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The Treatment of Acute Agitation in Schizophrenia

Published online by Cambridge University Press:  07 November 2014

Joseph Battaglia
Joseph Battaglia, MD, is assistant professor of psychiatry at Albert Einstein College of Medicine and clinical director of the Bronx Psychiatric Center in Bronx, New York. Dr. Battaglia reports no financial, academic, or other interest in any organization that may pose a conflict of interest.
Delbert G. Robinson
Delbert G. Robinson, MD, is an associate investigator at the Feinstein Institute for Medical Research of the North Shore Long Island Jewish Health System in Manhasset, New York, and associate professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine in Bronx, New York. Dr. Robinson receives research support from Bristol-Myers Squibb and Janssen.
Leslie Citrome
Leslie Citrome, MD, MPH, is professor of psychiatry at the New York University School of Medicine and director of the Clinical Research and Evaluation Facility at the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York. Dr. Citrome is a consultant and/or advisor to, receives honoraria and/or research support from, and owns stock in Bristol-Myers Squibb, Eli Lilly, and Pfizer.


Acute agitation is a nonspecific term applied to an array of syndromes and behaviors. It is frequently defined as an increase in psychomotor activity, aggression, disinhibition/impulsivity, and irritable or labile mood. Etiologies of acute agitation include medical disorders, delirium, substance intoxication or withdrawal, psychiatric disorders, and medication side effects. Treatment of acute agitation requires both environmental and pharmacologic intervention. Patients should be calmed with sedating agents early in the course of treatment, allowing for diagnostic tests to take place. Failure to correctly diagnose causes of agitation may lead to delayed treatment for serious conditions, and can even exacerbate agitation.The most common cause of agitation in patients with schizophrenia is psychotic relapse due to medication nonadherence. Pharmacologic treatment options for these patients include lorazepam and antipsychotic agents. Lorazepam causes nonspecific sedation and treats some substance withdrawal, but has little effect on psychosis. First-generation antipsychotics treat psychosis and, at high enough doses, cause sedation, but may induce extrapyramidal side effects (EPS). Some second-generation antipsychotics have been approved for the treatment of agitation in schizophrenia. These agents treat psychosis with a favorable EPS profile, but are comparatively expensive and cause risks such as hypotension. However, avoiding EPS may reduce patients' resistance to antipsychotic treatment.

In this expert roundtable supplement, Joseph Battaglia, MD, provides an overview of the definition of acute agitation. Next, Delbert, G. Robinson, MD, outlines evaluation methods for actue agitation. Finally, Leslie Citrome, MD, MPH, reviews interventions for acute and ongoing management of agitation.

Research Article
Copyright © Cambridge University Press 2007

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