1.00 / AMA PRA Category 1 Credit(s)TM 1.00 / CE for Pharmacists (0.10 CEUs) 1.00 / CE for Nurse Practitioners (0.50 pharmacology credit)
This activity is jointly provided by Global Education Group and Integritas Communications.
This activity is supported by an educational grant from Teva Pharmaceutical Industries Ltd.
Broadly defined as a state of extreme arousal characterized by excessive, poorly organized motor and/or verbal activity, agitation is a frequent cause of emergency psychiatric interventions and hospitalizations for patients with schizophrenia or bipolar disorder.1 In fact, studies suggest that as many as half of psychiatric emergency visits involve agitated patients.2,3 Differential diagnosis of the underlying cause can be challenging, particularly because patients often are uncooperative or otherwise unable to provide relevant details from their histories.4 In some cases, agitation can escalate to aggression and violent behavior, which can place the patient and members of the health care team at risk for injury.5,6 Thus, emergency care clinicians often are faced with the difficult tasks of quickly determining the etiology of agitation symptoms, implementing initial de-escalation efforts to decrease the likelihood of violent outbursts, and helping patients participate in assessment queries and treatment decisions.7 During this Interactive Exchange™ program, presenting faculty will discuss practical strategies for uncovering the likely cause of agitation, stratifying agitated patients with mental illnesses based on risks of aggressive behaviors, and implementing interpersonal and medical interventions that can ameliorate symptoms and reduce the utilization of seclusion and restraint.8-10 __________________________________
References 1. Sachs GS. A review of agitation in mental illness: burden of illness and underlying pathology. J Clin Psychiatry. 2006;67(suppl 10):5-12. 2. Harvey PD, Loewenstein DA, Czaja SJ. Hospitalization and psychosis: influences on the course of cognition and everyday functioning in people with schizophrenia. Neurobiol Dis. 2013;53:18-25. 3. Andreasen NC. Standardized remission criteria in schizophrenia. Acta Psychiatr Scand. 2006;113(2):81. 4. Stowell KR, Florence P, Harman HJ, Glick RL. Psychiatric evaluation of the agitated patient: consensus statement of the American association for emergency psychiatry project Beta psychiatric evaluation workgroup. West J Emerg Med. 2012;13(1):11-16. 5. Citrome L, Volavka J. Violent patients in the emergency setting. Psychiatr Clin North Am. 1999;22(4):789-801. 6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013. 7. Doshi A, Boudreaux ED, Wang N, Pelletier AJ, Camargo CA Jr. National study of US emergency department visits for attempted suicide and self-inflicted injury, 1997-2001. Ann Emerg Med. 2005;46(4):369-375. 8. Knox DK, Holloman GH Jr. Use and avoidance of seclusion and restraint: consensus statement of the American Association for Emergency Psychiatry Project Beta seclusion and restraint workgroup. West J Emerg Med. 2012;13(1):35-40. 9. Lesem MD, Tran-Johnson TK, Riesenberg RA, et al. Rapid acute treatment of agitation in individuals with schizophrenia: multicentre, randomised, placebo-controlled study of inhaled loxapine. Br J Psychiatry. 2011;198(1):51-58. 10. Richmond JS, Berlin JS, Fishkind AB, et al. Verbal de-escalation of the agitated patient: consensus statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. West J Emerg Med. 2012;13(1):17-25.
Emergency physicians and other health care providers involved in emergency psychiatry care
Upon completion of this activity, participants will be better prepared to:
Discuss the pathophysiology and potential presentations of schizophrenia and bipolar disorder with a focus on agitation
Evaluate agitated patients presenting for emergency care to determine likely etiology, stratify risks of aggression, and guide the course of care
Engage agitated patients with schizophrenia or bipolar disorder using de-escalation strategies
Tailor pharmacotherapy for agitated patients with schizophrenia or bipolar disorder based on presentation, medical history, patient preferences, and potential benefits and risks of available agents
Conflict Of Interest Disclosure Policy
Global Education Group (Global) requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.
Michael H. Allen, MD Professor, Department of Psychiatry University of Colorado School of Medicine Director of Psychiatry University of Colorado Hospital Anschutz Medical Campus Aurora, Colorado
Dr. Allen discloses: Consultant: Ferrer Internacional, S.A.
Leslie Citrome, MD, MPH Clinical Professor of Psychiatry & Behavioral Sciences New York Medical College Valhalla, New York
Dr. Citrome discloses: Consultant: Actavis plc, Alexza Pharmaceuticals, Inc., Alkermes plc, Allergan plc, Bristol-Myers Squibb, Eli Lilly and Company, Forest Laboratories, Inc., Forum Pharmaceuticals Inc., Genentech, H. Lundbeck A/S, Janssen Pharmaceuticals, Inc., Jazz Pharmaceuticals plc, Medivation, Inc., Merck & Co., Inc., Mylan N.V., Novartis, Noven Pharmaceuticals, Inc., Otsuka America Pharmaceutical, Inc., Pfizer Inc., Reckitt Benckiser Pharmaceuticals Inc., Reviva Pharmaceuticals, Inc., Shire plc, Sunovion Pharmaceuticals Inc., Takeda Pharmaceutical Company Limited, Teva Pharmaceutical Industries Ltd., Valeant Pharmaceuticals International, Inc.
Shareholder: Bristol-Myers Squibb, Eli Lilly and Company, Johnson & Johnson, Merck & Co., Inc., Pfizer Inc.
Kimberly Nordstrom, MD, JD Assistant Professor Department of Psychiatry Medical Director Psychiatric Emergency Services Denver Health Medical Center University of Colorado Denver Denver, Colorado
Dr. Nordstrom discloses: Honorarium: Teva Pharmaceutical Industries Ltd.
Planners' and Managers' Disclosures
The planners and managers reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:
Kristen Delisi, has nothing to disclose. Amanda Glazar, PhD, has nothing to disclose. Andrea Funk, has nothing to disclose. Jim Kappler, PhD, has nothing to disclose. Rose O’Connor, PhD, has nothing to disclose.
AMA PRA Category 1 Credit(s)TM
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas. Global is accredited by the ACCME to provide continuing medical education for physicians.
Global Education Group designates this enduring material for a maximum of 1.00 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CE for Pharmacists
Global Education Group is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
Global Education Group designates this continuing education activity for 1.00 contact hour (0.10 CEUs) of the Accreditation Council for Pharmacy Education.
Universal Activity Number - 0530-9999-16-040-H01-P
This is a knowledge-based activity.
CE for Nurse Practitioners
Global Education Group is approved as a provider of nurse practitioner continuing education by the American Association of Nurse Practitioners: AANP Provider Number 110121. This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standard.
This program has been approved for 1.00 contact hour of continuing education (which includes 0.50 hours of pharmacology).
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) and Integritas Communications do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Fee and Refund / Cancellation Policy
There is no fee for this educational activity.
In order to receive credit, participants must complete the preactivity questionnaire, post-test, and program evaluation. Participants must also score at least 70% on the post-test. Certificates will be distributed online at the conclusion of the activity. Your online certificate will be saved on myCME within your Profile/CME History, which you can access at any time.