State of Acute Agitation at Psychiatric Emergencies in Europe: The STAGE Study

Abstract

Background:Agitation is an array of syndromes and types of behaviors that are common in patients with psychiatric disorders. In Europe, the estimation of prevalence of agitation has been difficult due to the lack of standard studies or systematic data collection done on this syndrome.Objective:An observational, cross-sectional, multicenter study aimed to assess the prevalence of agitation episodes in psychiatric emergencies in different European countries.Method:For 1 week, all episodes of acute agitation that were attended to at the psychiatric emergency room (ER) or Acute Inpatient Unit (AIU) in the 27 participating centers were registered. The clinical characteristics and management of the agitation episode were also described. A descriptive analysis was performed.Results:A total of 334 agitation episodes out of 7295 psychiatric emergencies were recorded, giving a prevalence rate of 4.6% (95% CI: 4.12-5.08). Of them, 172 [9.4% (95% CI: 8.2-10.9)] were attended at the ER and 162 [2.8% (95% CI: 2.4-3.3)] at AIU. Only data from 165 episodes of agitation (those with a signed informed consent form) was registered and described in this report. The most common psychiatric conditions associated with agitation were schizophrenia, bipolar disorder and personality disorder. The management of agitation included from non-invasive to more coercive measures (mechanical, physical restraint or seclusion) that were unavoidable in more than half of the agitation episodes (59.5%).Conclusion:The results show that agitation is a common symptom in the clinical practice, both in emergency and inpatient psychiatric departments. Further studies are warranted to better recognize (using a standardized definition) and characterize agitation episodes.

Characterizing the inpatient care of young adults experiencing early psychosis: A medical record review

“…Examining these and other factors that contribute to the use of seclusion and restraints are important so that changes in policies and practices could be made to further reduce or minimize their use (Allen et al, ; Knox & Holloman, ; Lofchy, Boyles, & Delwo, ; Richmond et al, ). At a prevalence of 32.4%, the use of seclusion in our hospital is higher than the pooled prevalence of 29% reported for children and adolescents in psychiatric settings (De Hert, Dirix, Demunter, & Correll, ), and also appears high compared to the published estimate of the prevalence of conditions (Allen et al, ; San et al, ) that may require their use. In the literature, restraints and seclusion continue to be two of the most frequently reported interventions used to manage challenging behaviour (Cowman, Björkdahl, Clarke, Gethin, & Maguire, ), despite lack of strong evidence of effectiveness (Nelstrop et al, ) and potential for long‐term negative outcomes (McLaughlin, Giacco, & Priebe, ).…”

Recognition and Management of Agitation in Acute Mental Health Services: A Qualitative Evaluation of Staff Perceptions

“…There is limited epidemiologic evidence on the prevalence of agitation in mental health settings. Estimates range between a high of 47.5% among newly hospitalised adults with schizophrenia in China [8] to a low of 4.6% among psychiatric emergency presentations in Europe [9]. This variation is due in part to the ongoing debate over a standardised de nition of agitation and the use of appropriate measurement scales to aid the assessment of agitation in the clinical setting [10].…”

A survey of caregiver burden in those providing informal care for patients with schizophrenia or bipolar disorder with agitation: results from a European study

“…Although agitation states from mild to severe and their characterization have been previously described, there has been a failure to reach a consensus on the definition of agitation [ 6 , 7 ] which has been recognised as one factor underlying the lack of epidemiological data in this area [ 8 ]. Previous studies that have reported on the prevalence of agitation focus on emergency hospital or clinic attendance; a European study found that 4.6% of psychiatric emergencies were attributed to acute agitation, of which half of the patients had a diagnosis of schizophrenia and a quarter had a diagnosis of bipolar disorder [ 9 ]. Conversely, a US study found that 52% of psychiatric emergencies included agitation to some degree; [ 10 ] the discrepancy between the two studies is likely a result of differential definitions and an under-diagnosis of mild or moderate episodes [ 9 ].…”

“…Previous studies that have reported on the prevalence of agitation focus on emergency hospital or clinic attendance; a European study found that 4.6% of psychiatric emergencies were attributed to acute agitation, of which half of the patients had a diagnosis of schizophrenia and a quarter had a diagnosis of bipolar disorder [ 9 ]. Conversely, a US study found that 52% of psychiatric emergencies included agitation to some degree; [ 10 ] the discrepancy between the two studies is likely a result of differential definitions and an under-diagnosis of mild or moderate episodes [ 9 ]. The data from these studies indicate that agitation is observed in psychiatric emergencies, but do not provide insight into the day-to-day burden of agitation in the community.…”