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Chapter 14 - Pharmacologic Treatment of Agitation

Published online by Cambridge University Press:  09 March 2017

By
Leslie Citrome
Edited by
Scott L. Zeller ,
Kimberly D. Nordstrom  and
Michael P. Wilson
Scott L. Zeller
Affiliation:
University of California, Riverside
Kimberly D. Nordstrom
Affiliation:
Denver Health Medical Center, Colorado
Michael P. Wilson
Affiliation:
University of California, San Diego
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The Diagnosis and Management of Agitation , pp. 200 - 218
Publisher: Cambridge University Press
Print publication year: 2017

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References

Advokat, C. (2010). A brief overview of iatrogenic akathisia. Clinical Schizophrenia and Related Psychoses, 3, 226–236.Google Scholar
Allen, M. H., Currier, G. W., Carpenter, D., et al. (2005). The Expert Consensus Guideline Series. Treatment of behavioral emergencies 2005. Journal of Psychiatric Practice, 11 Suppl 1, 5–108.CrossRefGoogle ScholarPubMed
Allen, M. H., Feifel, D., Lesem, M. D., et al. (2011). Efficacy and safety of loxapine for inhalation in the treatment of agitation in patients with schizophrenia: a randomized, double-blind, placebo-controlled trial. Journal of Clinical Psychiatry, 72, 1313–1321.CrossRefGoogle ScholarPubMed
Alpert, M., Allan, E. R., Citrome, L., et al. (1990). A double-blind, placebo-controlled study of adjunctive nadolol in the management of violent psychiatric patients. Psychopharmacology Bulletin, 26, 367–371.Google Scholar
Alphs, L., Benson, C., Cheshire-Kinney, K., et al. (2015). Real-world outcomes of paliperidone palmitate compared to daily oral antipsychotic therapy in schizophrenia: a randomized, open-label, review board-blinded 15-month study. Journal of Clinical Psychiatry, 76, 554–561.CrossRefGoogle ScholarPubMed
Andrezina, R., Josiassen, R. C., Marcus, R. N., et al. (2006). Intramuscular aripiprazole for the treatment of acute agitation in patients with schizophrenia or schizoaffective disorder: a double-blind, placebo-controlled comparison with intramuscular haloperidol. Psychopharmacology (Berl), 188, 281–292.CrossRefGoogle ScholarPubMed
Baker, R. W., Kinon, B. J., Maguire, G. A., et al. (2003). Effectiveness of rapid initial dose escalation of up to forty milligrams per day of oral olanzapine in acute agitation. Journal of Clinical Psychopharmacology, 23, 342–348.CrossRefGoogle ScholarPubMed
Battaglia, J., Moss, S., Rush, J., et al. (1997). Haloperidol, lorazepam, or both for psychotic agitation? A multicenter, prospective, double-blind, emergency department study. American Journal of Emergency Medicine, 15, 335–340.Google Scholar
Bieniek, S. A., Ownby, R. L., Penalver, A., et al. (1998). A double-blind study of lorazepam versus the combination of haloperidol and lorazepam in managing agitation. Pharmacotherapy, 18, 57–62.Google Scholar
Breier, A., Meehan, K., Birkett, M., et al. (2002). A double-blind, placebo-controlled dose–response comparison of intramuscular olanzapine and haloperidol in the treatment of acute agitation in schizophrenia. Archives of General Psychiatry, 59, 441–448.CrossRefGoogle ScholarPubMed
Brook, S., Lucey, J. V., Gunn, K. P. (2000). Intramuscular ziprasidone compared with intramuscular haloperidol in the treatment of acute psychosis. Journal of Clinical Psychiatry, 61, 933–941.CrossRefGoogle ScholarPubMed
Brook, S., Walden, J., Benattia, I., et al. (2005). Ziprasidone and haloperidol in the treatment of acute exacerbation of schizophrenia and schizoaffective disorder: comparison of intramuscular and oral formulations in a 6-week, randomized, blinded-assessment study. Psychopharmacology (Berl), 178, 514–523.Google Scholar
Buss, A. H., Durkee, A. (1957). An inventory for assessing different kinds of hostility. Journal of Consulting and Clinical Psychology, 21, 343–349.CrossRefGoogle ScholarPubMed
Caspi, N., Modai, I., Barak, P., et al. (2001). Pindolol augmentation in aggressive schizophrenic patients: a double-blind crossover randomized study. International Clinical Psychopharmacology, 16, 111–115.Google Scholar
