Introduction: Methods, Commentary, and Summary

  title={Introduction: Methods, Commentary, and Summary},
  author={Michael H. Allen and Glenn Currier and Daniel Carpenter and Ruth Ross and John P Docherty},
  journal={Journal of Psychiatric Practice},
Objectives. Due to inherent dangers and barriers to research in emergency settings, few data are available to guide clinicians about how best to manage behavioral emergencies. Key constructs such as agitation are poorly defined. This lack of empirical data led us to undertake a survey of expert opinion, results of which were published in the 2001 Expert Consensus Guidelines on the Treatment of Behavioral Emergencies. Several second-generation (atypical) antipsychotics (SGAs) are now available… 
Are Low Doses of Antipsychotics Effective in the Management of Psychomotor Agitation? A Randomized, Rated-Blind Trial of 4 Intramuscular Interventions
Low doses of haloperidol combined with midazolam can be as effective as olanzapine in reducing psychomotor agitation without increasing the risk of extrapyramidal effects.
Aripiprazole in patients with bipolar mania and beyond: an update of practical guidance
Clinical practice guidelines widely recommend aripiprazole as a first-line treatment for mania, and clinical trials show that aripIPrazole is well tolerated and has a long-term stabilizing potential.
A Naturalistic Study of Intramuscular Haloperidol Versus Intramuscular Olanzapine for the Management of Acute Agitation
Findings suggest that in a naturalistic emergency department setting, haloperidol monotherapy is less effective—at least in requiring AMI—than olanzapine with or without a benzodiazepine or haloperodol plus a benzidiazepine.
Management of acutely ill patients in the hospital setting: focus on quetiapine
Oral atypical antipsychotics should be a first-choice medication for acutely ill cooperative patients in the hospital setting and emerging data show that rapid initiation of quetiapine in patients with acute psychosis or mania is as effective as standard initiation, but is also well tolerated.
Emergency management of agitation in pregnancy.
What is new in rapid tranquillisation
It is imperative that all staff involved in prescribing and administration should be familiar with the practical use of these medicines, including methods of preparation and administration, specific side effects and monitoring requirements, as well as their own responsibilities in regard to these medicines.
A Markov Model of the Cost Effectiveness of Olanzapine Treatment for Agitation and Psychosis in Alzheimer’s Disease
OlanZapine treatment for agitation and psychosis related to Alzheimer’s disease is cost effective when compared with no treatment, and sensitivity analyses demonstrated that olanzapine remained cost effective despite multiple variations of several parameters, both alone and concurrently.
Clinical perspectives on atypical antipsychotics for treatment of agitation.
  • E. Caine
  • Medicine, Psychology
    The Journal of clinical psychiatry
  • 2006
Intramuscular and oral atypical antipsychotics effectively treat acute agitation in both emergency and long-term care settings and are valid therapeutic options for acute as well as longer-term alleviation of manic symptoms, including agitation for bipolar patients.


The Expert Consensus Guideline Series. Treatment of behavioral emergencies.
These guidelines provide some direction for addressing common clinical dilemmas in the management of psychiatric emergencies and can be used to inform clinicians in acute care settings regarding the relative merits of various strategies.
What Do Consumers Say They Want and Need During a Psychiatric Emergency?
A survey of consumer perspectives described in this article was undertaken in response to the need to better understand consumer experiences and preferences and found important areas of agreement between the recommendations of the consumer panel and those of the experts in emergency psychiatry surveyed for the Expert Consensus Guidelines on the Treatment of Behavioral Emergencies.
Combination antipsychotics: pros, cons, and questions.
Potential problems with using combination antipsychotics are highlighted, paths to their maintenance use are discussed, and the efficacy evidence is reviewed.
Intramuscular ziprasidone, 2 mg versus 10 mg, in the short-term management of agitated psychotic patients.
Comparison with a study of identical design comparing 2-mg with 20-mg doses in patients with similar levels of psychopathology suggests that efficacy with 10 mg or 20 mg of ziprasidone i.m. is significant and dose related.
Best Clinical Practice With Ziprasidone IM: Update After 2 Years of Experience
In clinical trials, patients treated with ziprasidone IM demonstrated significant and rapid reduction in agitation and improvement in psychotic symptoms, agitation, and hostility to an extent greater than or equal to that attained with haloperidol IM.
Atypical antipsychotic medications in the psychiatric emergency service.
  • G. Currier
  • Psychology, Medicine
    The Journal of clinical psychiatry
  • 2000
Preliminary results have shown the atypical antipsychotic risperidone to have efficacy equal to that of the conventional agent haloperidol in a direct comparison in the PES; further study is required, however, to determine the appropriateness of the use of ris peridone and the other atypicals antipsychotics in the emergency treatment of psychosis.
Clinical profile of an atypical antipsychotic: risperidone.
R risperidone was consistently more effective than conventional antipsychotics in treating positive and negative symptoms and was effective in treating depression in schizophrenia.