Psychomotor agitation and aggression¶

Abstract

Agitation and aggression are transdiagnostic dimensions that can be frequently observed in emergency psychiatric services. They frequently co-occur though they are at least partially independent. We conducted two studies performing a dimensional evaluation recruiting, respectively, 312 patients presenting to the emergency room for psychiatric consultation and 817 psychiatric inpatients. According to our data, psychomotor agitation (PMA) and impulse/behavioral dyscontrol (IBD) account for almost one third of psychiatric consultations in emergency room, but they were not associated to a higher rate of admission. The most relevant dimensions underlying both conditions were activation, anger/aggressiveness, and impulsivity that were significantly higher than all the other conditions. Such dimensions defined an agitated cluster of patients, who were significantly more likely to reach the ER with a proposal of compulsory admission, to be assessed for psychomotor agitation (40.0%), impulse/behavioral dyscontrol (21.0%), or self-harm behavior (17.1%) as primary reason, to be treated with antipsychotics alone or in association with benzodiazepines, and to be diagnosed with psychotic disorder, but, again, they were not more likely to be admitted. As regards the second study conducted on 817 patients admitted in psychiatric intensive care unit, we found that agitation and aggressiveness were both very present in the clinical sample: this represents a further challenge in the treatment of psychiatric patients. In this chapter, we present case vignettes to better explain how to use empathic communication, normalization, and de-escalation with agitated and aggressive patient, showing the importance of END procedure in lowering aggressive and agitated behaviors in these patients and increase adherence to treatment and compliance.