Faculty Perspectives: Coping with Agitation Associated with Schizophrenia and Bipolar Disorder: How Can Healthcare Professionals Help Their Patients?

Management of agitation is critical to successful clinical outcomes in patients with mental health disorders such as schizophrenia or bipolar disorder. When patients are seen in clinical settings, however, healthcare professionals who are providing treatment are, by definition, in a reactive mode, managing symptoms that have already presented themselves. To take a proactive stance, providers must access multidisciplinary teams to work with patients coping with mental illness and create a collaborative framework, thus reducing the occurrence of future incidents of agitation. The main article in this publication provides an overview that outlines steps that can be taken by both professional healthcare providers and laypersons to create that framework.
Agitation refers to a spectrum of abnormal behaviors frequently seen in patients with psychiatric illnesses, including in individuals with schizophrenia or bipolar disorder. It is a mental and physical state that is characterized by motor restlessness, mental tension, and excitement, and it is often marked by poorly organized, aimless psychomotor activity. Agitated patients may exhibit aggressive behavior, resulting in harm to themselves, other patients, and healthcare workers. Therefore, prompt and effective management of agitation is critically important in the care of schizophrenia or bipolar disorder, and it requires the skills and expertise of several types of professionals. Typically, both pharmacologic and nonpharmacologic strategies are necessary to achieve optimal results.
The main article in this publication discusses the fact that psychotic agitation is characterized by motor restlessness, mental tension, and excitement, and that agitation includes a spectrum of abnormal behaviors frequently seen in patients with psychiatric illnesses, including in individuals with schizophrenia or bipolar disorder. This agitation is often marked by poorly organized, aimless psychomotor activity. Agitation accompanying psychosis often results in emergency department visits and admissions to psychiatric units, which may create burdens on emergency medical and psychiatric facilities. As payers, use of these resources is a major focus, as they account for a large portion of disease management. However, it is challenging for managed care organizations, especially pharmacy departments, to validate the prevalence of schizophrenia and bipolar disorder, because pharmacy claims are not associated with diagnosis codes. Therefore, payers may not be aware of the true impact of these conditions within their patient populations. Since much of the use of antipsychotic medications is “off-label,” an improved understanding of the causes of agitation and the development of more effective management strategies are important goals in the associated disorders, and these goals should be approached in a coordinated, integrated manner.
Agitated patients are at risk for becoming violent or aggressive, and causing harm to themselves, others, and property. In October 2010, the American Association for Emergency Psychiatry embarked on Project BETA (Best Practices in Evaluation and Treatment of Agitation) to address the inconsistency in treatment approaches for agitation, which can vary widely by region and institution. Project BETA provides guidelines for the medical evaluation and triage of the agitated patient, psychiatric evaluation of the agitated patient, verbal de-escalation of the agitated patient, psychopharmacologic approaches to agitation, and the use and avoidance of seclusion and restraint. These guidelines are available online and are free to access.

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