Emergency management of agitation in schizophrenia.
Schizophrenia is a common psychiatric condition, affecting approximately 1% of the population. Acute emergent presentations often include hallucinations, delusions, thought, and speech disorders. Agitation is common among emergency patients with schizophrenia. Decisional capacity should be assessed in all patients. Reversible causes of agitation should be ruled out, including infection, metabolic disorders, endocrine disorders, trauma, pain, noncompliance, toxicological disorders, and structural brain abnormalities. Agitation may be managed acutely using a combination of pharmacological agents and nonpharmacological interventions. Effective pharmacological agents include several classes of antipsychotic agents and benzodiazepines. Potential life-threatening complications of pharmacological therapy should be anticipated, which may include neuroleptic malignant syndrome (NMS), prolonged QT syndrome, and respiratory depression. Nonpharmacological interventions may include a quiet environment, physical restraints, and behavioral interventions. Disposition decisions should be made based on the etiology of agitation, effective management, decisional capacity, and presence of suicidal or homicidal intentions. Many patients who have required nonpharmacological or pharmacological management of agitation require inpatient psychiatric treatment, either voluntarily or involuntarily. Psychiatric consultation should be sought for patients with schizophrenia and uncertain disposition determinations, or those requiring other complex management decisions.
Marco
Catherine A
CA
Department of Emergency Medicine, St Vincent Mercy Medical Center, Toledo, OH 43608-2691, USA. cmarco2@aol.com
Vaughan
Jason
J
D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D002985:Clinical Protocols; D003134:Commitment of Persons with Psychiatric Disorders; D004637:Emergency Services, Psychiatric / Q000331:legislation & jurisprudence / Q000379:methods* / Q000592:standards; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence; D008133:Long QT Syndrome / Q000139:chemically induced; D016743:Mental Competency; D009459:Neuroleptic Malignant Syndrome / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000139:chemically induced; D012149:Restraint, Physical / Q000379:methods; D012559:Schizophrenia / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D016312:Treatment Refusal / Q000331:legislation & jurisprudence; D014481:United States
D014150:Antipsychotic Agents; D001569:Benzodiazepines