The comparative efficacy of intramuscular antipsychotics for the management of acute agitation

Bosanac, Peter; Hollander, Yitzchak; Castle, David

doi:10.1177/1039856213499620

Cited by 17 publications

(13 citation statements)

References 53 publications

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“…This exclusion limited consideration of interventions to reduce agitation, which may also lead to decreased aggression. An evidence base for reducing agitation exists (39,57), and it may inform aggression management. The decision to focus on aggression and not agitation, although narrowing the scope of our review, also reduced the heterogeneity of the outcomes under examination.…”

Section: Research Recommendationsmentioning

confidence: 99%

Preventing and De-escalating Aggressive Behavior Among Adult Psychiatric Patients: A Systematic Review of the Evidence

et al. 2017

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Available evidence about strategies for preventing and de-escalating aggressive behavior among psychiatric patients is very limited. Two preventive strategies, risk assessment and multimodal interventions consistent with the Six Core Strategies principles, may effectively lower aggressive behavior and use of seclusion and restraint, but more research is needed on how best to prevent and de-escalate aggressive behavior in acute care settings.

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Section: Research Recommendationsmentioning

confidence: 99%

Preventing and De-escalating Aggressive Behavior Among Adult Psychiatric Patients: A Systematic Review of the Evidence

et al. 2017

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“…They are at least as effective as haloperidol alone (without an anticholinergic agent) in controlling agitation, more effective at controlling aggression, 64 and carry a lower side effect burden. 65 In a study comparing the effectiveness of olanzapine and aripiprazole for the treatment of agitation in acutely ill patents with schizophrenia over a 5-day period, both were equally effective, but olanzapine was significantly more likely to increase fasting glucose and triglycerides. 66 Clinicians often use benzodiazepines alone or in combination with antipsychotics to control psychosis-induced aggression and agitation.…”

Section: Psychopharmalogical Interventionsmentioning

confidence: 99%

Inpatient aggression in community hospitals

White

Cummings

et al. 2015

CNS Spectr.

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Physical violence is a frequent occurrence in acute community psychiatry units worldwide. Violent acts by patients cause many direct injuries and significantly degrade quality of care. The most accurate tools for predicting near-term violence on acute units rely on current clinical features rather than demographic risk factors. The efficacy of risk assessment strategies to lower incidence of violence on acute units is unknown. A range of behavioral and psychopharmacologic treatments have been shown to reduce violence among psychiatric inpatients.

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“…Compared with second-generation antipsychotics, haloperidol is similarly efficacious but associated with more sedation, extrapyramidal symptoms and requirement for additional medications for agitation 13. In fact, a Cochrane Review comparing haloperidol with second-generation antipsychotics found similar severities of delirium with each, but also found that a higher dose of haloperidol (>4.5 mg/day) was associated with increased risk of extrapyramidal adverse effects 14. Furthermore, a recent clinical care practice guideline suggests that atypical antipsychotics may be more beneficial than haloperidol at reducing the duration of delirium in adult ICU patients, and should be the preferred first-line agent 15…”

Section: Discussionmentioning

confidence: 99%

Medication-induced acute dystonic reaction: the challenge of diagnosing movement disorders in the intensive care unit

2015

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A 62-year-old man presented with left middle cerebral artery stroke. 1 h postadministration of tissue plasminogen activator, he received a total of 4 mg of haloperidol for combativeness. He developed partial complex status epilepticus, requiring benzodiazepines, phenytoin, propofol and intubation. 5 h later, he developed recurrent stereotyped tonic movements involving arching of the back, extension of the arms and contraction of opposing muscle groups. Repeat CT scan of the head showed evolving insular infarct. Differential diagnoses for these movements included tonic/clonic seizures, extensor (decerebrate) posturing from haemorrhagic conversion, neuroleptic malignant syndrome, or dystonic reaction. Given the lack of response to antiseizure medications, the recent administration of haloperidol, and the prompt resolution of movements following diphenhydramine administration, an acute dystonic reaction was considered. This atypical case of a critically ill patient with stroke highlights the fact that these patients may have multiple abnormal movements requiring careful analysis to guide diagnosis-specific management.

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The comparative efficacy of intramuscular antipsychotics for the management of acute agitation

Abstract: Further studies are required in the ongoing development of contemporary, evidence-based clinical guidelines in acute agitation, including head-to-head comparisons of currently utilized IM atypical antipsychotics, sequential treatment or combinations of medications.

Cited by 17 publications

References 53 publications

Preventing and De-escalating Aggressive Behavior Among Adult Psychiatric Patients: A Systematic Review of the Evidence

Preventing and De-escalating Aggressive Behavior Among Adult Psychiatric Patients: A Systematic Review of the Evidence

Inpatient aggression in community hospitals

Medication-induced acute dystonic reaction: the challenge of diagnosing movement disorders in the intensive care unit

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