IV. Therapeutic and Management Strategies
The treatment of agitation is considered a medical emergency, prioritizing the safety of the patient and others while aiming to calm the individual without excessive sedation.
- Non-Pharmacological Interventions
Before resorting to medication, environmental and communicative strategies should be attempted.
- Provide a Safe Environment: Create a calm, quiet space with minimal stimuli. Remove any objects that could potentially be used for harm.
- Verbal De-escalation: Communicate in a calm, respectful, and supportive tone. Use validating language to show understanding of the patient’s feelings. Avoid loud, hurried, or confrontational speech.
- Avoid Physical Restraint: Restraint and seclusion should be avoided unless absolutely necessary, as they can escalate agitation. They should only be used as a last resort by trained personnel when there is an imminent risk of harm.
- Mindful Eye Contact: Be cautious with prolonged, direct eye contact, as some agitated patients may perceive it as a threat.
- Pharmacological Treatment
Medication is administered when agitation is severe or persists despite non-pharmacological efforts.
- Benzodiazepines: Effective for rapidly reducing anxiety, restlessness, and muscle tension. They are often the first choice for agitation related to alcohol or substance withdrawal.
- Antipsychotics: Preferred for agitation associated with psychotic symptoms. Atypical antipsychotics are commonly used.
- Combination Therapy: In cases of severe and resistant agitation, a combination of an antipsychotic and a benzodiazepine may be used.
The overarching goal of treatment is to manage the acute episode to enable communication and cooperation, while simultaneously planning for the long-term management of the underlying condition to prevent future episodes.