The pharmacological management of agitated and aggressive behaviour: A systematic review and meta-analysis

  title={The pharmacological management of agitated and aggressive behaviour: A systematic review and meta-analysis},
  author={Maarten Bak and Irene Weltens and Chris Bervoets and J{\"u}rgen De Fruyt and Jerzy Samochowiec and Andrea Fiorillo and Gaia Sampogna and Przemysław Bieńkowski and W Ulrich Preuss and Błażej Misiak and Dorota Frydecka and Agnieszka Samochowiec and Emma Bak and Marjan Drukker and Geert Dom},
  journal={European Psychiatry},
  pages={78 - 100}

Effectiveness and safety of intravenous valproate in agitation: a systematic review

Intravenous valproate seems efficacious in reducing agitation in psychiatric patients; it generally appears safe compared to other neuroleptics or antiepileptics; however, the evidence is still not strong as it relies mainly on open-label studies or case series.

Psychopharmacology of agitation in acute psychotic and manic episodes

The best approach is to summarize in some detail the evidence for each possible treatment and the interpretations published recently on each of those treatments, and then present recommendations for medication management in tiered rankings, based on the authors’ qualitative review of the data and opinions.

Effect of Sublingual Dexmedetomidine vs Placebo on Acute Agitation Associated With Bipolar Disorder: A Randomized Clinical Trial.

Among patients with mild to moderate agitation associated with bipolar disorder, treatment with a sublingual film formulation of dexmedetomidine 120 μg or 180 μg, compared with placebo, resulted in significantly greater reduction in the agitation score at 2 hours.

A Comparative Analysis Between Ketamine Versus Combination of Midazolam and Haloperidol for Rapid Safe Control of Agitated Patients in Emergency Department: A Systematic Review

It is concluded that ketamine use is superior when its primary focus is to sedate the patient as quickly as possible, but it carries some side effects that should be considered.

The Management of Psychomotor Agitation Associated with Schizophrenia or Bipolar Disorder: A Brief Review

The purpose of this brief review is to raise awareness about best practices for the management of PMA in emergency care situations and consider the role of new pharmacological interventions in patients with agitation associated with bipolar disorder or schizophrenia.

The treatment of acute agitation associated with schizophrenia or bipolar disorder: investigational drugs in early stages of their clinical development, and their clinical context and potential place in therapy

Although it is too early to make definitive statements about tolerability and efficacy, their unique administration mechanisms suggest that dexmedetomidine film and intranasal olanzapine may become valuable options for the rapid management of acute agitation in patients who are willing to cooperate with medication therapy.

Which Emergent Medication Should I Give Next? Repeated Use of Emergent Medications to Treat Acute Agitation

Examination of evidence available in the literature and clinical algorithms suggested by the authors for sequential medication administration in patients with persistent acute agitation in psychiatric emergency settings discuss risk factors for medication-related adverse events and provide options for patients who are able to take oral medications and for Patients who require parenteral intervention.

Evaluation of long-acting injectable antipsychotics with the corresponding oral formulation in a cohort of patients with schizophrenia: a real-world study in Spain

LAIs improved clinical outcomes by reducing the need for concomitant treatments and hospital admissions over oral antipsychotics, and showed better outcomes versus A1M and biweekly LAIs.



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.

Haloperidol for psychosis-induced aggression or agitation (rapid tranquillisation).

Whether haloperidol alone is an effective treatment for psychosis-induced aggression or agitation, wherein clinicians are required to intervene to prevent harm to self and others is examined.

Haloperidol for psychosis-induced aggression or agitation (rapid tranquillisation).

Haloperidol alone, administered orally, intramuscularly or intravenously, is effective treatment for psychosis-induced agitation or aggression and, with notable exceptions, most were small and carried considerable risk of bias.

[Rapid tranquillisation; review of the literature and recommendations].

Haloperidol in combination with promethazine, and olanzapine, are effective in psychotic agitation, although haloperodol plus promethazines has a more rapid onset of effect faster than lorazepam, haloperIDol or olanZapine.

Intramuscular aripiprazole or haloperidol and transition to oral therapy in patients with agitation associated with schizophrenia: sub-analysis of a double-blind study*

Intramuscular aripiprazole is effective in patients with acute agitation associated with schizophrenia, comparable to IM haloperidol, and enables convenient transfer to oral aripIPrazole therapy.

Assessment and management of agitation in psychiatry: Expert consensus

  • M. GarrigaI. Pacchiarotti E. Vieta
  • Medicine, Psychology
    The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry
  • 2016
Recommendations on the assessment of agitation emphasise the importance of identifying any possible medical cause and the “ideal” medication should calm without over-sedate.

Efficacy and safety of intramuscular aripiprazole in patients with acute agitation: a randomized, double-blind, placebo-controlled trial.

Intramuscular aripiprazole 9.75 mg is a rapidly effective and well-tolerated alternative to IM haloperidol for the control of agitation, without oversedation, in patients with schizophrenia, schizo-affective disorder, or schizophreniform disorder.

Droperidol for psychosis-induced aggression or agitation.

The effects of droperidol, including its cost-effectiveness, when compared to placebo, other 'standard' or 'non-standard' treatments, or other forms of management of psychotic illness, in controlling acutely disturbed behaviour and reducing psychotic symptoms in people with schizophrenia-like illnesses are estimated.

Intramuscular Aripiprazole in the Control of Agitation

Improvements with aripiprazole IM appeared to be specific to core agitation symptoms, as opposed to nonspecific sedation, and to be independent of baseline level of agitation.