title: Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup.
abstract: Agitation is an acute behavioral emergency requiring immediate intervention. Traditional methods of treating agitated patients, ie, routine restraints and involuntary medication, have been replaced with a much greater emphasis on a noncoercive approach. Experienced practitioners have found that if such interventions are undertaken with genuine commitment, successful outcomes can occur far more often than previously thought possible. In the new paradigm, a 3-step approach is used. First, the patient is verbally engaged; then a collaborative relationship is established; and, finally, the patient is verbally de-escalated out of the agitated state. Verbal de-escalation is usually the key to engaging the patient and helping him become an active partner in his evaluation and treatment; although, we also recognize that in some cases nonverbal approaches, such as voluntary medication and environment planning, are also important. When working with an agitated patient, there are 4 main objectives: (1) ensure the safety of the patient, staff, and others in the area; (2) help the patient manage his emotions and distress and maintain or regain control of his behavior; (3) avoid the use of restraint when at all possible; and (4) avoid coercive interventions that escalate agitation. The authors detail the proper foundations for appropriate training for de-escalation and provide intervention guidelines, using the "10 domains of de-escalation."
authors.affiliation: Tufts University School of Medicine, Department of Psychiatry, Boston, Massachusetts.
authors.forename: Janet S
authors.initials: JS
authors.lastname: Richmond
authors.forename: Jon S
authors.initials: JS
authors.lastname: Berlin
authors.forename: Avrim B
authors.initials: AB
authors.lastname: Fishkind
authors.forename: Garland H
authors.initials: GH
authors.lastname: Holloman
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zeller
authors.forename: Michael P
authors.initials: MP
authors.lastname: Wilson
authors.forename: Muhamad Aly
authors.initials: MA
authors.lastname: Rifai
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Ng