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

Luis San, Josef Marksteiner, Peter Zwanzger, María Aragüés Figuero, Francisco Toledo Romero, Grigorios Kyropoulos, Alberto Bessa Peixoto, Roxana Chirita, Anca Boldeanu, Luis San, Josef Marksteiner, Peter Zwanzger, María Aragüés Figuero, Francisco Toledo Romero, Grigorios Kyropoulos, Alberto Bessa Peixoto, Roxana Chirita, Anca Boldeanu

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.

Keywords: Aggression; Agitation; Bipolar disorder; Emergency; Epidemiology; Quality of care; Schizophrenia.

Figures

Fig. (1)
Fig. (1)
Severity of agitation according to PANSS-EC Score from admission to discharge at ER and AIU.
Fig. (2)
Fig. (2)
CGI-S score change from admission to discharge at ER and AIU.
Fig. (3)
Fig. (3)
Severity of agitation according to PANSS-EC.
Fig. (4)
Fig. (4)
Severity of agitation according to CGI scale.
Fig. (5)
Fig. (5)
Patient satisfaction with treatment.

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