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

Abstract

Objective: This study aimed to examine the characteristics, diagnosis and management of agitated inpatients before psychiatric consultation in a general hospital and to explore the concordance between the diagnoses by attending physicians with that of consultant psychiatrists. Methods: Medical records of inpatients aged 18 years or older that were referred for psychiatric consultation due to agitation in a general hospital in Thailand in 2018 were abstracted by a consultant psychiatrist. Data included (1) demographic and clinical factors, (2) the working diagnoses before the consultation, and final diagnoses by consultant psychiatrists, and (3) initial management. Results: Of the 188 patients, confusion was the most commonly detected early sign of agitation (33.5%), while fidgeting was the most common symptom/behavior that led to psychiatric consultations (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 (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.