Consensus on acute behavioural disturbance in the UK: a multidisciplinary modified Delphi study to determine what it is and how it should be managed

Abstract

BackgroundAcute behavioural disturbance (ABD) is a term used in law enforcement and healthcare, but there is a lack of clarity regarding its meaning. Common language should be used across staff groups to support the identification, prioritisation and delivery of care to this group of patients. The terminology currently used is inconsistent and confusing. This study aimed to reach a consensus on the criteria for identification and management of ABD, and to agree when other care pathways or guidelines might be more appropriately used.MethodsA modified Delphi study with participation from stakeholder organisation representatives was conducted in January–April 2023 online. In round 1, statements were generated by participants in response to broad questions. Participants then rated their level of agreement with statements in subsequent rounds, with statements achieving a consensus removed for inclusion in the final derived consensus statement. Non-consensus statement responses were assessed for stability.ResultsOf 430 unique statements presented for rating, 266 achieved a consensus among 30 participants representing eight stakeholder organisations. A derived consensus statement was generated from these statements. The median group response to statements which failed to achieve a consensus was reliable (Krippendorff’s alpha=0·67).ConclusionsThere is a consensus across stakeholder organisations that ABD is not a separate entity to agitation, and guidance should instead be altered to address the full range of presentations of agitation. While the features of concern in this severely agitated group of patients can be described, the advice for recognition may vary depending on staff group. Criteria for recognition are provided and potential new terminology is described.

A retrospective study of the characteristics and toxicology of cases of lysergic acid diethylamide (LSD)‐ and psilocybin‐related death in Australia

“…The role of intense agitation observed in a number of these deaths must be considered, as it is likely to have increased the risk to the individual. In particular, the intense agitation in what has previously been termed excited delirium, but which is now more commonly termed acute severe behavioural disturbance or, alternatively, hyperactive delirium with severe agitation [45, 46]. This appeared to play a significant role in a number of the LSD self‐harm cases that appeared spontaneous, with no known prior history of such acts.…”

Acute behavioural disturbance: what's in a name?

“…I am not sure that ABD as a term remains fit for purpose, and I am minded it is too heavily tainted by the weight of too many injustices to persevere. A recent UK-based multidisciplinary Delphi study 11 has proposed some areas of consensus from participants from a range of professional backgrounds, including that ABD is not a separate entity to agitation and should be renamed. They have proposed key criteria to identify those at most risk of poor outcomes, specifically tactile hyperthermia (being hot to touch), constant activity and extreme agitation or aggression.…”