The role of typical and atypical antipsychotic medications in the management of agitation and aggression.
The management of agitation and aggression in psychiatric inpatients is a significant clinical dilemma. Establishing a clear diagnosis and distinguishing whether aggression is an acute manifestation or a long-standing or repetitive problem are fundamental antecedents of medication treatment. For acute aggression, either benzodiazepines or antipsychotic medications (typical and atypical) are recommended choices. Currently, on the basis of efficacy, ease of use, and availability in multiple (tablet, liquid, intramuscular) preparations, typical antipsychotics such as loxapine should be considered as first choice for acute aggression (in psychosis). On the other hand, atypical antipsychotics, particularly clozapine, should be considered when aggression in psychosis persists and/or is repetitive. Typical antipsychotics are indicated for persistent aggression in psychosis when medication noncompliance is the obstacle to effective treatment.
Buckley
P F
PF
Department of Psychiatry, Case Western Reserve University, and Northcoast Behavioral Healthcare System, Cleveland, Ohio 44106, USA.
D000374:Aggression / Q000187:drug effects*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines; D003024:Clozapine / Q000627:therapeutic use; D006801:Humans; D008152:Loxapine / Q000627:therapeutic use; D001523:Mental Disorders / Q000188:drug therapy* / Q000523:psychology; D000077152:Olanzapine; D010890:Pirenzepine / Q000031:analogs & derivatives / Q000627:therapeutic use; D011595:Psychomotor Agitation / Q000188:drug therapy*; D011618:Psychotic Disorders / Q000188:drug therapy / Q000523:psychology; D018967:Risperidone / Q000627:therapeutic use; D012559:Schizophrenia / Q000188:drug therapy; D012565:Schizophrenic Psychology
D014150:Antipsychotic Agents; D001569:Benzodiazepines; D010890:Pirenzepine; D003024:Clozapine; D018967:Risperidone; D008152:Loxapine; D000077152:Olanzapine