title: Qualitative study of the agitation states and their characterization, and the interventions used to attend them.
abstract: BACKGROUND
  Agitation is a common problem in psychiatric care with serious clinical and economic consequences.
  
  
  METHODS
  The aim of the study was to define and characterize the agitation states present in usual medical practice in the acute and emergency units of a psychiatric hospital. Two nominal groups, one with 7 nurses and the other with 10 psychiatrists from the Parc Sanitari Sant Joan de Déu, were established.
  
  
  RESULTS
  The nurses described two main states forming the endpoints of a spectrum: from mild (pre-agitation) to severe (agitation). A third state was outlined in which agitation was characterized by disorganized behavior problems. Various care packages were described for each agitation state. The care packages were divided into first, second and third line approaches. The first line approaches (i.e., verbal containment) were used on every (pre)agitated patient. If the first line approach was not effective, the second and third line approaches were implemented, culminating with physical restraint. The psychiatrists described 3 states: a mild initial state (anxiety and irritability), moderate (pre-agitation without aggressiveness) and a severe state of agitation with aggressiveness and/or violence.
  
  
  CONCLUSIONS
  In order to avoid progression to a severely agitated state, both groups agreed on the importance of appropriate verbal containment for all states. This would be followed by environmental measures, medication and mechanical restrain depending on the severity of the state.
authors.affiliation: Fundació Sant Joan de Déu. Esplugues de Llobregat, Spain Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP). Barcelona, Spain Facultad de Farmacia, Universitat de Barcelona. Barcelona, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Rubio-Valera
authors.affiliation: Fundació Sant Joan de Déu. Esplugues de Llobregat, Spain Parc Sanitari Sant Joan de Déu. Sant Boi de Llobregat, Spain Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental (CIBERSAM). Madrid, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Huerta-Ramos
authors.affiliation: Parc Sanitari Sant Joan de Déu. Sant Boi de Llobregat, Spain.
authors.forename: Luisa
authors.initials: L
authors.lastname: Baladón
authors.affiliation: Fundació Sant Joan de Déu. Esplugues de Llobregat, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Aznar-Lou
authors.affiliation: Parc Sanitari Sant Joan de Déu. Sant Boi de Llobregat, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Ortiz-Moreno
authors.affiliation: Fundació Sant Joan de Déu. Esplugues de Llobregat, Spain Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP). Barcelona, Spain Universitat Oberta de Catalunya (UOC). Barcelona, Spain.
authors.forename: Juan V
authors.initials: JV
authors.lastname: Luciano
authors.forename: Pere N
authors.initials: PN
authors.lastname: Roset-Arisso
authors.affiliation: Centre for Disability Research and Policy, Faculty of Health Sciences, and Mental Health Policy Unit, Brain and Mind Research Institute, University of Sydney. Sydney, Australia.
authors.forename: Luis
authors.initials: L
authors.lastname: Salvador-Carulla
authors.forename: José M
authors.initials: JM
authors.lastname: Villagrán
authors.affiliation: UGC salud Mental Regional de Málaga. Instituto Biosanitario de Málaga (IBIMA). Málaga, Spain.
authors.forename: Fermín
authors.initials: F
authors.lastname: Mayoral
authors.forename: Alfredo
authors.initials: A
authors.lastname: Gracia
authors.affiliation: Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP). Barcelona, Spain Parc Sanitari Sant Joan de Déu. Sant Boi de Llobregat, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Serrano-Blanco
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011595:Psychomotor Agitation / Q000175:diagnosis* / Q000628:therapy*