[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Behavioral science](https://durgical.com/en/behavioral-science/) › [Somatic treatments and levels of care](https://durgical.com/en/behavioral-science/areas/care/) › Psychiatric emergencies: agitation, violence risk and the suicidal patient

# Psychiatric emergencies: agitation, violence risk and the suicidal patient

- Topic

How to calm an agitated patient safely, judge the risk of violence, approach the suicidal patient and rule out medical causes.

Updated Nov 13, 2026

## Key points

- Safety first: adequate exits, objects that could be used as weapons removed or secured, and a trained team of four to six people.
- Verbal de-escalation is the first-line response to agitation; one person talks, calmly and briefly.
- In psychosis, criminal history carries the greatest risk of violent crime; past violence, recent victimisation, substance misuse and comorbid personality disorder also raise risk.
- New agitation in someone older than about 45 with no psychiatric history suggests a medical cause.
- Check a full set of vital signs and fingerstick glucose in every agitated patient, and oxygenation if it was not measured at triage.
- Restraint is a last resort; afterwards, explain to the patient why it was needed and debrief with the team.

## What it is

A psychiatric emergency is a situation in which a mental or behavioural disturbance puts the patient or others at immediate risk, such as severe agitation, threats of violence, a suicide attempt or acute psychosis. The priorities are safety, a search for medical causes and the least coercive response that works. Verbal de-escalation comes first; medication is offered, with a choice of how to take it; and restraint is a last resort.

## Key facts

- Intoxication lowers impulse control, which links it to violence.
- Even in psychosis, violence within five years of diagnosis typically affects fewer than 10 % of people, so risk is assessed for each person and not assumed from the diagnosis.
- For the suicidal patient, follow the suicide risk page.

## Step by step

- Keep at least two arm’s lengths away, stand at an angle and make sure there are adequate exits.
- One person speaks: give your name and title, and ask how the patient prefers to be addressed.
- Use short sentences and simple words, and repeat your message.
- Ask what the patient wants; listen and repeat back what they said.
- Agree where you honestly can, or agree to disagree.
- Set clear limits calmly.
- Offer choices, such as food and something to drink, or medication by mouth or by injection.
- If danger persists despite this, restraint is a last resort.
- Afterwards, debrief with the patient and with the team.

## Medical causes of acute agitation to rule out

| Cause | Clues |
| --- | --- |
| [Hypoglycaemia](https://durgical.com/en/conditions/hypoglycaemia/) | Low fingerstick glucose; easily reversible when treated |
| [Delirium from infection, hypoxia or organ failure](https://durgical.com/en/conditions/delirium/) | Fever, changes in breathing pattern, poor attention; meningitis, sepsis, kidney or liver failure |
| [Alcohol or drug intoxication or withdrawal](https://durgical.com/en/conditions/alcohol-withdrawal-and-delirium-tremens/) | Abnormal vital signs, odour of alcohol, drug paraphernalia; withdrawal can cause disorientation, hallucinations and seizures |
| [Medicines with anticholinergic effects](https://durgical.com/en/conditions/anticholinergic-toxicity/) | Recent anticholinergic medicine with confusion and poor attention |
| [Neuroleptic malignant syndrome](https://durgical.com/en/conditions/neuroleptic-malignant-syndrome/) | Recent antipsychotic, lead-pipe rigidity, fever, tachycardia, labile blood pressure |
| [Serotonin syndrome](https://durgical.com/en/conditions/serotonin-syndrome/) | Recent serotonergic drug, myoclonus, hyperreflexia, fever, tachycardia |
| Head injury, seizure or postictal state | Headache, memory loss or loss of consciousness after trauma; confusion after a recent seizure |

## Clinical notes

- When medication is needed, it is offered and the patient may choose by mouth or by injection; intravenous benzodiazepines are the drugs of choice for alcohol or benzodiazepine withdrawal.
- Benzodiazepines are avoided in delirium from other causes; the underlying disorder is treated, and antipsychotics are only sometimes used for severe agitation.
- Restrained patients are more likely to be admitted to a psychiatric hospital, and de-escalation can take less time than restraint.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the first-line approach to an agitated patient?

Verbal de-escalation in a safe setting, with one person talking calmly and briefly, after checking for medical causes.

## In people with psychosis, which group of risk factors carries the greatest risk of violent crime?

Criminal history; past violence, recent victimisation and substance misuse also raise risk.

## Which quick bedside checks are done in every agitated patient?

A full set of vital signs and fingerstick glucose, plus oxygenation if not measured at triage.

