title: Assessment and management of agitation in psychiatry: Expert consensus.
abstract: BACKGROUND
  Psychomotor agitation is associated with different psychiatric conditions and represents an important issue in psychiatry. Current recommendations on agitation in psychiatry are not univocal. Actually, an improper assessment and management may result in unnecessary coercive or sedative treatments. A thorough and balanced review plus an expert consensus can guide assessment and treatment decisions.
  
  
  METHODS
  An expert task force iteratively developed consensus using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new, re-worded or re-rated items.
  
  
  RESULTS
  Out of 2175 papers assessing psychomotor agitation, 124 were included in the review. Each component was assigned a level of evidence. Integrating the evidence and the experience of the task force members, a consensus was reached on 22 statements on this topic.
  
  
  CONCLUSIONS
  Recommendations on the assessment of agitation emphasise the importance of identifying any possible medical cause. For its management, experts agreed in considering verbal de-escalation and environmental modification techniques as first choice, considering physical restraint as a last resort strategy. Regarding pharmacological treatment, the "ideal" medication should calm without over-sedate. Generally, oral or inhaled formulations should be preferred over i.m. routes in mildly agitated patients. Intravenous treatments should be avoided.
authors.affiliation: a Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona , Barcelona , Catalonia , Spain ;|b Barcelona Clinic Schizophrenia Unit (BCSU), Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona , Barcelona , Catalonia , Spain ;
authors.forename: Marina
authors.initials: M
authors.lastname: Garriga
authors.affiliation: a Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona , Barcelona , Catalonia , Spain ;
authors.forename: Isabella
authors.initials: I
authors.lastname: Pacchiarotti
authors.affiliation: c Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria ;
authors.forename: Siegfried
authors.initials: S
authors.lastname: Kasper
authors.affiliation: d Alameda Health System , Oakland , CA 94602 , USA ;
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zeller
authors.affiliation: e University of Colorado Depression Center , Denver , CO 80045 , USA ;
authors.forename: Michael H
authors.initials: MH
authors.lastname: Allen
authors.affiliation: f Research Center for Neuroscience and Neuropsychology, Department of Neuroscience , University of Palermo , Buenos Aires , Argentina ;
authors.forename: Gustavo
authors.initials: G
authors.lastname: Vázquez
authors.affiliation: g Federal University of Tocantins , Palmas , Tocantis , Brazil ;
authors.forename: Leonardo
authors.initials: L
authors.lastname: Baldaçara
authors.affiliation: h CIBERSAM, Parc Sanitari Sant Joan De Déu , Barcelona , Catalonia , Spain ;
authors.forename: Luis
authors.initials: L
authors.lastname: San
authors.affiliation: i Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumberland Tyne and Wear NHS Foundation Trust , Newcastle upon Tyne , UK ;
authors.forename: R Hamish
authors.initials: RH
authors.lastname: McAllister-Williams
authors.affiliation: j 3rd Department of Psychiatry, School of Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece ;
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Fountoulakis
authors.affiliation: k Department of Emergency Psychiatry and Post Acute Care , Hôpital Lapeyronie , CHU Montpellier , France ;
authors.forename: Philippe
authors.initials: P
authors.lastname: Courtet
authors.affiliation: l Department for Psychiatry and Psychotherapy , University Medical Center Hamburg-Eppendorf , Hamburg , Germany ;
authors.forename: Dieter
authors.initials: D
authors.lastname: Naber
authors.affiliation: m Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine , the University of Hong Kong , Hong Kong , China ;
authors.forename: Esther W
authors.initials: EW
authors.lastname: Chan
authors.affiliation: n School of Medicine, Department of Molecular Medicine , University of Siena , Siena , Italy ;
authors.forename: Andrea
authors.initials: A
authors.lastname: Fagiolini
authors.affiliation: o Department of Psychiatry and Psychotherapy , Ludwig Maximilian University , Munich , Germany ;
authors.forename: Hans Jürgen
authors.initials: HJ
authors.lastname: Möller
authors.affiliation: p Paracelsus Medical University , Salzburg , Austria ;
authors.forename: Heinz
authors.initials: H
authors.lastname: Grunze
authors.affiliation: q Service De Psychiatrie B , CHU De Clermont-Ferrand , Clermont-Ferrand , France ;
authors.forename: Pierre Michel
authors.initials: PM
authors.lastname: Llorca
authors.affiliation: r Belmont Behavioral Hospital , Philadelphia , PA , USA ;
authors.forename: Richard L
authors.initials: RL
authors.lastname: Jaffe
authors.affiliation: s Mood Disorders Centre, Department of Psychiatry , University of British Columbia , Vancouver , British Columbia , Canada ;
authors.forename: Lakshmi N
authors.initials: LN
authors.lastname: Yatham
authors.affiliation: a Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona , Barcelona , Catalonia , Spain ;
authors.forename: Diego
authors.initials: D
authors.lastname: Hidalgo-Mazzei
authors.affiliation: t Centre Hospitalier Pierre-Jamet, SAUS , Albi , France ;
authors.forename: Marc
authors.initials: M
authors.lastname: Passamar
authors.affiliation: u Danuvius Klinik GmbH, Pfaffenhofen an Der Ilm , Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Messer
authors.affiliation: b Barcelona Clinic Schizophrenia Unit (BCSU), Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona , Barcelona , Catalonia , Spain ;
authors.forename: Miquel
authors.initials: M
authors.lastname: Bernardo
authors.affiliation: a Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona , Barcelona , Catalonia , Spain ;
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D032921:Consensus; D019468:Disease Management; D004632:Emergency Medical Services; D006801:Humans; D015201:Meta-Analysis as Topic; D000077152:Olanzapine; D017410:Practice Guidelines as Topic; D011569:Psychiatric Status Rating Scales; D011570:Psychiatry; D011595:Psychomotor Agitation / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D000077152:Olanzapine
keywords: Agitation; assessment; psychiatric emergency; restraint; verbal de-escalation