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.
The author begins by providing a brief description of agitation, and various pharmaceutical and nonpharmaceutical interventions used for its treatment. Although this summary may be beneficial as a review, it is important for readers to familiarize themselves with more detailed descriptions of the causes of agitation, as well as pharmacologic and nonpharmacologic interventions used for the management of individuals with agitation, both of which are discussed in previous supplements in this series.
Patients with agitation are often treated through community-based mental health facilities, using either assertive community treatment (ACT) or intensive case management (ICM). The author outlines the benefits of these programs, including decreased symptom severity, improved quality of life for patients, and greater housing stability. One consideration for future discussion is the occasional contradictory assertion that ICM does not always reduce the length of hospital stay, whereas both ACT and ICM often reduce inpatient hospitalization time. Regardless, the evidence supports both short- and long-term benefits associated with community programs in the treatment of patients with mental illness.
The inclusion of the benefits of lay support for patients with agitation highlights the reality of reintegrating individuals with mental illness into the community. It is unreasonable in a postinstitutional treatment paradigm to expect healthcare professionals to provide the daily care needed to help patients proactively manage agitation. Therefore, the inclusion of family, friends, and other community members in the process is critical. It would be beneficial to both providers and payers to seek out and support various resources in their community beyond those already listed to develop the best possible support network for discharging patients, while, at the same time, controlling treatment efficacy.
The effective management of agitation in patients with schizophrenia or bipolar disorder involves reactive treatment of presenting symptoms as well as proactive prevention through collaborative efforts and the use of targeted therapies. A multidisciplinary approach to care should be encouraged to improve patient outcomes and reduce the cost of care.
The author thanks Nolan Lawless, MS, LPC, founder of Mount Scott Counseling, Lawton, OK, for his contributions to the reviews in this series.