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Strategies to Help Manage the Agitated Patient

Strategies to Help Manage the Agitated Patient

  • 6 Goals of Emergency Psychiatric Care


How to manage the agitated patient?

That’s the subject of this brief podcast. The speaker is Scott Zeller, MD, chief of psychiatric emergency services at John George Hospital in Oakland, California, and the immediate past president of the American Association for Emergency Psychiatry.

Dr Zeller presents on this topic at a course entitled “Emergency Psychiatry: Triage, Evaluation, and Initial Treatment of the Crisis Patient” at the American Psychiatric Association’s Annual Meeting in New York City.

Agitation is a spectrum of symptoms . . . it can go all the way from being irritable up to pacing to lashing out to clenched fists to outright violence. Intervention via de-escalation techniques at an early stage is optimal.

Here: Dr. Zeller outlines 6 basic goals of intervention.


Show of force is not always to threaten, not always to coerce, not even force ultimatum but it also serve to approach a ready to act out patient to take deep breath, I truly dubious of all those who vehemently oppose any positive reinforcement worked ever with manipulative barely psychotic but limit testing non voluntary patients, please be aware that those days are gone when poor psychotic, paranoid, insight lacking patients were treated with force and threat, but the spectrum have changed a 180 degree and that manipulative, antisocial, criminal minded are more often seen in the psych inits.

mohamed @

This is better advice than usual. I would add these points. "A show of force" in any form is ill-advised as it does what it is, of course, intended to do: it frightens the patient, which immediately heightens any paranoia and promotes escalation of the situation, not de-escalation. Likewise, issuing any ultimatum -- "either you do this or this will happen" -- signals the end of a possible "happy outcome" for all. Both should be avoided. If possible, a single person who is able to remain calm and unruffled should approach someone who is agitated and speak to her or him slowly and calmly, as Dr Zeller suggested. Suggest that perhaps taking a deep breath would help. Anger and accusations should be met with a steadfast refusal to react. Sometimes offers of a warmed up blanket or strangely enough something ice cold to eat, like a popsicle (if possible) have been useful. Remember that listening is often the most useful tool in the clinician's arsenal; find out what is bothering the patient most before you try to fix what you think is wrong.

P @

I agree with the calm non-threatening approach when someone is agitated and offering choices where feasible. It usually leads to cooperation and trust. This is in contrast to how the agitated person in public or home is treated/approached by police often leading to an escalation in agitation and more explosive and injurious and even fatal outcomes. When you approach someone from a place of fear and control rather than empathy and desire to help them "feel better" you get a much different outcome.

Lynn @

Agreed. So how do you change the system of including a police officer and a "team" that will incite the already frightened person?

E @

This would be better in a readable format. The general approach is good, but when you have intoxicated patients suffering from psychotic disorders, coercion may be necessary to protect the patient, other patients, and staff.

Farrel @

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