Management of Acute Behavioral Emergencies in Adolescents: A Scoping Review

Background: The rate of adolescent acute behavioral emergencies has increased dramatically and poses a major burden to psychiatric services and emergency departments. Acute behavioral emergencies include suicidal ideation, violent behaviors, acute psychosis or agitation, which are often compounded by the psychological impacts of the COVID-19 pandemic, environmental stressors, and systemic barriers to accessing mental health care. Aim: This scoping review aims to provide a summary of the current evidence from research regarding the assessment and management of acute behavioral emergencies in adolescents, which includes both short-term stabilization and long-term recovery strategies. Methods: A systematic search of PubMed, PsycINFO, and Embase was conducted from January 1985 to July 2020 and included descriptive summaries and assessments of interventions for acute behavioral emergencies for adolescents aged 12 - 20 years. Systematic reviews, randomized controlled trials, observational studies, and clinical guidelines were its focus. Results: The review identifies a multimodal strategy: expedited assessment using standardized instruments (for example, C-SSRS, BARS), evidence-based de-escalation strategies, and careful pharmacological management (specifically second-generation antipsychotics and benzodiazepines) when non-pharmacological strategies may not be effective. Effective de-escalation includes addressing environmental factors and the involvement of a support network, such as family members. For long-term mental health, follow-up and continuity of care are necessary to mitigate recurrence. Conclusion: To adequately treat adolescent behavioral emergencies requires a prompt, multidisciplinary engagement of clinical assessment, de-escalation of agitation, pharmacological and non-pharmacological intervention, and aggressive follow-up care to mitigate the undisputed high-risk factors in this population. It is imperative to alleviate systemic barriers and leverage support systems to optimize the desired results within the high-risk populations.