Rethinking Agitation Management: From Force to Partnership
Jan 21, 2025
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In a thought-provoking discussion, Scott Zeller, Vice President for Acute Psychiatry at Vituity and former president of the American Association for Emergency Psychiatry, challenges traditional views on managing agitation. He emphasizes the importance of involving patients in medication decisions, even in crises. The conversation addresses the stigma of 'chemical restraints' and promotes respectful, patient-centered approaches that prioritize calming strategies. Zeller advocates for innovative methods blending medication with verbal de-escalation to enhance outcomes in emergency settings.
The redefinition of agitation management emphasizes that pharmacological interventions should be viewed as legitimate treatments rather than coercive measures.
Involving patients in their treatment decisions enhances recovery by fostering collaboration and reducing aggressive behaviors during episodes of agitation.
Deep dives
Reframing Agitation Management
The approach to managing agitation has been redefined by emphasizing that pharmacological interventions should not be labeled as chemical restraints. Medications administered during episodes of agitation are legitimate treatments for a medical condition rather than tools of coercion. The stigma associated with the term 'chemical restraints' detracts from the understanding that these interventions address actual psychiatric conditions. By shifting the narrative to highlight the therapeutic nature of these medications, healthcare professionals can improve patient outcomes and promote a more humane treatment environment.
Engaging Patients in Treatment Decisions
Involving patients in their treatment decisions can significantly enhance the process of managing agitation. Many agitated individuals retain the ability to communicate their preferences and can suggest medications that have worked for them in the past. This collaborative approach not only fosters a therapeutic alliance but also reduces the likelihood of aggressive behaviors during treatment. By giving patients the opportunity to participate in their care, clinicians can facilitate a more conducive atmosphere for recovery.
Prioritizing Calmness Over Sedation
The primary goal when treating agitation is to achieve calmness, rather than sedation or unconsciousness. Clinicians should focus on reducing distress and hyperactivity while minimizing medication side effects to ensure patient safety. An understanding of pharmacological options, such as the comparative onset times of oral versus parenteral medications, is vital for making informed choices. Effective agitation management should integrate medication as part of a broader de-escalation strategy, allowing for a patient-centered and ethical approach to care.
In this episode, we explore evidence-based pharmacologic strategies for managing acute agitation in emergency settings, challenging the stigmatizing concept of “chemical restraints” and providing practical approaches to achieve optimal patient outcomes. Did you know that many agitated patients can actively participate in medication decisions, even during a crisis?
Faculty: Scott Zeller, M.D. Host: Richard Seeber, M.D.