Are Oral Medications Effective in the Management of Acute Agitation?

Gault, Travis I.; Gray, Siobhan; Vilke, Gary M.; Wilson, Michael P.

doi:10.1016/j.jemermed.2012.01.028

Cited by 31 publications

(12 citation statements)

References 12 publications

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“…Additionally, intramuscular administration is preferred by clinicians for rapid and effective treatment. Note that a systematic review of studies from 2001 to 2010 showed that oral and intramuscular medications are equally effective in rapidly reducing psychotic agitation in the emergency department [21]. Nonetheless, further studies are needed.…”

Section: Discussionmentioning

confidence: 99%

Prescription practices in the treatment of agitation in newly hospitalized Chinese schizophrenia patients: data from a non-interventional naturalistic study

Zhang

Liu

et al. 2019

BMC Psychiatry

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Background Data on the pharmacological management of acute agitation in schizophrenia are scarce. The aim of this study is to investigate the prescription practices in the treatment of agitation in Chinese patients with schizophrenia. Methods We conducted a large, multicenter, observational study in 14 psychiatry hospitals in China. Newly hospitalized schizophrenia patients with the PANSS-EC total score ≥ 14 and a value ≥4 on at least one of its five items were included in the study. Their drug treatments of the first 2 weeks in hospital were recorded by the researchers. Results Eight hundred and 53 patients enrolled in and 847 (99.30%) completed the study. All participants were prescribed antipsychotics, 40 (4.72%) were prescribed benzodiazepine in conjunction with antipsychotics and 81 were treated with modified electric convulsive therapy (MECT). Four hundred and 12 (48.64%) patients were prescribed only one antipsychotic, in the order of olanzapine (120 patients, 29.13%), followed by risperidone (101 patients, 24.51%) and clozapine (41 patients, 9.95%). About 435 (51.36%) participants received antipsychotic polypharmacy, mostly haloperidol + risperidone (23.45%), haloperidol+ olanzapine (17.01%), olanzapine+ ziprasidone (5.30%), haloperidol + clozapine (4.37%) and haloperidol + quetiapine (3.90%). Binary logistic regression analysis suggests that a high BARS score (OR 2.091, 95%CI 1.140–3.124), severe agitation (OR 1.846, 95%CL 1.266–2.693), unemployment or retirement (OR 1.614, 95%CL 1.189–2.190) and aggressiveness on baseline (OR 1.469, 95%CL 1.032–2.091) were related to an increased antipsychotic polypharmacy odds. Male sex (OR 0.592, 95%CL 0.436–0.803) and schizophrenia in older persons (age ≥ 55 years, OR 0.466, 95%CL 0.240–0.902) were less likely to be associated with antipsychotic polypharmacy. Conclusion The present study demonstrates that monotherapy and polypharmacy display equally common patterns of antipsychotic usage in managing agitation associated with schizophrenia in China. The extent and behavioral activities of agitation and several other factors were associated with polypharmacy. Electronic supplementary material The online version of this article (10.1186/s12888-019-2192-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Prescription practices in the treatment of agitation in newly hospitalized Chinese schizophrenia patients: data from a non-interventional naturalistic study

Zhang

Liu

et al. 2019

BMC Psychiatry

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“…This increased LOS is present despite the fact that agitation, which is the most common reason medications are administered, is itself not associated with longer stays. It is tempting to speculate that use of overly sedating medications, particularly delivered intramuscularly or intravenously by emergency medicine clinicians, might increase LOSs [25][26][27]. However, this awaits more prospectively collected data.…”

Section: Discussionmentioning

confidence: 99%

“…One additional factor that might be important is the type of medication that is used by ED clinicians. Nonsedating oral medication, for example, would be expected to decrease LOSs but is infrequently used by ED clinicians [26,27]. However, given the multiplicity of doses and types of medication in the ED, it is difficult to compare across medications, routes of administration, and doses in this study.…”

