Dexmedetomidine as an Emerging Treatment of Agitation in Psychiatric Patients: A Narrative Review

Abstract

Acute agitation occurs in a variety of medical and psychiatric conditions and is the clinical presentation in a significant percentage of urgent psychiatric episodes, requiring prompt and effective intervention. Traditionally, agitation was managed in psychiatric wards using physical restraint. With the advent of tranquilizing neuroleptics, such as chlorpromazine, the pharmacological management of these conditions became possible. Acute agitation, although a potential result of most psychiatric disorders, is often associated with psychotic conditions, mood disorders and neurodegenerative disorders. The authors propose to explore dexmedetomidine as a therapeutic option in states of acute agitation in psychiatric patients in which traditional drugs are not effective. The authors based the work on a non-systematic review of the literature. Keywords used included: dexmedetomidine, acute agitation, rapid tranquilisation, restraint, sedation, psychiatric population and psychiatric disorders. Recently, a significant step forward in methods of treating acute agitation has been achieved through the use of dexmedetomidine in psychiatric patients. It is a selective α2‐receptor agonist being approved for short‐term sedation with the benefit of not having excessive sedation, thus allowing a concomitant psychotherapeutic approach. This proves to be a promising treatment option for those with acute agitation. The amount of studies available on its usefulness in psychiatric mental illness are still scarce. The interventional recommendations in the literature for agitation were developed based on research data, theoretical considerations and clinical experience, however, studies that provide definitive data are needed. It is imperative that the investigation of episodes of acute agitation and their restraint evolve, in order to protect these patients from the consequences of this behaviour and its treatment. Exploring the potential of dexmedetomidine as a tool in the mental health professional’s kit is well deserved as there are few alternatives that reassure the highly agitated patient without excessive sedation.