Acute Behavioural Disturbance

Acute Behavioural Disturbance (ABD), one of the most challenging, dangerous and serious presentations that we will encounter in emergency management of patients.

There is no widely accepted definition of ABD. Really it’s an umbrella term for a patient presenting with a triad of features, secondary to a specific underlying cause, made up of;

  • Delirium
  • Severe agitation and aggressive behaviour
  • Autonomic dysfunction

In this episode we’re going to run through ABD, it’s causes, the approach and investigation. Excellent management of these cases relies upon high quality team working, planning, communications and strategies to keep all involved safe and we’ll be discussing each of those in turn.


Simon, Rob & James

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Intramuscular midazolam, olanzapine, or haloperidol for the management of acute agitation: A multi-centre, double-blind, randomised clinical trial

Esther W Chan. EClinicalMedicine. 2021

Acute behavioural disturbance’ and ‘excited delirium. Royal College of Psychiatrists. 2022

Acute behavioural disturbance (ABD): guidelines on management in police custody. Faculty of Forensic & Legal Medicine. 2022

Acute Behavioural Disturbance in Emergency Departments. Royal College of Emergency Medicine. Best Practice Guidelines. 2022

Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation. NAPICU. 2018

Randomized controlled trial of intramuscular droperidol versus midazolam for violence and acute behavioral disturbance: the DORM study. Geoffrey K Isbister. Ann Emerg Med. 2010

Rapid Agitation Control With Ketamine in the Emergency Department: A Blinded, Randomized Controlled Trial. David Barbic. Ann Emerg Med. 2021

Oral Medication for Agitation of Psychiatric Origin: A Scoping Review of Randomized Controlled Trials. Samuel Mullinax. J Emerg Med. 2017

A Prospective Before and After Study of Droperidol for Prehospital Acute Behavioral Disturbance. Colin B Page. Prehosp Emerg Care 2018

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