Fast Five Quiz: Bipolar Disorder With Agitation

W. Clay Jackson, MD, DipTh; Heidi Moawad, MD


February 23, 2023

Agitation has the potential to progress to physical aggression; therefore, it is important to promptly identify it and address it appropriately. The best approach to agitation is one that is ethical and noninvasive; verbal de-escalation techniques aim to reduce distress for the patient and prevent further escalation of symptoms. It facilitates the establishment of a rapport, which improves patient cooperation and final clinical outcomes, per Prakash and colleagues.

For patients who are not receptive to de-escalation, pharmacologic treatment may be an option. Physical restraint should be avoided if possible, but may become necessary in severe cases. Studies have shown that restrained patients have higher psychiatric admission rate and inpatient costs.

Cognitive-behavioral therapy alone is not recommended for the management of agitation or acute mania. In combination with pharmacotherapy, cognitive-behavioral therapy has been shown to be an effective option for maintenance therapy.

Learn more about agitation in bipolar disorder.


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