Systematic reviews of assessment measures and pharmacologic treatments for agitation

doi:10.1016/j.clinthera.2010.03.006

Clinical Therapeutics

Volume 32, Issue 3, March 2010, Pages 403-425

https://doi.org/10.1016/j.clinthera.2010.03.006 Get rights and content

Abstract

Background: Agitation is a common behavioral emergency associated with high risk of injury to patients and health care professionals. There are a wide variety of approaches to assessing the severity of agitation and the risk of violence/aggression, and many different pharmacotherapies have been used to manage this condition.

Objectives: Two systematic reviews were carried out. The first focused on measures used to assess agitation and predict aggression/violence and/or the need for medication. The second focused on clinical trials of the efficacy and tolerability of pharmacotherapies for agitation.

Methods: Publications relevant to each topic were identified by searches of MEDLINE through December 24, 2009. The search concerning the assessment of agitation included the terms agitation AND assessment AND (scale OR instrument); the search for clinical trials of pharmacotherapies for agitation included the terms agitation and treatment AND (emergency OR acute). Both searches were limited to reports of studies published in English involving patients aged ≥18 years.

Results: The literature search identified 13 scales used to assess the severity of agitation across multiple patient populations; only 3 of these reports involved the prediction of aggression/violence in patients with agitation, and 1 involved prediction of the need for medication. Thirty-one clinical trials of pharmacotherapy for agitation were identified by the literature search. Based on their results, orally administered olanzapine, risperidone, aripiprazole, quetiapine, haloperidol, and lorazepam; intramuscularly administered olanzapine, lorazepam, ziprasidone, haloperidol, aripiprazole, midazolam, and droperidol; and intravenously administered droperidol and lorazepam were effective for the treatment of agitation. The intramuscular route of administration was associated with a more rapid onset of action compared with the oral route (eg, for olanzapine, 30 minutes vs 1 hour, respectively).

Conclusions: Agitation is a common behavioral emergency that may require pharmacotherapy. The management of agitated patients may be improved through the use of easy-to-administer instruments that predict the need for medication and the availability of rapid-acting treatments that are well accepted by patients and health care professionals.

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Systematic reviews of assessment measures and pharmacologic treatments for agitation

Abstract

Am J Emerg Med.

Cochrane Database Syst Rev.

J Clin Psychiatry

J Am Geriatr Soc.

Int J Geriatr Psychiatry

Am J Psychiatry

J Clin Psychiatry

J Clin Psychopharmacol.

Psychopharmacology (Berl)

Am J Geriatr Psychiatry

Bull Soc Sci Med Grand Duche Luxemb.

J Clin Psychiatry

Eur J Emerg Med.

J Emerg Med.

Psychiatry Clin Neurosci.

Neuropsychopharmacol Hung.

Am J Med.

Actas Esp Psiquiatr.

Pharmacological control of acute agitation: Focus on intramuscular preparations

CNS Drugs.

Atypical antipsychotics for acute agitation. New intramuscular options offer advantages

Postgrad Med.

Atypical antipsychotics for acute agitation. New intramuscular options offer advantages

Postgrad Med.

The pathophysiology of agitation

J Clin Psychiatry

Managing the acutely agitated and psychotic patient

CNS Spectr.

Use of restraints and pharmacotherapy in academic psychiatric emergency services

Gen Hosp Psychiatry

Pharmacological management of acute agitation

Drugs.

Psychosis-related disturbances. Psychosis, agitation, and disinhibition in Alzheimer's disease: Definitions and treatment options

Geriatrics

The symptoms of hyperglycaemia in people with insulin-treated diabetes: Classification using principal components analysis

Diabetes Metab Res Rev.

New treatments for agitation

Psychiatr Q.

The epidemiology of the homeless population and its impact on an urban emergency department

Acad Emerg Med.

Level of agitation of psychiatric patients presenting to an emergency department

Prim Care Companion J Clin Psychiatry

The Numbers Count: Mental Disorders in America

Rapid tranquillisation. A survey of emergency prescribing in a general psychiatric hospital

Br J Psychiatry

Psychiatric emergencies in the elderly population

Emerg Med Clin North Am.

Psychiatric emergencies in the elderly population

Emerg Med Clin North Am.

Treatment of agitation in the emergency room [in French]

Rev Med Suisse.

Patients in a state of agitation at the admission service of a Rouen hospital emergency department [in French]

Presse Med.

Survey of management methods for patients in a state of agitation at admission and emergency departments in France [in French]

Encephale.

Management of the agitated elderly patient in the nursing home: The role of the atypical antipsychotics

J Clin Psychiatry

Frequency of alternative to restraints and seclusion and uses of agitation reduction techniques in the emergency department

Gen Hosp Psychiatry

Pharmacologic treatment of agitation

Development of a scale for assessment of agitation following traumatic brain injury

J Clin Exp Neuropsychol.

A brief agitation rating scale (BARS) for nursing home elderly

J Am Geriatr Soc.

Predicting clinical and social outcome of patients attending ‘real world’ mental health services: A 6-year multi-wave follow-up study

Acta Psychiatr Scand Suppl.

The Brøset Violence Checklist. Sensitivity, specificity, and interrater reliability

J Interpers Violence.

Validation of a Clinical Global Impression Scale for Aggression (CGI-A) in a sample of 558 psychiatric patients

Schizophr Res.

Conceptualization of agitation: Results based on the Cohen-Mansfield Agitation Inventory and the Agitation Behavior Mapping Instrument

Int Psychogeriatr.

HCR-20 violence risk assessment scheme: Overview and annotated bibliography

Screening for risk of inpatient violence

Law Hum Behav.

Assessment of neuropsychologic impairments after head injury: Interrater reliability and factorial and criterion validity of the Neuro-behavioral Rating Scale-Revised

Arch Phys Med Rehabil.