A Review of Agitation in Mental Illness: Treatment Guidelines and Current Therapies

Background: Agitation is an important therapeutic target in the acute and/or emergent setting, as well as for longer-term care of patients with psychiatric illness. Method: Select reviews and guidelines published (from 2000 to 2006) on the treatment of agitation in various psychiatric disorders were evaluated. Results: After maximizing the safety of all individuals in the presence of an acutely agitated patient, initial therapy generally involves verbal de-escalation. Pharmacologic management of acute agitation relies on typical antipsychotics, particularly haloperidol; benzodiazepines; and atypical antipsychotics. The selection of a specific agent (or combination of agents) should be guided by etiologic considerations, efficacy of the drug(s), side effects, potential drug interactions, and drug formulation. Seclusion or restraints are treatments of last resort due to safety issues. Conclusion: Compared with conventional antipsychotics (e.g., haloperidol), preliminary evidence indicates that atypical antipsychotics effectively reduce agitation, are better tolerated, and have fewer side effects. After an acute episode, atypical agents also help ease the transition from intramuscular to oral medication to promote ongoing treatment.