State of Acute Agitation at Psychiatric Emergencies in Europe: The STAGE Study

Luis Sana, *, Josef Marksteinerb, Peter Zwanzgerc, María Aragüés Figuerod, Francisco Toledo Romeroe, Grigorios Kyropoulosf, Alberto Bessa Peixotog, Roxana Chiritah, Anca Boldeanui
a Hospital Sant Joan de Déu, Department of Child and Adolescent Psychiatry, Barcelona, Spain
b LKH Hall, Department of Psychiatry and Psychotherapy, Milser Strasse 10-12. A-6060, Hall in Tirol, Austria
c Kbo-Inn-Salzach Clinic for Psychiatry, Psychotherapy, Neurology and Psychosomatic Medicine, Gabersee 7, 83512, Wasserburg am Inn, Germany
d Hospital Universitario 12 de Octubre, Department of Psychiatry, Avda de Córdoba, s/n, 28041, Madrid, Spain
e Hospital Clínico Universitario Virgen de la Arrixaca, Department of Psychiatry Acute Unit, Ctra. Madrid-Cartagena, s/n, 30120 Murcia, Spain
f General Hospital of Thessaloniki "Papanikolaou", Psychiatric Clinic Department of Psychiatry, Eksoxi - 57010, Thessaloniki, Greece
g Hospital de Braga, Department of Psychiatry, Sete Fontes, 4710-243 São Victor, Braga, Portugal
h Psychiatric Clinical Hospital Socola, Department of Psychiatry, Șoseaua Bucium 36, 700282, Iasi, Romania
i Ferrer International, Barcelona, Spain

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© San et al.; Licensee Bentham Open

open-access license: This is an open access articles licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided that the work is properly cited.

* Address correspondence to this author at the Parc Sanitari Sant Joan de Déu, CIBERSAM. Carrer Camí Vell de la Colònia, 25. ES 08830 Sant Boi de Llobregat. Barcelona, Spain; Tel/Fax: 00-34-677595717; E-mail:



Agitation is an array of syndromes and types of behaviors that are common in patients with psychiatric disorders. In Europe, the estimation of prevalence of agitation has been difficult due to the lack of standard studies or systematic data collection done on this syndrome.


An observational, cross-sectional, multicenter study aimed to assess the prevalence of agitation episodes in psychiatric emergencies in different European countries.


For 1 week, all episodes of acute agitation that were attended to at the psychiatric emergency room (ER) or Acute Inpatient Unit (AIU) in the 27 participating centers were registered. The clinical characteristics and management of the agitation episode were also described. A descriptive analysis was performed.


A total of 334 agitation episodes out of 7295 psychiatric emergencies were recorded, giving a prevalence rate of 4.6% (95% CI: 4.12-5.08). Of them, 172 [9.4% (95% CI: 8.2-10.9)] were attended at the ER and 162 [2.8% (95% CI: 2.4-3.3)] at AIU. Only data from 165 episodes of agitation (those with a signed informed consent form) was registered and described in this report. The most common psychiatric conditions associated with agitation were schizophrenia, bipolar disorder and personality disorder. The management of agitation included from non-invasive to more coercive measures (mechanical, physical restraint or seclusion) that were unavoidable in more than half of the agitation episodes (59.5%).


The results show that agitation is a common symptom in the clinical practice, both in emergency and inpatient psychiatric departments. Further studies are warranted to better recognize (using a standardized definition) and characterize agitation episodes.

Keywords: Agitation, Aggression, Bipolar disorder, Emergency, Epidemiology, Quality of care, Schizophrenia.