Agitation: Neurobiology and current management guidelines.
Christopher W T Miller, Mario Rullo, Sarah Van Remmen, Sara Mahmood
The American journal of emergency medicine February 1, 2025 DOI: 10.1016/j.ajem.2024.11.068 via PubMed
Summary
AI-generated from the abstractGuidelines for managing agitation in emergency and psychiatric emergency settings have been updated since the 2012 Project BETA recommendations. This paper synthesizes current guidelines, explains the neurobiology of agitation, and links brain mechanisms to the pharmacological profiles of recommended drugs, including ketamine and droperidol, which have seen increased use. Clinicians are given treatment strategies tailored to specific causes of agitation.
Study at a glance
| Characteristics | Review Peer reviewed |
|---|---|
| Topics | Ketamine |
| Keywords | Agitation Antipsychotic Benzodiazepines Dexmedetomidine Emergency department |
| Citations | 4 |
| Key finding | Updated guidelines for agitation management in emergency settings incorporate increased use of ketamine and droperidol, and link neurobiological mechanisms to pharmacological profiles. |
Abstract
There have been important updates in the guidelines for the management of agitation in emergency room settings, including psychiatric emergency services. This manuscript provides a synthesis of current recommendations, combined with a detailed breakdown of the neurobiology of agitation, linking these neuroscientific dimensions with the pharmacological profiles of the drugs recommended by practice guidelines (as well as the profiles of other important agents). Since Project BETA (Best Practices in Evaluation and Treatment of Agitation) guidelines were published in 2012 (by the American Association for Emergency Psychiatry), there have been several developments in the standard of care, including an increase in use of ketamine and droperidol. Recommended treatment strategies for clinicians will be presented, including consideration of how to address specific causes of agitation.