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Pharmacotherapy for pediatric and adolescent agitation in an inpatient behavioral health unit

Michelle Yang1, Christine M Rarrick2, Clint Ross3

  • 1(Corresponding author) Clinical Pharmacy Specialist, The Johns Hopkins Hospital, Baltimore, MD, myang.pharm@gmail.com.

The Mental Health Clinician
|June 4, 2026
PubMed

Insights

This study analyzed medication use for agitation in pediatric behavioral health units. Antipsychotics were most common, with diphenhydramine, lorazepam, and olanzapine frequently used, and few adverse events observed.

Area of Science:

  • Pediatric behavioral health
  • Psychopharmacology
  • Inpatient psychiatric care

Background:

  • Evidence-based guidelines for managing agitation in pediatric and adolescent behavioral health units are limited.
  • Pro re nata (PRN) medications are often used for acute agitation.
  • Understanding current medication practices is crucial for improving care.

Purpose of the Study:

  • To analyze medication use patterns for agitation management in a pediatric and adolescent inpatient behavioral health unit.
  • To evaluate the effectiveness and safety of commonly administered PRN medications in this population.

Main Methods:

  • Retrospective chart review of patients (July 2020 - June 2022) receiving PRN medication for agitation.
  • Examined medication agents, routes, and concurrent administration.
  • Assessed subsequent medication use, restraint/seclusion, and adverse events.

Main Results:

  • 191 patients received 1238 doses of PRN medication for agitation.
  • Antipsychotics were most frequent (53.4%), but diphenhydramine (26.4%), lorazepam (19%), and olanzapine (18.1%) were most commonly administered.
  • Extrapyramidal symptoms (EPS) occurred in 0.24% of administrations, managed with diphenhydramine.

Conclusions:

  • Antipsychotics are frequently used for agitation in pediatric inpatient settings.
  • Commonly administered PRN medications like diphenhydramine, lorazepam, and olanzapine appear generally well-tolerated.
  • Extrapyramidal symptoms are rare but can occur with antipsychotic use.
Abstract

Keywords:
adolescentagitationbehavioral healthinpatientpediatric

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