Patient Evaluation
Once the safety of the patient and those around him is assured, a thorough evaluation is needed to identify contributing factors and to prevent further episodes. Medical, psychiatric and medication histories are core to an effective evaluation. Physicians, nurses, and pharmacists should participate using their particular expertise. Contributing factors may become clear after reviewing the patient’s psychiatric history, especially if noncompliance, substance abuse, or psychosocial stressors coexist. A mental status exam identifying underlying symptoms, such as hallucinations or delusional thinking, will further guide treatment. Patients who develop agitation two to three weeks after starting antipsychotic treatment should be evaluated for akathisia as a potential underlying cause. When the cause is unknown, physical examinations and laboratory tests that identify common causes of aggression due to a general medical condition are undertaken (Table 3). The need for a specific test is based on the patient’s presentation, physical findings, and medical history. The social context and environmental precipitants surrounding the aggression are also important to explore. During the initial assessment of all patients, it is important to determine their specific risk for aggression, even if they are currently calm, as preventable measures may be taken to minimize risk.
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Table 3. Common Tests to Identify Medical
Causes of Agitation and Aggression |
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General examinations: Common Laboratory Tests Other tests |
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- Acute Agitation and Aggression in Psychiatric Illnesses. Part 3 Causes There are two ways to describe the causes of agitation and aggression: by the underlying disease state (see Table 1), or the exact pathophysiology that causes the aggression. The DSM-IV-TR has several diagnostic categories describing the relationship between a medical condition or substance...