Acute agitation

Presentation and immediate needs

Agitation is a presentation with psychiatric, medical, substance-related and environmental causes. Distress and behaviour should be described concretely.

Begin assessment → History, examination and context

History, examination and context

Prioritise a calm approach, safe space and assistance. Assess attention, consciousness, vital signs, pain, intoxication, withdrawal and possible injury while establishing communication needs.

Consider the branch → Altered awareness, physical instability or intoxication/withdrawal clues?

Altered awareness, physical instability or intoxication/withdrawal clues?

Use clinical findings and collateral. Uncertainty needs clarification, not a default negative answer.

Yes / concerning features → Priority assessment; No / not established → Formulation and care discussion; Uncertain / not assessed → Obtain the missing information

Priority assessment

Assess and treat medical/substance contributors with appropriate assistance.

After appropriate assessment → Formulation and care discussion

Obtain the missing information

Review the examination, timeline, relevant investigations and consented collateral. Escalate urgent concerns while uncertainty is resolved.

Reassess the branch → Altered awareness, physical instability or intoxication/withdrawal clues?

Formulation and care discussion

Use verbal de-escalation and environmental adjustments first where feasible. Restrictive interventions require trained staff, applicable law, local protocols and physical monitoring; this reference does not select a rapid-tranquillisation regimen.

Agree follow-up → Reassess and follow up

Reassess and follow up

Reassess physical state, distress and the cause. Explain interventions, document the episode and conduct an appropriate debrief.