Acute treatment of agitation in schizophrenia

Agitation in patients with schizophrenia is a serious condition seen frequently in emergency settings. Control of agitation, and in its extreme form violence, represents a significant challenge for healthcare providers. Historically, most interventions for agitation in the acute care setting have focused on medications and restraint, not on verbal de-escalation or other non-pharmacologic calming techniques. Recent expert consensus, however, recommends a non-coercive, collaborative approach to quell agitation if this can be done safely. Oral antipsychotics are preferred interventions in these collaborative interventions. The use of restraints and intramuscular medications should be a last resort; the authors recommend the use of atypical antipsychotic parenteral medications in such cases, as these tend to be efficacious yet with a more benign side-effect profile than traditional agents.