Castle, D. J., Udristoiu, T., Kim, C. Y., et al. (2009). Intramuscular olanzapine versus short-acting typical intramuscular antipsychotics: comparison of real-life effectiveness in the treatment of agitation. World Journal of Biological Psychiatry, 10, 43–53.CrossRefGoogle ScholarPubMed
Citrome, L. (2007). Comparison of intramuscular ziprasidone, olanzapine, or aripiprazole for agitation: a quantitative review of efficacy and safety. Journal of Clinical Psychiatry, 68, 1876–1885.CrossRefGoogle ScholarPubMed
Citrome, L. (2009). Adjunctive lithium and anticonvulsants for the treatment of schizophrenia: what is the evidence? Expert Review of Neurotherapeutics, 9, 55–71.Google Scholar
Citrome, L. (2010). Relative vs. absolute measures of benefit and risk: what’s the difference? Acta Psychiatrica Scandinavica, 121, 94–102.CrossRefGoogle ScholarPubMed
Citrome, L. (2011). Evidence-based medicine: it’s not just about the evidence. International Journal of Clinical Practice, 65, 634–635.Google Scholar
Citrome, L. (2012). Inhaled loxapine for agitation revisited: focus on effect sizes from 2 Phase III randomised controlled trials in persons with schizophrenia or bipolar disorder. International Journal of Clinical Practice, 66, 318–325.Google Scholar
Citrome, L. (2013a). Addressing the need for rapid treatment of agitation in schizophrenia and bipolar disorder: focus on inhaled loxapine as an alternative to injectable agents. Therapeutics and Clinical Risk Management, 9, 235–245.CrossRefGoogle ScholarPubMed
Citrome, L. (2013b). New second-generation long-acting injectable antipsychotics for the treatment of schizophrenia. Expert Review of Neurotherapeutics, 13, 767–783.CrossRefGoogle ScholarPubMed
Citrome, L. (2014). Asenapine review, part I: chemistry, receptor affinity profile, pharmacokinetics and metabolism. Expert Opinion on Drug Metabolism & Toxicology, 10, 893–903.CrossRefGoogle ScholarPubMed
Citrome, L., Du, Y., Risinger, R., et al. (2016). Effect of aripiprazole lauroxil on agitation and hostility in patients with schizophrenia. International Clinical Psychopharmacology, 31, 69–75.CrossRefGoogle ScholarPubMed
Citrome, L., Durgam, S., Lu, K., et al. (2016). The effect of cariprazine on hostility associated with schizophrenia: post hoc analyses from 3 randomized controlled trials. Journal of Clinical Psychiatry, 77:109–115.CrossRefGoogle ScholarPubMed
Citrome, L., Ketter, T. A. (2013). When does a difference make a difference? Interpretation of number needed to treat, number needed to harm, and likelihood to be helped or harmed. International Journal of Clinical Practice, 67, 407–411.Google Scholar
Citrome, L., Shope, C. B., Nolan, K. A., et al. (2007). Risperidone alone versus risperidone plus valproate in the treatment of patients with schizophrenia and hostility. International Clinical Psychopharmacology, 22, 356–362.CrossRefGoogle ScholarPubMed
Citrome, L., Volavka, J. (2011). Pharmacological management of acute and persistent aggression in forensic psychiatry settings. CNS Drugs, 25, 1009–1021.CrossRefGoogle ScholarPubMed
Citrome, L., Volavka, J., Czobor, P., et al. (2001). Effects of clozapine, olanzapine, risperidone, and haloperidol on hostility among patients with schizophrenia. Psychiatric Services, 52, 1510–1514.CrossRefGoogle ScholarPubMed
Citrome, L., Volavka, J., Czobor, P., et al. (2006). Efficacy of ziprasidone against hostility in schizophrenia: post hoc analysis of randomized, open-label study data. Journal of Clinical Psychiatry, 67, 638–642.Google Scholar
Currier, G. W., Chou, J. C., Feifel, D., et al. (2004). Acute treatment of psychotic agitation: a randomized comparison of oral treatment with risperidone and lorazepam versus intramuscular treatment with haloperidol and lorazepam. Journal of Clinical Psychiatry, 65, 386–394.Google Scholar
Currier, G. W., Simpson, G. M. (2001). Risperidone liquid concentrate and oral lorazepam versus intramuscular haloperidol and intramuscular lorazepam for treatment of psychotic agitation. Journal of Clinical Psychiatry, 62, 153–157.CrossRefGoogle ScholarPubMed
Daniel, D. G., Currier, G. W., Zimbroff, D. L., et al. (2007). Efficacy and safety of oral aripiprazole compared with haloperidol in patients transitioning from acute treatment with intramuscular formulations. Journal of Psychiatric Practice, 13, 170–177.CrossRefGoogle ScholarPubMed
