Agitation: Neurobiology and current management guidelines

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 for managing agitation, combined with a detailed breakdown of the neurobiology of agitation, linking these neurobiological dimensions with the mechanisms of action and relevant pharmacodynamic / pharmacokinetic profiles of the drugs that were presented in the guidelines (as well as some important agents that might not be included). Since Project BETA (Best Practices in Evaluation and Treatment of Agitation) published its guidelines in 2012, there have been several developments in the standard of care, including an increased use of ketamine and droperidol. Updated guidelines provided by The American College of Emergency Physicians (ACEP) will also be reviewed.