title: [Pharmacological Treatment for Adult Diagnosed With Schizophrenia With Agitation or Violent Behavior].
abstract: OBJECTIVE
  To determine the most effective pharmacological intervention and to bring recommendations for decision-making in the management of adults with schizophrenia with violent behavior or agitation.
  
  
  METHODS
  A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. The evidence of NICE guide 82 was adopted and updated. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced.
  
  
  RESULTS
  It is recommended the use of parenteral drugs in all agitated patient who does not respond to the measures of persuasion. The drugs with better evidence on effectiveness (control of violent behavior) are haloperidol and benzodiazepines, administered jointly or individually. Olanzapine is also an option considering that should only be used in institutions where a psychiatrist is available 24hours. Ziprasidone can be considered as a second-line drug. The information about the side effects associated with these drugs is insufficient and has low quality.
  
  
  CONCLUSIONS
  Violent behavior in adults with schizophrenia represents a risk for themselves and for those around them, so the opportune implementation of interventions aimed to calm the patient, in order to prevent potential negative outcomes is necessary. It is recommended to initiate these interventions with measures of verbal persuasion, and if these measures are not effective, appropriate use of parenteral drugs: haloperidol and benzodiazepines as first-line and olanzapine and ziprasidone as second choices.
authors.affiliation: Médico psiquiatra, psicoanalista, psiquiatra de enlace, magíster en Epidemiología Clínica. Profesor titular y Director del Departamento de Epidemiología Clínica y Bioestadística. Pontificia Universidad Javeriana. Hospital Universitario San Ignacio, Bogotá, Colombia. Electronic address: cgomez@javeriana.edu.co.
authors.forename: Carlos
authors.initials: C
authors.lastname: Gómez-Restrepo
authors.affiliation: Médica psiquiatra, magístra en Epidemiología Clínica. Profesora asistente del departamento de Psiquiatría y Salud Mental. Pontificia Universidad Javeriana, Bogotá, Colombia.
authors.forename: Adriana Patricia
authors.initials: AP
authors.lastname: Bohórquez Peñaranda
authors.affiliation: Médico Servicio Social Obligatorio. Pontificia Universidad Javeriana, Bogotá, Colombia.
authors.forename: Mauricio J
authors.initials: MJ
authors.lastname: Ávila
authors.affiliation: Médico psiquiatra, Master en Farmacología. Profesor Universidad Nacional de Colombia, Bogotá, Colombia.
authors.forename: Luis Eduardo
authors.initials: LE
authors.lastname: Jaramillo González
authors.affiliation: Médica cirujana, Residente de Psiquiatría Pontificia Universidad Javeriana. Asistente de investigación, Bogotá, Colombia.
authors.forename: Carolina
authors.initials: C
authors.lastname: Vélez Fernández
authors.affiliation: Médica psiquiatra. Bogotá D.C. Delegada Asociación Colombiana de Psiquiatría, Colombia.
authors.forename: Ángela
authors.initials: Á
authors.lastname: Vélez Traslaviña
authors.affiliation: Médica psiquiatra, Doctora en Epidemiología Clínica. Profesora titular del Departamento de Psiquiatría, Universidad de Antioquia, Medellín, Antioquia, Colombia.
authors.forename: Jenny
authors.initials: J
authors.lastname: García Valencia
authors.affiliation: Médico psiquiatra. Magister en Epidemiología Clínica. Profesor Asistente, Universidad Industrial de Santander, Bucaramanga. Delegado Asociación Colombiana de Psiquiatría, Colombia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Pinzón-Amado
keywords: Agitación; Agitation; Antipsicóticos; Antipsychotics ;; Autoagresión; Clinical Practice Guidelines; Conducta violenta; Esquizofrenia; Guía de práctica clínica; Hetero-aggression; Heteroagresión; Schizophrenia; Self-harm; Violent behavior