Treating Aggression in the Psychiatric Emergency Service

Reports indicate that the severely mentally ill, those patients with schizophrenia or bipolar disorder,are at increased risk of being violent to others. They are also at increased risk of being victims ofviolence or homicide. This article discusses the state of knowledge concerning the 3 most commonclasses of drugs used to decrease agitation in the psychiatric emergency service setting: benzodiazepines,conventional antipsychotics, and atypical antipsychotics. The decision whether to use benzodiazepinesalone versus benzodiazepines combined with an antipsychotic, and whether that antipsychoticshould be a conventional or atypical antipsychotic, hinges on considerations of mental healthhistory, need for synergistic sedating effects, and the side effect profiles of the various medications.