## When is restraint used?

Only as a last resort, when verbal de-escalation and other less coercive measures have failed.

## A 60-year-old with no psychiatric history becomes agitated and confused with fever. What is the most likely problem?

A medical cause such as an infection: new agitation after 45 with no psychiatric history suggests a medical cause, and it needs a medical work-up, not just sedation.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/behavioral-science/psychiatric-emergencies-agitation-violence-risk-and-the-suicidal-patient/)

## Elsewhere in DurgiPedia

- [Physical restraints: a last resort and their safe use](https://durgical.com/en/nursing/physical-restraints-a-last-resort-and-their-safe-use/)
- [The limits of confidentiality: duty to warn and legal disclosure](https://durgical.com/en/medical-ethics/the-limits-of-confidentiality-duty-to-warn-and-legal-disclosure/)
- [Consent in emergencies and the exceptions to consent](https://durgical.com/en/medical-ethics/consent-in-emergencies-and-the-exceptions-to-consent/)
- [Decision-making capacity (competence) and how to assess it](https://durgical.com/en/medical-ethics/decision-making-capacity-and-how-to-assess-it/)
- [Vital signs: what they are and how to record them](https://durgical.com/en/clinical-exam/vital-signs-what-they-are-and-how-to-record-them/)

## Connections

## Related 5

- [Crisis intervention and supportive psychotherapy](https://durgical.com/en/behavioral-science/crisis-intervention-and-supportive-psychotherapy/)
- [Difficult encounters: anger, demands and boundaries](https://durgical.com/en/behavioral-science/difficult-encounters-anger-demands-and-boundaries/)
- [The psychiatric interview](https://durgical.com/en/behavioral-science/the-psychiatric-interview/)
- [Levels of mental health care and involuntary admission](https://durgical.com/en/behavioral-science/levels-of-mental-health-care-and-involuntary-admission/)
- [Psychiatric symptoms caused by medical illness and drugs](https://durgical.com/en/behavioral-science/psychiatric-symptoms-caused-by-medical-illness-and-drugs/)

## Related conditions 10

- [Suicidal behaviour and suicide risk](https://durgical.com/en/conditions/suicidal-behaviour-and-suicide-risk/)
- [Delirium](https://durgical.com/en/conditions/delirium/)
- [Alcohol withdrawal and delirium tremens](https://durgical.com/en/conditions/alcohol-withdrawal-and-delirium-tremens/)
- [Neuroleptic malignant syndrome](https://durgical.com/en/conditions/neuroleptic-malignant-syndrome/)
- [Serotonin syndrome](https://durgical.com/en/conditions/serotonin-syndrome/)
- [Hypoglycaemia (including insulin-induced)](https://durgical.com/en/conditions/hypoglycaemia/)
- [Anticholinergic toxicity (incl. scopolamine «burundanga»)](https://durgical.com/en/conditions/anticholinergic-toxicity/)
- [Cocaine and sympathomimetic toxicity](https://durgical.com/en/conditions/cocaine-and-sympathomimetic-toxicity/)
- [Schizophrenia](https://durgical.com/en/conditions/schizophrenia/)
- [Bipolar disorder](https://durgical.com/en/conditions/bipolar-disorder/)

## In Pharmacology 2

- [Benzodiazepines](https://durgical.com/en/pharmacology/classes/benzodiazepines/)
- [Second-generation antipsychotics](https://durgical.com/en/pharmacology/classes/second-generation-antipsychotics/)

[← All of behavioral science](https://durgical.com/en/behavioral-science/)

Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.

Sources: [Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup](https://pmc.ncbi.nlm.nih.gov/articles/PMC3298202/) (Western Journal of Emergency Medicine, PubMed Central, 2012); [Medical Evaluation and Triage of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Medical Evaluation Workgroup](https://pmc.ncbi.nlm.nih.gov/articles/PMC3298208/) (Western Journal of Emergency Medicine, PubMed Central, 2012); [Systematic review of risk factors for violence in psychosis: a 10-year update](https://pmc.ncbi.nlm.nih.gov/articles/PMC7617503/) (British Journal of Psychiatry, PubMed Central, 2025); [Delirium](https://www.msdmanuals.com/professional/neurologic-disorders/delirium-and-dementia/delirium) (MSD Manual Professional Edition, 2025).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/behavioral-science/psychiatric-emergencies-agitation-violence-risk-and-the-suicidal-patient/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/behavioral-science/psychiatric-emergencies-agitation-violence-risk-and-the-suicidal-patient/