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A common symptom of psychiatric and medical disorders, agitation often appears in a variety of medical environments. This practical guide explores the origins of the condition and the differing approaches and treatments available. The biology of agitation is discussed, followed by specific chapters on substance abuse, medical causes, personality disorders, and treatment in pediatrics and the elderly. Treatment options including psychiatric work-ups, medical work-ups, psychopharmacology, de-escalation, and calming techniques are provided. The complexities of legal issues, patients' rights, and prehospital settings are also addressed, providing physicians, nurses, and mental health workers with a comprehensive resource in providing safe, focused, and effective treatment.
This chapter discusses the goals, designs, benefits, and shortcomings of the varied delivery models of emergency mental health care. It is extremely important that crisis professionals work with patients in a supportive and compassionate manner, creating with the patient what is known as a therapeutic alliance. Although there are numerous hybrid or idiosyncratic versions, generally emergency psychiatry programs in fixed settings fall into one of three basic models: the psychiatric consultant who sees patients in the medical emergency department (ED); a separate section of the medical ED dedicated to mental health patients, with specially trained and dedicated staff; and the stand-alone Psychiatric Emergency Service (PES), a facility separate from a medical ED that is solely for treatment of acute mental health patients. While many acute patients receive emergency psychiatric evaluations by consultants in the general ED, alternative specialized treatment services have been established successfully in numerous locations.