Pharmacological Management of Acute Agitation

@article{Battaglia2012PharmacologicalMO,
  title={Pharmacological Management of Acute Agitation},
  author={John Battaglia},
  journal={Drugs},
  year={2012},
  volume={65},
  pages={1207-1222}
}
Acute agitation occurs in a variety of medical and psychiatric conditions, and when severe can result in behavioural dyscontrol. Rapid tranquillisation is the assertive use of medication to calm severely agitated patients quickly, decrease dangerous behaviour and allow treatment of the underlying condition. Intramuscular injections of typical antipsychotics and benzodiazepines, given alone or in combination, have been the treatment of choice over the past few decades.Haloperidol and lorazepam… 

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...

References

SHOWING 1-10 OF 117 REFERENCES

Intramuscular ziprasidone: moving beyond the conventional in the treatment of acute agitation in schizophrenia.

  • S. Brook
  • Psychology, Medicine
    The Journal of clinical psychiatry
  • 2003
In patients with acute psychosis, with or without agitation, IM ziprasidone has been demonstrated to be superior to IM haloperidol in improving overall symptom severity and represents an important advance over older, conventional IM agents in the treatment of the acutely ill patient with schizophrenia.

Rapid parenteral treatment of acute psychosis.

Acute treatment of psychotic agitation: a randomized comparison of oral treatment with risperidone and lorazepam versus intramuscular treatment with haloperidol and lorazepam.

A single oral dose of risperidone plus lorazepam was as effective as parenterally administered haloperidol plus lorbizepam for the rapid control of agitation and psychosis.

Long-Acting Antipsychotic Medication, Restraint and Treatment in the Management of Acute Psychosis

  • P. Fitzgerald
  • Medicine, Psychology
    The Australian and New Zealand journal of psychiatry
  • 1999
ZA is the first parenteral antipsychotic medication introduced for clinical use in the treatment of aggression and agitation that has a relatively prolonged duration of action and is a novel and potentially useful treatment alternative in the acutely disturbed patient.

The use of midazolam in acutely agitated psychiatric patients.

Both midazolam and sodium amytal were significantly more effective than haloperidol in controlling motor agitation and there were no treatment differences on any other symptom rated.

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.

Alprazolam as a neuroleptic adjunct in the emergency treatment of schizophrenia.

The combination of alprazolam and haloperidol seems to be the most effective for agitated patients, particularly in the first 48 hours of treatment, and may also result in fewer dystonic reactions.

Intramuscular flunitrazepam versus intramuscular haloperidol in the emergency treatment of aggressive psychotic behavior.

Intramuscular flunitrazepam may serve as a convenient, rapid, safe, and effective adjunct to neuroleptics in reducing aggressive behavior in emergency psychiatric settings.

Intramuscular (IM) ziprasidone 20 mg is effective in reducing acute agitation associated with psychosis: a double-blind, randomized trial

Ziprasidone IM 20 mg was substantially and significantly reduced the symptoms of acute agitation in patients with psychotic disorders and was very well tolerated and produced no dystonia or akathisia.
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