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Understanding Agitation
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What is Agitation?
• Agitation is defined as "excessive verbal and/or motor behavior" that can be loud, disruptive,
hostile, sarcastic, threatening, hyperactive, and/or combative”
• Can be caused by a mental health condition such as depression or bipolar disorder, or may be
related to intoxication. Many other medical conditions can cause someone to become agitated,
such as a head injury.
• Only a small number of patients experiencing agitation become aggressive.
• Agitation is experienced on a spectrum and it is best to intervene in the earlier stages to help a
person to calm.
Understanding Agitation
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What Agitation Feels Like
• People experiencing agitation are often in distress, frightened, and vulnerable. They may have
paranoia or racing thoughts. These experiences lead people into a “fight or flight” response,
which accounts for behaviors such as irritability, pacing, and argumentativeness.
• Because this is such a distressing experience, many patients want help and will respond best to a
compassionate, empathetic approach.
Understanding Agitation
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The Old Treatment Model
• Primarily medication focused
• Patients would often end up physically restrained and sedated without any prior attempted
interventions
• This approach can be dehumanizing or traumatizing to both patients, staff, and those in the
surrounding area
• This type of trauma can have long-term impact on the individual
• Additionally, as many as 2/3 of staff injuries occur while physically restraining a person
Understanding Agitation
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One Young Adult’s Perspective
“Being restrained costs a lot! I was abused before I was in psychiatric care. Being restrained made
me feel the same way – except staff are supposed to help you, right?
It made me worse and took away my self-esteem. How is that supposed to make me feel better? I
don’t get it.
Wouldn’t it be cheaper if staff just listened?”
-Juliana
Understanding Agitation
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Background on Project BETA
• Regulatory agencies and peer advocacy groups have called for a reduction in coercion and the use
of restraints.
• The American Association for Emergency Psychiatry embarked on Project BETA to disseminate
guidelines for the Best practices for the Evaluation and Treatment of Agitation in the emergency
setting.
• Project BETA was a collaboration between dozens of seasoned experts in psychiatry, emergency
medicine, and patient advocates.
• Guidelines for treatment include the entire agitation clinical spectrum, including triage, diagnosis,
and interpersonal calming skills, as well as medicine choices.
Understanding Agitation
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Project BETA Recommendation
Highlights
• De-escalation can work far more often than many clinicians may be aware
• It is nearly always worth attempting verbal calming as part of an agitation treatment approach
• Patients should be encouraged to take oral medications voluntarily, as opposed to forcible
involuntary injections. This will enhance the therapeutic alliance
• Second-generation antipsychotics are as efficacious as first-generation antipsychotics in agitation,
and preferable because of side effect profiles
• Agitation from stimulant intoxication should be treated with benzodiazepines alone
• Myth: emergency programs frequently have fewer staff assaults and injuries
Source: psychiatrictimes.com/psychiatric-emergencies/best-practice-guidelines-agitated-patients
Understanding Agitation
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Benefits to Your Facility,
Staff, and Patients
• Based on results from a California psychiatric ER implementing Project BETA recommendations,
you can expect:
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Decrease in assaults and injuries
Lowered insurance costs
Increase in patient satisfaction and long-term outcomes
Improved staff satisfaction and retention
A shift towards less restrictive interventions
• These results have been replicated and sustained over time.
• To view the evidence, visit DBSAlliance.org/UnderstandingAgitationKit
Understanding Agitation
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How Can DBSA Help?
• Resources for Your Facility
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Educational de-escalation poster
Treatment cards convenient to fit on a lanyard
Video series and webinar on agitation
DBSAlliance.org/UnderstandingAgitationKit
• Resources for Your Patients and their Families
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Your local DBSA support group
Understanding Agitation brochure
Personal crisis planning cards
DBSAlliance.org
Understanding Agitation
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Thank You!
Your Name
DBSA [Chapter Name]
Phone number
Email
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Understanding Agitation
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