Clinical perspectives on atypical antipsychotics for treatment of agitation

In the past, the use of atypical antipsychotics in treating acute agitation was limited by a lack of data in behavioral emergencies and by the lack of intramuscular formulations or alternate rapid-acting oral formulations. This article evaluates current data from studies of atypical antipsychotics in agitated patients in both short- and long-term care settings. For patients with underlying psychosis, intramuscular atypical antipsychotics are effective and help ease the transition from intramuscular therapy in the acute care setting to oral dosing in inpatient or community settings. Evidence exists that atypical antipsychotics demonstrate antiagitation effects in schizophrenic patients for as long as 10 weeks and that overall clinical response may be partly mediated by these antiagitation properties. Intramuscular and oral atypical antipsychotics effectively treat acute agitation in both emergency and long-term care settings. For bipolar patients, these agents are valid therapeutic options for acute as well as longer-term alleviation of manic symptoms, including agitation. Safety concerns, however, limit their use in agitated elderly patients with dementia.