Daniel, D. G., Potkin, S. G., Reeves, K. R., et al. (2001). Intramuscular (IM) ziprasidone 20 mg is effective in reducing acute agitation associated with psychosis: a double-blind, randomized trial. Psychopharmacology (Berl), 155, 128–134.Google Scholar
Daniel, D. G., Zimbroff, D. L., Swift, R. H., et al. (2004). The tolerability of intramuscular ziprasidone and haloperidol treatment and the transition to oral therapy. International Clinical Psychopharmacology, 19, 9–15.Google Scholar
Fazel, S., Zetterqvist, J., Larsson, H., et al. (2014). Antipsychotics, mood stabilisers, and risk of violent crime. Lancet, 384, 1206–1214.Google Scholar
Foster, S., Kessel, J., Berman, M. E., et al. (1997). Efficacy of lorazepam and haloperidol for rapid tranquilization in a psychiatric emergency room setting. International Clinical Psychopharmacology, 12, 175–179.Google Scholar
Gillies, D., Sampson, S., Beck, A., et al. (2013). Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database of Systematic Reviews, 4, CD003079.Google Scholar
Greenblatt, D. J., Divoll, M., Harmatz, J. S., et al. (1982). Pharmacokinetic comparison of sublingual lorazepam with intravenous, intramuscular, and oral lorazepam. Journal of Pharmaceutical Sciences, 71, 248–252.Google Scholar
Greenblatt, D. J., Shader, R. I., Franke, K., et al. (1979). Pharmacokinetics and bioavailability of intravenous, intramuscular, and oral lorazepam in humans. Journal of Pharmaceutical Sciences, 68, 57–63.CrossRefGoogle ScholarPubMed
Hankin, C. S., Bronstone, A., Koran, L. M. (2011). Agitation in the inpatient psychiatric setting: a review of clinical presentation, burden, and treatment. Journal of Psychiatric Practice, 17, 170–185.Google Scholar
Huf, G., Alexander, J., Allen, M. H., et al. (2009). Haloperidol plus promethazine for psychosis-induced aggression. Cochrane Database of Systematic Reviews, 3, CD005146.Google Scholar
Jhee, S. S., Zarotsky, V., Mohaupt, S. M., et al. (2003). Delayed onset of oculogyric crisis and torticollis with intramuscular haloperidol. Annals of Pharmacotherapy, 37, 1434–1437.Google Scholar
Kay, S. R., Fiszbein, A., Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261–276.Google Scholar
Khan, S. S., Mican, L. M. (2006). A naturalistic evaluation of intramuscular ziprasidone versus intramuscular olanzapine for the management of acute agitation and aggression in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 16, 671–677.Google Scholar
Kinon, B. J., Stauffer, V. L., Kollack-Walker, S., et al. (2008). Olanzapine versus aripiprazole for the treatment of agitation in acutely ill patients with schizophrenia. Journal of Clinical Psychopharmacology, 28, 601–607.Google Scholar
Knox, D. K., Holloman, G. H. Jr. (2012). Use and avoidance of seclusion and restraint: consensus statement of the American Association for Emergency Psychiatry Project BETA Seclusion and Restraint Workgroup. Western Journal of Emergency Medicine, 13, 35–40.Google Scholar
Kohen, I., Preval, H., Southard, R., et al. (2005). Naturalistic study of intramuscular ziprasidone versus conventional agents in agitated elderly patients: retrospective findings from a psychiatric emergency service. American Journal of Geriatric Pharmacotherapy, 3, 240–245.CrossRefGoogle ScholarPubMed
Krakowski, M. I., Czobor, P., Citrome, L., et al. (2006). Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder. Archives of General Psychiatry, 63, 622–629.Google Scholar
Kwentus, J., Riesenberg, R. A., Marandi, M., et al. (2012). Rapid acute treatment of agitation in patients with bipolar I disorder: a multicenter, randomized, placebo-controlled clinical trial with inhaled loxapine. Bipolar Disorders, 14, 31–40.Google Scholar
Lesem, M. D., Tran-Johnson, T. K., Riesenberg, R. A., et al. (2011). Rapid acute treatment of agitation in individuals with schizophrenia: multicentre, randomised, placebo-controlled study of inhaled loxapine. British Journal of Psychiatry, 198, 51–58.Google Scholar
Lesem, M. D., Zajecka, J. M., Swift, R. H., et al. (2001). Intramuscular ziprasidone, 2 mg versus 10 mg, in the short-term management of agitated psychotic patients. Journal of Clinical Psychiatry, 62, 12–18.Google Scholar
