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      1st International Experts’ Meeting on Agitation: Conclusions Regarding the Current and Ideal Management Paradigm of Agitation

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          Abstract

          Agitation is a heterogeneous concept without a uniformly accepted definition, however, it is generally considered as a state of cognitive and motor hyperactivity characterized by excessive or inappropriate motor or verbal activity with marked emotional arousal. Not only the definition but also other aspects of agitated patients’ care are still unsolved and need consensus and improvement. To help the discussion about agitation among experts and improve the identification, management, and treatment of agitation, the 1st International Experts’ Meeting on Agitation was held in October 2016 in Madrid. It was attended by 20 experts from Europe and Latin America with broad experience in the clinical management of agitated patients. The present document summarizes the key conclusions of this meeting and highlights the need for an updated protocol of agitation management and treatment, the promotion of education and training among healthcare professionals to improve the care of these patients and the necessity to generate clinical data of agitated episodes.

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          Most cited references28

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          The positive and negative syndrome scale (PANSS) for schizophrenia.

          The variable results of positive-negative research with schizophrenics underscore the importance of well-characterized, standardized measurement techniques. We report on the development and initial standardization of the Positive and Negative Syndrome Scale (PANSS) for typological and dimensional assessment. Based on two established psychiatric rating systems, the 30-item PANSS was conceived as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative symptoms and gauges their relationship to one another and to global psychopathology. It thus constitutes four scales measuring positive and negative syndromes, their differential, and general severity of illness. Study of 101 schizophrenics found the four scales to be normally distributed and supported their reliability and stability. Positive and negative scores were inversely correlated once their common association with general psychopathology was extracted, suggesting that they represent mutually exclusive constructs. Review of five studies involving the PANSS provided evidence of its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment.
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            Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup

            Agitation is an acute behavioral emergency requiring immediate intervention. Traditional methods of treating agitated patients, ie, routine restraints and involuntary medication, have been replaced with a much greater emphasis on a noncoercive approach. Experienced practitioners have found that if such interventions are undertaken with genuine commitment, successful outcomes can occur far more often than previously thought possible. In the new paradigm, a 3-step approach is used. First, the patient is verbally engaged; then a collaborative relationship is established; and, finally, the patient is verbally de-escalated out of the agitated state. Verbal de-escalation is usually the key to engaging the patient and helping him become an active partner in his evaluation and treatment; although, we also recognize that in some cases nonverbal approaches, such as voluntary medication and environment planning, are also important. When working with an agitated patient, there are 4 main objectives: (1) ensure the safety of the patient, staff, and others in the area; (2) help the patient manage his emotions and distress and maintain or regain control of his behavior; (3) avoid the use of restraint when at all possible; and (4) avoid coercive interventions that escalate agitation. The authors detail the proper foundations for appropriate training for de-escalation and provide intervention guidelines, using the “10 domains of de-escalation.”
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              Assessment and management of agitation in psychiatry: Expert consensus.

              Psychomotor agitation is associated with different psychiatric conditions and represents an important issue in psychiatry. Current recommendations on agitation in psychiatry are not univocal. Actually, an improper assessment and management may result in unnecessary coercive or sedative treatments. A thorough and balanced review plus an expert consensus can guide assessment and treatment decisions.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                27 February 2018
                2018
                : 9
                : 54
                Affiliations
                [1] 1Hospital Universitario Doctor Peset, University of Valencia & CEU Cardenal Herrera University , Valencia, Spain
                [2] 2San Martino Hospital , Genova, Italy
                [3] 3Azienda Ospedaliero Universitaria "Consorziale Policlinico" di Bari , Bari, Italy
                [4] 4Hôpitaux Universitaires de Montpellier , Montpellier, France
                [5] 5Hospital Clínic de Barcelona , Barcelona, Spain
                [6] 6Hospital de Emergencias Psiquiátricas Torcuato de Alvear , Buenos Aires, Argentina
                [7] 7Medizinische Hochschule , Hannover, Germany
                [8] 8Norrbottens Läns Landsting , Luleå, Sweden
                [9] 9Johanniter Krankenhaus, Evangelisches Klinikum Niederrhein , Oberhausen, Germany
                [10] 10Medical School of Athens, National and Kapodistrian University of Athens, Eginition Hospital , Athens, Greece
                [11] 11Azienda Ospedaliera Universitaria Pisana , Pisa, Italy
                [12] 12Medical University of Vienna , Vienna, Austria
                [13] 13II Medical School, Sapienza University of Rome , Rome, Italy
                [14] 14Centre Hospitalier Sainte Anne , Paris, France
                [15] 15Complejo asistencial Universitario de Palencia , Palencia, Spain
                [16] 16Hospital Universitari Mútua Terrassa, Universitat de Barcelona , Barcelona, Spain
                [17] 17Danube Hospital , Vienna, Austria
                [18] 18Øyane DPS Bergen , Bergen, Norway
                [19] 19Hospital Universitario Fundación Alcorcón , Alcorcón, Spain
                [20] 20Hôpitaux Universitaires de Strasbourg , Strasbourg, France
                Author notes

                Edited by: Maria Rosaria Anna Muscatello, Università degli Studi di Messina, Italy

                Reviewed by: Filippo Caraci, Università degli Studi di Catania, Italy; Pasquale De Fazio, Università degli Studi Magna Graecia di Catanzaro, Italy

                *Correspondence: José Martínez-Raga, martinez_josrag@ 123456gva.es

                Specialty section: This article was submitted to Psychopharmacology, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2018.00054
                5835036
                29535649
                aa856312-dedb-48d7-adad-521e1b4e537f
                Copyright © 2018 Martínez-Raga, Amore, Di Sciascio, Florea, Garriga, Gonzalez, Kahl, Karlsson, Kuhn, Margariti, Pacciardi, Papageorgiou, Pompili, Rivollier, Royuela, Safont, Scharfetter, Skagen, Tajima-Pozo and Vidailhet.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 15 September 2017
                : 08 February 2018
                Page count
                Figures: 4, Tables: 1, Equations: 0, References: 32, Pages: 9, Words: 5612
                Categories
                Psychiatry
                Review

                Clinical Psychology & Psychiatry
                schizophrenia,bipolar disorder,psychomotor agitation,management,clinical practice

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