Understanding Acute Behavioural Disturbance (ABD): A Critical Condition

Acute Behavioural Disturbance (ABD) is a serious and potentially life-threatening condition often seen in emergency departments, mental health settings, and sometimes out in the community before hospital admission. It is sometimes also called Excited Delirium or Acute Excited Delirium, though terms vary between regions and healthcare systems.

People experiencing ABD often present with extreme agitation, confusion, and sometimes aggression.

They can appear extremely strong, resistant to pain, and may be very difficult to calm down. Because of the risks associated with ABD, it is considered a medical emergency requiring prompt recognition and treatment.

What Causes ABD?

ABD can be triggered by a range of factors, including:

• Severe mental health episodes, such as acute psychosis or mania

• Substance use, particularly stimulants like cocaine, amphetamines, or synthetic drugs such as "spice"

• Underlying medical issues, such as infections, brain injuries, or metabolic imbalances

  
  

In many cases, there’s a combination of physical and mental health factors.

The exact cause isn’t always clear at the point of care, but the symptoms and risks remain the same.

Why is ABD so Dangerous

One of the reasons ABD is life-threatening is that it can lead to metabolic acidosis — a serious chemical imbalance in the body.

Simplified Explanation: Our bodies naturally keep the blood at a very specific acidity level (pH). When the blood becomes too acidic because of a build-up of harmful substances (like lactic acid from overexertion or toxins), this is called metabolic acidosis.

It can make the heart and other organs stop working properly.

In ABD, the combination of extreme physical activity, high stress hormones, and sometimes drugs can push the body into metabolic acidosis, leading to cardiac arrest if not managed quickly.

Signs and Symptoms of Acute Behavioural Disturbance

Recognising the early signs of ABD is critical. A person with ABD may display:

• Extreme agitation: pacing, shouting, or thrashing around

• Bizarre or aggressive behaviour: seeming out of control or hallucinating

• Profuse sweating and very hot skin: The body often overheats

• Unusual strength or “superhuman” effort: despite exhaustion, they keep going

• High heart rate and fast breathing: signs the body is under huge stress

• Confusion or sudden collapse: a late and dangerous sign

Healthcare staff often use the “ABC” approach (Airway, Breathing, Circulation) while managing ABD, but controlling behaviour safely while preventing harm to the patient and others is also essential.

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Managing Acute Behavioural Disturbance

Treatment usually involves:

1. Rapid recognition of ABD by staff.

2. Early sedation (if safe and appropriate) to protect the patient from overexertion.

3. Cooling measures are taken if overheating is severe.

4. Monitoring and treating metabolic acidosis with oxygen, IV fluids, and emergency drugs.

   
   

Patients often require emergency department care and close monitoring, as things can deteriorate quickly.

Key Takeaway

Acute Behavioural Disturbance isn’t just someone “acting out.” It is a medical emergency with serious risks, including sudden cardiac arrest due to metabolic acidosis and overheating.

Quick recognition, calm but firm control, and rapid hospital treatment save lives.

Anyone working in healthcare, security, or emergency response should be familiar with the signs of ABD and the importance of getting medical help fast.