Marder, S. R., Sorsaburu, S., Dunayevich, E., et al. (2010). Case reports of postmarketing adverse event experiences with olanzapine intramuscular treatment in patients with agitation. Journal of Clinical Psychiatry, 71, 433–441.Google Scholar
Meehan, K. M., Wang, H., David, S. R., et al. (2002). Comparison of rapidly acting intramuscular olanzapine, lorazepam, and placebo: a double-blind, randomized study in acutely agitated patients with dementia. Neuropsychopharmacology, 26, 494–504.Google Scholar
Meehan, K., Zhang, F., David, S., et al. (2001). A double-blind, randomized comparison of the efficacy and safety of intramuscular injections of olanzapine, lorazepam, or placebo in treating acutely agitated patients diagnosed with bipolar mania. Journal of Clinical Psychopharmacology, 21, 389–397.Google Scholar
Miceli, J. J., Tensfeldt, T. G., Shiovitz, T., et al. (2010). Effects of high-dose ziprasidone and haloperidol on the QTc interval after intramuscular administration: a randomized, single-blind, parallel-group study in patients with schizophrenia or schizoaffective disorder. Clinical Therapeutics, 32, 472–491.CrossRefGoogle ScholarPubMed
Montoya, A., Valladares, A., Lizán, L., et al. (2011). Validation of the excited component of the Positive and Negative Syndrome Scale (PANSS-EC) in a naturalistic sample of 278 patients with acute psychosis and agitation in a psychiatric emergency room. Health and Quality of Life Outcomes, 9, 18.Google Scholar
Nolan, K. A., Czobor, P., Roy, B. B., et al. (2003). Characteristics of assaultive behavior among psychiatric inpatients. Psychiatric Services, 54, 1012–1016.CrossRefGoogle ScholarPubMed
Nordstrom, K., Allen, M. H. (2013). Alternative delivery systems for agents to treat acute agitation: progress to date. Drugs, 73, 1783–1792.Google Scholar
Parker, C. (2015) Midazolam for rapid tranquillisation: its place in practice. Journal of Psychiatric Intensive Care, 11, 66–72.Google Scholar
Perkins, J., Ho, J. D., Vilke, G. M., et al. (2015). American Academy of Emergency Medicine position statement: safety of droperidol use in the emergency department. Journal of Emergency Medicine, 49, 91–97.Google Scholar
Powney, M. J., Adams, C. E., Jones, H. (2012). Haloperidol for psychosis-induced aggression or agitation (rapid tranquillisation). Cochrane Database of Systematic Reviews, 11, CD009377.Google ScholarPubMed
Pratts, M., Citrome, L., Grant, W., et al. (2014). A single-dose, randomized, double-blind, placebo-controlled trial of sublingual asenapine for acute agitation. Acta Psychiatrica Scandinavica, 130, 61–68.CrossRefGoogle ScholarPubMed
Preval, H., Klotz, S. G., Southard, R., Francis, A. (2005). Rapid-acting IM ziprasidone in a psychiatric emergency service: a naturalistic study. Gen Hosp Psychiatry, 27(2), 140–144.Google Scholar
Rappaport, S. A., Marcus, R. N., Manos, G., et al. (2009). A randomized, double-blind, placebo-controlled tolerability study of intramuscular aripiprazole in acutely agitated patients with Alzheimer’s, vascular, or mixed dementia. Journal of the American Medical Directors Association, 10, 21–27.Google Scholar
Ratey, J. J., Sorgi, P., O’Driscoll, G. A., et al. (1992). Nadolol to treat aggression and psychiatric symptomatology in chronic psychiatric inpatients: a double-blind, placebo-controlled study. Journal of Clinical Psychiatry, 53, 41–46.Google Scholar
Richmond, J. S., Berlin, J. S., Fishkind, A. B., et al. (2012). Verbal de-escalation of the agitated patient: consensus statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. Western Journal of Emergency Medicine, 13, 17–25.CrossRefGoogle Scholar
Sackett, D. L., Rosenberg, W. M., Gray, J. A., et al. (1996). Evidence-based medicine: what it is and what it isn’t. British Medical Journal, 312, 71–72.Google Scholar
Salzman, C. (1988). Use of benzodiazepines to control disruptive behavior in inpatients. Journal of Clinical Psychiatry, 49 Suppl. 13–15.Google ScholarPubMed
Salzman, C., Solomon, D., Miyawaki, E., et al. (1991). Parenteral lorazepam versus parenteral haloperidol for the control of psychotic disruptive behavior. Journal of Clinical Psychiatry, 52, 177–180.Google ScholarPubMed
