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Agitation in mania
In his keynote talk about the management of agitation in mania, Professor Heinz Grunze spoke from a background of more than 20 years’ experience of admissions.
No second chance for a first impression
Prof Grunze highlighted that, at least where agitation is concerned, the first encounter between the patient and psychiatrist can be very unpleasant for the patient – often taking place during an emergency admission. It is important therefore that psychiatrists handle this situation well to ensure not only the best treatment for the patient but to secure the optimal ongoing relationship between patient and psychiatrist.
Agitation is a state of mind
Theories on the neurochemical causes of agitation were discussed, as well as the best practice for its diagnosis and treatment. Current theory has it that agitation results from decreased activity of inhibitory GABAergic neurons and increased activity of excitatory dopaminergic, 5HT and noradrenergic neurons (although this is still yet to be definitively proven).
Made to measure
Next, the optimal measures to evaluate agitation were discussed. For use within the field of psychiatry, the Professor recommended the PANSS-EC (Positive And Negative Syndrome Scale, Excited Component).1 He recommended the less complex BARS (Behavioural Activity Rating Scale) when discussing agitation with other medical specialties (e.g. general medicine or surgery).2
There is a wide spectrum of interventions for agitation, beginning with well-established verbal de-escalation techniques,3 then adding pharmacological intervention and finally physical restraint. The choice of intervention depends on how dangerous patients are to themselves and to others.
Do no harm
In his summary, Prof Grunze highlighted the lack of consensus on a firm definition of agitation as one cause for a lack of a single, standard agitation rating scale.
He stressed that the optimal drug for treating agitation depended on the aetiology of the agitation itself. Careful selection of intervention (pharmacological or otherwise) was crucial to avoid making the medical situation worse or causing lasting psychological damage to the patient. He also noted the benefits of a debriefing session, both for clinical staff and the patient themselves, once the episode of agitation had been resolved.
In this reporter’s opinion, IRPB was a phenomenal success – a small conference with a big heart, filled to the brim with interesting lectures and posters. Until next year...
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Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.
References
1. Van den Oord EJ, et al. Schizophr Res 2006; 82(2–3); 213–223.
2. Swift RH, et al. J Psychiatr Res 2002; 36(2):87–95.
3. Richmond JS, et al. West J Emerg Med 2012; 13(1): 1–25.