Abstract
Agitated behavior constitutes up to 10% of emergency psychiatric interventions. Pharmacological tranquilization is often used as a valid treatment for agitation but a strong evidence base does not underpin it. Available literature shows different recommendations, supported by research data, theoretical considerations, or clinical experience. Rapid tranquilization (RT) is mainly based on parenteral drug treatment and the few existing guidelines on this topic, when suggesting the use of first generation antipsychotics and benzodiazepines, include drugs with questionable tolerability profile such as chlorpromazine, haloperidol, midazolam, and lorazepam. In order to systematically evaluate safety concerns related to the adoption of such guidelines, we reviewed them independently from principal diagnosis while examining tolerability data for suggested treatments. There is a growing evidence about safety profile of second generation antipsychotics for RT but further controlled studies providing definitive data in this area are urgently needed.
Highlights
In order to systematically evaluate safety concerns related to the adoption of such guidelines, we reviewed them independently from principal diagnosis while examining tolerability data for suggested treatments
A computerized search for guidelines was conducted using “PUBMED.” Medical subject heading terms used for our search were: “agitation,” “acute agitation,” “psychomotor agitation,”“behavioral agitation,”and each of these terms was combined, combined with each of the following terms, as medical subject headings:“rapid tranquillization,” “tranquillization,” “treatment,” “drug treatment,” “pharmacological treatment,” “management.” Data resulting from computer searches were integrated with available published guidelines
As for the safety profile, we found no mention of respiratory depression risk, and the role of BDZ in alcohol intoxication is far from being clear: on one side there is lack of consensus among authors on BDZ use as a first-line treatment in such condition, on the other there is no clear distinction between alcohol withdrawal and intoxication where BDZ are indicated as second-line treatment (Allen et al, 2001)
Summary
Agitated behavior constitutes up to 10% of emergency psychiatric interventions (Tardiff and Sweillam, 1982). The overall prevalence of agitation in patients with schizophrenia or mood disorder is about 11–13%, with even higher rates among individuals with alcoholism (25%) or substance misuse (35%) (Swanson et al, 1990), dementia (24–45%), anxiety disorders (20–30%). Agitation has rarely been the primary focus of both phenomenological classification and therapeutic intervention. In addition the study of agitation in mental illness has been complicated by a host of often imprecise or conflicting definitions (Mintzer, 2006). Available evidences indicate an extreme variability in the management of agitation cases in emergency settings (Bourdinaud and Pochard, 2003; Chan et al, 2011). Notwithstanding, rapid and effective pharmacological treatment is often required to ensure the safety of patients, and caregivers
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