San, L., Arranz, B., Querejeta, I., Barrio, S., De la Gándara, J., Pérez, V. (2006). A naturalistic multicenter study of intramuscular olanzapine in the treatment of acutely agitated manic or schizophrenic patients. Eur Psychiatry, (8), 539–543.Google Scholar
Satterthwaite, T. D., Wolf, D. H., Rosenheck, R. A., et al. (2008). A meta-analysis of the risk of acute extrapyramidal symptoms with intramuscular antipsychotics for the treatment of agitation. Journal of Clinical Psychiatry, 69, 1869–1879.CrossRefGoogle ScholarPubMed
Shale, J. H., Shale, C. M., Mastin, W. D. (2003). A review of the safety and efficacy of droperidol for the rapid sedation of severely agitated and violent patients. Journal of Clinical Psychiatry, 64, 500–505.Google Scholar
Spyker, D. A., Riesenberg, R. A., Cassella, J. V. (2015). Multiple dose pharmacokinetics of inhaled loxapine in subjects on chronic, stable antipsychotic regimens. Journal of Clinical Pharmacology, 55, 985–994.Google Scholar
Suzuki, H., Gen, K., Takahashi, Y. (2013). A naturalistic comparison of the efficacy and safety of intramuscular olanzapine and intramuscular haloperidol in agitated elderly patients with schizophrenia. Therapeutic Advances in Psychopharmacology, 3, 314–321.Google Scholar
Swift, R. H., Harrigan, E. P., Cappelleri, J. C., et al. (2002). Validation of the behavioural activity rating scale (BARS): a novel measure of activity in agitated patients. Journal of Psychiatric Research, 36, 87–95.Google Scholar
Tran-Johnson, T. K., Sack, D. A., Marcus, R. N., et al. (2007). Efficacy and safety of intramuscular aripiprazole in patients with acute agitation: a randomized, double-blind, placebo-controlled trial. Journal of Clinical Psychiatry, 68, 111–119.Google Scholar
Volavka, J., Citrome, L. (2008). Heterogeneity of violence in schizophrenia and implications for long-term treatment. International Journal of Clinical Practice, 62, 1237–1245.Google Scholar
Volavka, J., Czobor, P., Citrome, L., et al. (2014). Effectiveness of antipsychotic drugs against hostility in patients with schizophrenia in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. CNS Spectrums, 19, 374–381.Google Scholar
Volavka, J., Czobor, P., Derks, E. M., et al. (2011). Efficacy of antipsychotic drugs against hostility in the European First-Episode Schizophrenia Trial (EUFEST). Journal of Clinical Psychiatry, 72, 955–961.Google Scholar
Volavka, J., Czobor, P., Nolan, K., et al. (2004). Overt aggression and psychotic symptoms in patients with schizophrenia treated with clozapine, olanzapine, risperidone, or haloperidol. Journal of Clinical Psychopharmacology, 24, 225–228.Google Scholar
Volavka, J., Van Dorn, R. A., Citrome, L., et al. (2015). Hostility in schizophrenia: an integrated analysis of the combined Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and the European First Episode Schizophrenia Trial (EUFEST) studies. European Psychiatry, 31, 13–19.Google Scholar
Wilson, M. P., Pepper, D., Currier, G. W., et al. (2012). The psychopharmacology of agitation: consensus statement of the American Association for Emergency Psychiatry Project BETA Psychopharmacology Workgroup. Western Journal of Emergency Medicine, 13, 26–34.Google Scholar
Wright, P., Birkett, M., David, S. R., et al. (2001). Double-blind, placebo-controlled comparison of intramuscular olanzapine and intramuscular haloperidol in the treatment of acute agitation in schizophrenia. American Journal of Psychiatry, 158, 1149–1151.Google Scholar
Wright, P., Meehan, K., Birkett, M., et al. (2003). A comparison of the efficacy and safety of olanzapine versus haloperidol during transition from intramuscular to oral therapy. Clinical Therapeutics, 25, 1420–1428.CrossRefGoogle ScholarPubMed
Zeller, S. L., Rhoades, R. W. (2010). Systematic reviews of assessment measures and pharmacologic treatments for agitation. Clinical Therapeutics, 32, 403–425.Google Scholar
Zimbroff, D. L., Marcus, R. N., Manos, G., et al. (2007). Management of acute agitation in patients with bipolar disorder: efficacy and safety of intramuscular aripiprazole. Journal of Clinical Psychopharmacology, 27, 171–176.Google Scholar

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