Managing the agitated psychotic patient: a reappraisal of the evidence

Under intense public pressure, regulatory agencies have recently defined circumstances in which medications will be considered a form of restraint, so-called "chemical restraint." This article proposes that the emergency management of the agitated patient be viewed as a brief departure from the usual physician-patient collaboration. Viewed in this way, the goal is simply to terminate the emergency in the manner most likely to be acceptable to patients and conducive to a more typical dialogue. To that end, the author reviews all controlled studies of medication treatment of agitation that have appeared in English since the advent of the neuroleptic medications. Issues of diagnosis, relative efficacy, dosage, route, onset, offset, safety, tolerability, and consumer preference are considered.