The use of intramuscular benzodiazepines and antipsychotic agents in the treatment of acute agitation or violence in the emergency department

The management of an agitated, abusive or violent patient is a common and challenging problem in Emergency Medicine. Priorities include measures to ensure the safety of the patient and the emergency staff, including provision of physical restraint of the patient and evaluation for correctable medical causes of such behavior. Medications used in the treatment of such patients include benzodiazepines and antipsychotic agents. The newer atypical antipsychotic agents seem to provide a safe and effective treatment for such patients. The atypical antipsychotic agents may have fewer short-term side effects than older typical antipsychotic agents, such as haloperidol and droperidol. Currently available atypical antipsychotic medications for the treatment of acute agitation include ziprasidone and olanzapine, which can be administered in an intramuscular formulation, and risperidone, which is available in a rapidly dissolvable tablet and liquid formulation.