Managing the Acutely Agitated and Psychotic Patient

Abstract

Agitation can present as an emergency in the course of numerous psychiatric conditions including intoxication, schizophrenia, bipolar disorder, and delirium. This article reviews relevant literature regarding the definition, etiology, measurement, and management of episodic agitation and pays particular attention to intramuscular treatments. The impact of changes in methodology between the era of first- and second-generation antipsychotics, the implications of those changes for external validity of studies of second-generation studies, and the recent evolution of expert consensus are discussed.

Transition from Ziprasidone IM to Oral Formulation in Agitated Patients with Acute Exacerbation of Schizophrenia: An Open Trial

“…Treatment discontinuation, when necessary, occurred in most cases between 3 and 6 weeks from the initiation of oral therapy, when the eff ect of ziprasidone may have likely been already evident. We believe that the rapid eff ect of ziprasidone reported in the present study could be important in daily practice, as a fast improvement of clinical symptoms is a key goal in the management of the agitated patient [ 2 ] . Overall, our effi cacy results are in line with those of previous studies, which showed an improvement in symptoms following the sequential administration of IM and oral ziprasidone [ 12 , 15 ] .…”

“…Ziprasidone was the fi rst atypical antipsychotic to be available in a rapid-acting IM formulation [ 6 ] , but the IM administration is now available for other drugs of the same class, e. g., olanzapine and aripiprazole [ 2 ] . Overall, the results of comparative studies have suggested an improved effi cacy for atypical antipsychotics in the treatment of acute exacerbation of schizophrenia, compared with conventional antipsychotics, even if further clinical experiences are advocated [ 2 ] . Additional evidence, possibly derived from robust studies, is also needed to provide new and more defi nite insights about the transition from IM to oral formulations of antipsychotics [ 3 ] .…”

“…orthostatic hypotension [ 1,2 ] , while benzodiazepines may result in excessive sedation [ 7 ] . Moreover, conventional antipsychotics and benzodiazepines do not provide an eff ective control of the negative manifestations of schizophrenia [ 5,6 ] .…”

“…However, IM administration is not a realistic option over a long-term period; a transition to an oral formulation of the same or of a diff erent atypical antipsychotic may improve the patient's compliance and optimize the subsequent management of the disease [ 9 ] . Although some clinical experiences on the IM-to-oral transition have been published, further research on this topic is advocated [ 2,3 ] . Ziprasidone is an atypical antipsychotic with a characteristic neurotransmitter receptor-binding profi le, and a favourable benefi t/risk ratio in schizophrenic patients [ 10,11 ] .…”

The incidence of involuntary movements in school-children with special emphasis on the blink rate and refractive errors

“…Ova terapija je posebno značajna kod učestalog treptanja i grčevitog zatvaranja očnih kapaka (blefarospazam) odraslih, jer pacijentu omogućava normalan vid. Blefarospazam se češće sreće kod odraslih pacijenata i nije specifičan za decu [13,14,15,16]. Mi nismo imali decu sa tim problemom.…”