Agitation: Neurobiology and current management guidelines.
The American journal of emergency medicine – February 01, 2025
Source: PubMed
Summary
Recent advances in neurobiology reveal that agitation stems from complex brain chemistry changes. Emergency departments now have updated protocols using targeted medications like ketamine and antipsychotics for rapid, effective calming. Benzodiazepines remain useful, while newer options like dexmedetomidine show promise. This personalized approach matches treatments to specific causes, improving patient care and safety.
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.