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Treating aggression in the psychiatric emergency service.
Douglas H Hughes1, Phillip M Kleespies
1Boston Medical Center/Solomon Carter Fuller Health Center, Boston, MA, USA. douglas.h.hughes@dmh.state.ma.us
The Journal of Clinical Psychiatry
|April 4, 2003
Summary
Severely mentally ill patients face higher risks of violence and victimization. This review covers common psychiatric emergency drugs like benzodiazepines and antipsychotics for agitation management.
Area of Science:
- Psychiatry
- Emergency Medicine
- Pharmacology
Background:
- Severely mentally ill individuals, including those with schizophrenia or bipolar disorder, are at elevated risk for both perpetrating and experiencing violence.
- This vulnerability necessitates effective management strategies in acute psychiatric settings.
Purpose of the Study:
- To review the current knowledge on the three primary drug classes used to manage agitation in psychiatric emergency services.
- To inform clinical decision-making regarding the selection and combination of these agents.
Main Methods:
- Literature review of common psychotropic medications used in psychiatric emergency settings.
- Discussion of benzodiazepines, conventional antipsychotics, and atypical antipsychotics.
- Analysis of factors influencing drug selection.
Main Results:
- Benzodiazepines, conventional antipsychotics, and atypical antipsychotics are the mainstays for managing agitation.
- Treatment choices depend on patient history, desired sedative effects, and medication side effect profiles.
- Combinations of benzodiazepines with antipsychotics may be considered.
Conclusions:
- The choice between monotherapy (benzodiazepines) and combination therapy (benzodiazepines with antipsychotics) requires careful consideration of individual patient factors.
- Understanding the distinct properties and side effect profiles of conventional versus atypical antipsychotics is crucial for optimizing patient care in emergency psychiatric situations.