Title:Older and Newer Strategies for the Pharmacological Management of Agitation in Patients with Bipolar Disorder or Schizophrenia
Volume: 16
Issue: 8
Author(s): Giovanni Amodeo*, Andrea Fagiolini, Gabriele Sachs and Andreas Erfurth
Affiliation:
- Department of Molecular Medicine, University of Siena School of Medicine, Viale Bracci 1, Siena 53100,Italy
Keywords:
Agitation, bipolar, schizophrenia, antipsychotics, benzodiazepines, loxapine, intramuscular, oral, inhaled.
Abstract: Background: The management of acute agitation in patients with bipolar disorder or schizophrenia
is a multifaceted and dynamic task, which presents unique and complex challenges to
healthcare providers.
Objective: To ascertain and describe which medications are best to use in patients with agitation, affected
by bipolar disorder or schizophrenia.
Method: Selective review of current literature and guidelines referred to the treatment of agitation in
individuals affected with bipolar disorder or schizophrenia
Results: When possible, the pharmacologic management of agitation should be preceded by a in-depth
evaluation of the possible causes of the agitation. The use for of first and second-generation antipsychotic
medications, of benzodiazepines and of the newer inhaled antipsychotic loxapine, is reviewed
and commented.
Conclusion: The mainstay of medication treatment of acute agitation should be based on a thotough
assessment cause. If agitation is due to delirium or to another physial condition, an attempt to address
the underlying causes should be always considered. When agitation is primarily due to schizophrenia
or bipolar disorder, antipsychotics and/or benzodiazepines are usually the mainstay of treatment.
Newer inhaled formulation of loxapine has shown ability to rapidly reduce the agitation in mild to
moderate patients with schizophrenia or bipolar disorder, with a decrease in agitation that was evident
since the first assessment, 10 minutes after the first dose.
