Workgroup.
Stowell KR, et al. West J Emerg Med. 2012;13(1):11-16.
The psychopharmacology of agitation: consensus statement of the American Association for Emergency Psychiatry Project BETA Psychopharmacology Workgroup.
Wilson MP, et al. West J Emerg Med. 2012;13(1):26-34.
Suggested Readings
Delirium: a neurologist's view—the neurology of agitation and overactivity.
Caplan LR. Rev Neurol Dis. 2010;7:111-118.
Heisenberg in the ER: observation appears to reduce involuntary intramuscular injections in a psychiatric emergency service.
Damsa C, et al. Gen Hosp Psychiatry. 2006;28(5):431-433.
Alternative delivery systems for agents to treat acute agitation: progress to date.
Nordstrom K, Allen MH. Drugs. 2013;73:1783-1792.
The neurobiology of the switch process in bipolar disorder: a review.
Salvadore G, et al. J Clin Psychiatry. 2010;71(11):1488-1501.
Schizophrenia: a systematic review of the disease state, current therapeutics and their molecular mechanisms of action.
Shin JK, et al. Curr Med Chem. 2011;18(9):1380-1404.
A national study of violent behavior in persons with schizophrenia.
Swanson JW, et al. Arch Gen Psych. 2006;63(5):490-499.
The assessment and management of the violent patient in critical hospital settings.
Tischler CL, et al. Gen Hosp Psychiatry. 2013;35(2):181-185.
Interactive PresentationScientific Insights into Agitation Pathophysiology
Leslie Citrome, MD, MPH
Relevant Resources
Improved Diagnostic and Management Strategies
Overcoming Diagnostic Challenges, Targeting Remission, and Optimizing Cardiometabolic Health
New Approaches to Optimizing Patient Outcomes
Overcoming Diagnostic Barriers and Optimizing Long-Term Patient Outcomes
Accelerating Diagnosis, Achieving Remission, and Encouraging Adherence
Managing Patients Across the Disease Spectrum
Consensus and Controversies Across the Spectrum of Patient Presentations
Finding the Way Forward
