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Measurement of agitation and aggression in adult and aged neuropsychiatric patients: review of definitions and frequently used measurement scales

Published online by Cambridge University Press:  09 February 2017

Ladislav Volicer ,
Leslie Citrome  and
Jan Volavka
Ladislav Volicer*
Affiliation:
School of Aging Studies, University of South Florida, Tampa, Florida, USA
Leslie Citrome
Affiliation:
New York Medical College, Department of Psychiatry and Behavioral Sciences, Valhalla, New York, USA
Jan Volavka
Affiliation:
New York University School of Medicine, Department of Psychiatry, New York, New York, USA
*
*Address correspondence and reprint requests to: Ladislav Volicer, School of Aging Studies, University of South Florida, 4202 East Fowler Avenue, Tampa, Florida 33620, USA. (Email: volicer@cas.usf.edu)
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Abstract

Agitation and aggression in adult psychiatric patients with psychoses and in persons with dementia increase the burden of disease and frequently cause hospitalization. The implementation of currently available management strategies and the development of new ones is hindered by inconsistent terminology that confuses agitation with aggression. This confusion is maintained by many rating scales that fail to distinguish between these two syndromes. We review the frequently used rating scales with a particular focus on their ability to separate agitation from aggression. Agitation and aggression are two different syndromes. For example, reactive aggression is often precipitated by rejection of care and may not be associated with agitation per se. We propose, in treatment studies of behavioral symptoms of dementia and challenging behaviors in psychoses, that outcomes should be evaluated separately for agitation and aggression. This is important for investigation of drug effectiveness since the medication may be effective against one syndrome but not the other. Separate assessments of agitation and aggression should be a general principle of trial design with particular salience for registration studies of medications proposed for approval by the U.S. Food and Drug Administration and other regulatory bodies.

Keywords

Agitationaggressionpsychosisdementia
Type
Review Articles
Information
CNS Spectrums , Volume 22 , Issue 5 , October 2017 , pp. 407 - 414
Copyright
© Cambridge University Press 2017 

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