[Benzodiazepines, typical and atypical antipsychotics in the management of acute agitation: a review]

Given the diversity of clinical entities from which agitation may arise, it is not surprising that it is among the most commonly encountered clinical problems in psychiatric facilities and hospital emergency services. However, quite surprisingly this area has received very little attention and has not been studied in clinical trials until recently. Thus, tremendous variability exists in approaches to agitation. In this work, we review what is known about the pharmacologic management of agitation; first, by examining published studies comparing conventional antipsychotics, benzodiazepines, and/or a combination of both to achieve calm in acutely agitated psychiatric patients; and second, by reviewing available data on the use of atypical antipsychotic medications for the acute treatment of agitation associated with psychiatric illness. In our first review, we identified 11 trials meeting our inclusion criteria, 8 with a blind design. These studies taken together suggest that combination treatment may be superior to either agent alone, with higher improvement rates and lower incidence of extrapyramidal side effects. In our review of atypical antipsychotic agents as acute antiagitation compounds, we identified 5 studies, 3 with a blind design. This review found atypical antipsychotics to be as effective as the classical ones and more advantageous. Based on the data available to date, among the present novel antipsychotic agents, ziprasidone, risperidone, and olanzapine seem to be the best acute antiagitation compounds.