Book Review: The Diagnosis and Management of Agitation

Abstract

Agitation is a common symptom of psychiatric and medical emergencies, and it often appears in a variety of medical environments. The origin of agitation and the differing approaches and treatments available are the principal focus of this book. The book begins with emphasis on the biology of agitation, followed by chapters on substance abuse, medical evaluation and psychiatric evaluation of patients with agitation, medical causes of agitation, personality disorders, pediatrics, and geriatrics. Treatment options are outlined, including psychiatric and medical workups, psychopharmacology, deescalation, and calming techniques. Legal issues, patients’ rights, and approaches in prehospital settings are addressed that provide physicians, nurses, and health care workers in general with guidelines for safe, focused, and effective treatment. The book consists of 18 chapters written by 31 authors often working in pairs. The authors have long and distinguished experience in emergency medicine and psychiatry, as do the three editors. Each chapter begins with an introduction and proceeds to provide a background of the development of agitation, discussing the key concepts of etiology and management. The biology of agitation takes up a chapter of its own in substantial length and detailed depth. This is followed by the medical evaluation of the agitated patient and the diagnostic evaluation of psychiatric patients and the elderly. The next chapter deals with agitation related to substance use, abuse, and withdrawal. This chapter provides a good picture of the impact of alcohol-related agitation and alcohol-related dementia. The frequency of agitated behavior as a symptom of psychiatric conditions and somatic conditions, particularly neurological states, is discussed, as are stimulants, especially cocaine, which could lead to stroke, heart attack, and heart failure. Withdrawal symptoms, alcohol-related dementia including WernickeKorsakoff syndrome, and scales to assess agitation are discussed. This chapter, like the previous chapters, concludes with a detailed list of references. The next chapter is focused on medical causes of agitation arising from systemic illness. Chapter 6 deals with agitation in the elderly, since they constitute a special population presenting unique problems to health care providers. The three subsequent chapters deal with the psychiatric evaluation of patients with agitation and the causes of exacerbation of agitation in those with personality disorders and those with mood and psychotic disorders. The next chapter deals with standards of care leading to collaborative deescalation to prepare to engage early and safely the person around medication use. Chapter 11’s focus is on agitation in field settings by emergency medical services providers and law enforcement personnel. Chapter 12 deals with the use of conducted energy devices and of TASERS in the prehospital environment. There appears to be a significant focus on patients suffering from excited delirium syndrome, which is a true medical emergency requiring rapid identification and control. Chapter 13 is focused on the appropriate use of restraint and seclusion, and Chapter 14 deals with the pharmacologic treatment of agitation. Chapter 15 discusses the socioenvironmental and cultural aspects of agitation, whereas chapter 16 deals with the ethics of agitation and the patient’s capacity. Chapter 17 discusses the patient’s rights and the family’s perspective. The last chapter, chapter 18, is focused on the special population of children and adolescents. This book is a practical guide exploring the origins of agitation as well as the different approaches and treatments available in the management of agitation. While the chapters of the book offer a scientific base for both the etiology and management of agitation, fairly often the reader will find a good degree of overlap and duplication between chapters. Such duplication is apparent from the beginning of the book. For instance, a description of the subject literature provided in chapter 2, “The Biology of Agitation,” is repeated in subsequent chapters. However, the chapters in this book provide valuable guidance to create much-needed clinical guidelines and recommendations for the diagnosis and effective management of agitation. The book is commendable for its humane approach to the diagnosis and management of agitation and for covering the life span from youth through the elderly. The book is free of production errors. The price is reasonable. The Canadian Journal of Psychiatry / La Revue Canadienne de Psychiatrie 2018, Vol. 63(7) 501 a The Author(s) 2018 Reprints and permission: sagepub.com/journalsPermissions.nav TheCJP.ca | LaRCP.ca Canadian Psychiatric Association