Management of Acute Agitation on Inpatient Ward – Dr Matthew Warden

Posted on: September 10, 2020
Last Updated: September 18, 2020

Dr Matthew Warden is Director of Acute Inpatient Services (AIS) at St Vincent’s Hospital and consultant psychiatrist with Clarity Health Care, in Melbourne, Australia with research interests in the management of schizophrenia. He is a Fellow of the Royal Australian and New Zealand College of Psychiatrists (FRANZCP) and a Member of the Royal College of Psychiatrists (MRCPSYC). 

Author Quotes  

So we started an education programme; we began to look at reinforcing our policies and procedures, not to do anything different but to actually follow the guidelines that were already in place.

Switching medications – medication choices – this is a really important thing, and trying to avoid high side effect medications…using the time that they are in hospital to switch them and try to get them on the right medication before they go home is really time well spent.


Dr Matthew Warden introduces the topic of sedative medication and in-patient aggression and talks about seclusion rates at St Vincent’s Hospital, Melbourne. (Hospital data on file shown below) 

Although St Vincent’s acute behavioural disturbance guideline is the one printed in the College guidelines, a closer look at individual clinical teams showed that each one used different interventions and strategies to manage individualised patients. From the 1st August, you can see a dramatic change once everyone began to adhere to the guidelines quite strictly.

He concludes this section of the presentation with a discussion of dietary measures and interventions seen as important for the successful management of patients on the ward.

Take-Home Points  

  • Adhering strictly to the guidelines allows for seclusion rates to be maintained at a low rate. 
  • Interventions such as smoking cessation, improved diet, and physical activity, are important to implement. 
  • Metformin initiated early can ameliorate some of the weight gain patients experience. 


Learn more

  1. Metabolic and Physical Side Effects of Antipsychotics By Dr Matthew Warden
  2. Antipsychotics and Avoidance of Relapse By Dr Matthew Warden
  3. Acute Behavioural Disturbance in Psychosis: Which Antipsychotic Medications? By Dr Matthew Warden


  1. Curtis, J et al. Early Interv Psychiatry. 2012;6:347-353.