Section: Limitationsmentioning

confidence: 99%

Lengths of stay for involuntarily held psychiatric patients in the ED are affected by both patient characteristics and medication use

Wilson¹,

Brennan²,

Modesti³

et al. 2015

The American Journal of Emergency Medicine

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Background: Psychiatric patients experience longer treatment times (length of stay [LOS]) in the emergency department (ED) compared to nonpsychiatric patients. Although patients on involuntary mental health holds are relatively understudied, common wisdom would hold that times for these patients can only be affected by addressing systems issues because they are not free to leave. The objective of this study was to determine whether both selected ED and patient-specific factors were associated with longer LOS. We hypothesized that nonmodifiable factors (age, sex, agitation, presentation during evenings/nights, presentation during weekends, suicidal ideation) would prolong LOS but that potentially modifiable factors (such as use of medication) would reduce LOS. Methods: A historical cohort of patients (January 1, 2009-August 16, 2010) placed on involuntary mental health holds was studied in 2 general EDs. A regression model was used to calculate the effects of modifiable and nonmodifiable factors on LOS. Results: Six hundred forty patient visits met all inclusion/exclusion criteria. Longer LOSs were significantly associated with suicidal ideation, use of antipsychotics, and use of benzodiazepines, although agitation did not predict longer LOSs. Longer LOSs were also longer with presentation on the weekends. Conclusions: Lengths of stay for patients on involuntary mental health holds are associated with several factors outside the control of the typical ED clinician such as the ability to clear holds quickly due to day of week or placement of the hold for suicidal ideation. Lengths of stay are also increased by factors within the control of the typical ED clinician, such as administration of calming medication.

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“…PO, ODT, or OS risperidone were effective in the control of psychomotor agitation when administered alone (A)29,61-64 or with lorazepam (B) 46,47,59,61. OS risperidone together with clonazepam was as effective as IM haloperidol25 or PO risperidone in combination with PO lorazepam (B) 46,47…”

Section: Resultsmentioning

confidence: 99%

“…PO or ODT olanzapine may be effective for psychomotor agitation control 21,61-63,65,66. IM olanzapine is as effective40,67 as ziprasidone,2 haloperidol,2,22,30,31,37,40,42,43 and other antipsychotics 16,27,62,68,69.…”

Section: Resultsmentioning

confidence: 99%

Brazilian guidelines for the management of psychomotor agitation. Part 2. Pharmacological approach

Baldaçara

Diaz

Leite

et al. 2019

Braz. J. Psychiatry

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Objective:To present the essential guidelines for pharmacological management of patients with psychomotor agitation in Brazil.Methods:This is a systematic review of articles retrieved from the MEDLINE (PubMed), Cochrane Database of Systematic Reviews, and SciELO databases published from 1997 to 2017. Other relevant articles in the literature were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools.Results:Of 5,362 articles retrieved, 1,731 abstracts were selected for further reading. The final sample included 74 articles that met all inclusion criteria. The evidence shows that pharmacologic treatment is indicated only after non-pharmacologic approaches have failed. The cause of the agitation, side effects of the medications, and contraindications must guide the medication choice. The oral route should be preferred for drug administration; IV administration must be avoided. All subjects must be monitored before and after medication administration.Conclusion:If non-pharmacological strategies fail, medications are needed to control agitation and violent behavior. Once medicated, the patient should be monitored until a tranquil state is possible without excessive sedation.Systematic review registry number:CRD42017054440.

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Are Oral Medications Effective in the Management of Acute Agitation?

Cited by 31 publications

References 12 publications

Prescription practices in the treatment of agitation in newly hospitalized Chinese schizophrenia patients: data from a non-interventional naturalistic study

Prescription practices in the treatment of agitation in newly hospitalized Chinese schizophrenia patients: data from a non-interventional naturalistic study

Lengths of stay for involuntarily held psychiatric patients in the ED are affected by both patient characteristics and medication use

Brazilian guidelines for the management of psychomotor agitation. Part 2. Pharmacological approach

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