Front Psychiatry. 2021 Dec 7;12:750686. doi: 10.3389/fpsyt.2021.750686. eCollection 2021.Which Emergent Medication Should I Give Next? Repeated Use of Emergent Medications to Treat Acute Agitation.
Veronica B Searles Quick, Ellen D Herbst, Raj K Kalapatapu
Abstract: Front Psychiatry. 2021 Dec 7;12:750686. doi: 10.3389/fpsyt.2021.750686. eCollection 2021.
Agitation is a common symptom encountered among patients treated in psychiatric emergency settings. While there are many guidelines available for initial management of the acutely agitated patient, there is a notable dearth of guidelines that delineate recommended approaches to the acutely agitated patient in whom an initial medication intervention has failed. This manuscript aims to fill this gap by examining evidence available in the literature and providing clinical algorithms suggested by the authors for sequential medication administration in patients with persistent acute agitation in psychiatric emergency settings. We discuss risk factors for medication-related adverse events and provide options for patients who are able to take oral medications and for patients who require parenteral intervention. We conclude with a discussion of the current need for well-designed studies that examine sequential medication options in patients with persistent acute agitation.
Annotation (unstructured)
The finding:
This review aims to guide readers in the management of persistent agitation in psychiatric emergency settings. The authors offer an accessible and helpful review of existing guidelines for agitation management that will be of interest to C-L psychiatrists. The limitations of the guidelines are briefly addressed, and the review proposes sequential algorithms for treatment-resistant psychiatric agitation. There is little literature to guide practice in this area, and unfortunately the review has no systematic search methodology to ensure that the latest scientific advances in this area are presented. Nevertheless, the juxtaposition of existing guidelines is interesting and helpful, and clinicians should appreciate seeing existing protocols from other countries and recommendations for monitoring when administering medications to these high-risk patients.
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