Assessment of agitation and aggression in inpatients with alcohol use disorder: A systematic review of informant-based scales

Background

Agitation and aggression are commonly observed in inpatients with alcohol use disorder (AUD). Adequate assessment is essential to provide appropriate care for these behaviors. To date, a systematic evaluation of existing measurement scales for use in AUD is lacking. The aim of this systematic review was to provide an overview of existing informant-based scales to assess agitation and/or aggression and to evaluate their psychometric properties and applicability in people with AUD.

Methods

Existing reviews on the assessment of agitation and/or aggression in psychiatric populations and neurocognitive disorders were searched to identify existing instruments to assess agitation and aggression. Next, for each scale, systematic literature searches were conducted in Embase, MEDLINE, and PsychINFO to evaluate the use in AUD and to identify psychometric studies using a validated methodological search filter. We applied the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) to evaluate the psychometric properties.

Results

We included 20 unique scales for which we identified 86 studies reporting on psychometric properties and 65 studies that used any of these scales in AUD. To assess agitation and aggression retrospectively, the Rating Scale for Aggressive Behavior in the Elderly (RAGE) and Cohen-Mansfield Agitation Inventory (CMAI) have the best psychometric qualities. The Pittsburgh Agitation Scale (PAS) showed the best psychometric properties of all scales that assess agitation and aggression during a prospective observation period. To assess agitation and aggression following an incident, the Overt Aggression Scale (OAS) has the best psychometric properties. Sixty-five studies used any of the included scales to assess agitation and/or aggression in individuals with AUD, with the MOAS and OAS as the most commonly used scales within the AUD population.

Conclusions

This review is the first to provide an overview of existing scales to assess agitation and aggression together with their psychometric properties and use in AUD. Findings guide clinicians and researchers to select the most appropriate instruments to improve the diagnosis and treatment of agitation and aggression in AUD.