Diagnosis and Initial Management of Agitated Patients in a General Hospital :

Tiyarat Kayankit; Pavita Chongsuksiri; Pornjira Pariwatcharakul

doi:10.33192/Smj.2021.23

Authors

Tiyarat Kayankit Department of Psychiatry, Buddhachinaraj Hospital, Phitsanulok 65000, Thailand http://orcid.org/0000-0002-2911-8040
Pavita Chongsuksiri Department of Psychiatry, Buddhachinaraj Hospital, Phitsanulok 65000, Thailand http://orcid.org/0000-0002-5733-4891
Pornjira Pariwatcharakul Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 http://orcid.org/0000-0003-0228-3043

DOI:

https://doi.org/10.33192/Smj.2021.23

Keywords:

agitation, delirium, alcohol withdrawal, diagnostic concordance, restraint, consultation-liaison psychiatry, diagnosis, management, benzodiazepine, antipsychotics

Abstract

Objective: To examine the characteristics, diagnosis and management of agitated inpatients before psychiatric consultation in a general hospital.
Methods: A retrospective chart review of inpatients aged 18 years or older that were referred for psychiatric consultation due to agitation in a general hospital in Thailand.
Results: Of the 188 patients, confusion was the most commonly detected early sign of agitation (63;33.5%), while fidgeting was the most common symptom/behavior that led to psychiatric consultations (94;50.0%). The average onset time of agitation after admission was 62 hours 48 minutes. The most common cause of agitation was delirium due to a medical condition (89;47.3%). Primary psychiatric disorders were only found in 9 (4.8%) of agitated patients. There was a low diagnostic concordance between attending physicians and psychiatrists (Cohen’s Kappa=0.32). Physical restraints were used in 109 (58.0%) patients, whereas 166 (88.3%) were prescribed with sedatives. Attending physicians prescribed benzodiazepine to ameliorate agitation in 32 (36.0%) of patients with delirium. However, 4 (7.3%) patients with alcohol-withdrawal delirium were untreated initially with benzodiazepine.
Conclusion: Medical conditions are more common causes of agitation than psychiatric illness. There is poor diagnostic concordance between attending physicians and psychiatrists, and high rates of physical restraints and benzodiazepine injection were found. Medical education on the detection and management of agitation and the appropriate use of sedative medications and restraints is needed.

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