Pharmacological management of aggression and violence.
The pharmacological management of violence and aggression is a common and substantial clinical dilemma in the emergency psychiatric situation. A literature search was conducted through PubMed and using the Cochrane Library. This was followed by a manual search of selected literature. Randomised controlled trials were sought that specifically addressed the acute situation, rather than the ongoing management of chronic conditions. There was a paucity of well-controlled data and insufficient evidence to support the use of many agents in emergency situations. Many studies had considerable limitations making comparison difficult. Efficacy data for a range of treatment options exists, including the use of classical and atypical anti-psychotic agents, benzodiazepines and combination therapies. Clinical risk, tolerability and environmental factors need to form part of a careful and considered judgement in the choice of treatment. Safety, tolerability and the potential for a positive experience are major considerations, thus paving the way for long term compliance.
Humble
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Barwon Health Mental Health, Swanston Centre, PO Box 281, Geelong, Victoria 3220, Australia.
Berk
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M
D000374:Aggression / Q000187:drug effects*; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy*; D011569:Psychiatric Status Rating Scales; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome; D014754:Violence / Q000517:prevention & control* / Q000523:psychology
D014151:Anti-Anxiety Agents; D014150:Antipsychotic Agents; D011619:Psychotropic Drugs