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Agitation and Psychiatric Disease: Best Practices for Emergency Care

Agitation and Psychiatric Disease: Best Practices for Emergency Care

Format

Webcast

Time to Complete

1 hour

Released

March 28, 2016

Expires

March 28, 2017
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Maximum Credits

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)

Accredited Provider

This activity is jointly provided by Global Education Group and Integritas Communications.

Commercial Supporter

This activity is supported by an educational grant from Teva Pharmaceutical Industries Ltd.

Program Description

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
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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.

Intended Audience

Emergency physicians and other health care providers involved in emergency psychiatry care

Educational Objectives

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.

Faculty

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.

Speakers Bureaus: Actavis plc, Allergan plc, AstraZeneca, Forest Laboratories, Inc., H. Lundbeck A/S, Janssen Pharmaceuticals, Inc., Jazz Pharmaceuticals plc, Merck & Co., Inc., Novartis, Otsuka America Pharmaceutical, Inc., Pfizer Inc., Shire plc, Sunovion Pharmaceuticals Inc., Takeda Pharmaceutical Company Limited, Teva Pharmaceutical Industries Ltd.

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.

Credit

1.00

Type

AMA PRA Category 1 Credit(s)TM

Accreditation Statement

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.

Designation Statement

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.

Credit

1.00

Type

CE for Pharmacists

Accreditation Statement

Global Education Group is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Designation Statement

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.

Credit

1.00

Type

CE for Nurse Practitioners

Accreditation Statement


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.

Designation Statement

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.

Disclaimer

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.

Instructions

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.

For information about the accreditation of this program, please contact Global at 303-395-1782 or inquire@globaleducationgroup.com

If you have any other questions relating to your certificate or other issues with the activity, please contact
myCME.Support@haymarketmedical.com.

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SYSTEM REQUIREMENTS

Hardware and Software Requirements
  • A computer with an internet connection
  • Internet Browser: Internet Explorer 7.x or higher, Firefox 4.x or higher, Safari 2.x or higher, or any other W3C standards compliant browser
  • Additional Software: Adobe Flash Player and/or an HTML 5 capable browser maybe required for video or audio playback. PowerPoint or Adobe Acrobat Reader may occasionally be required
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