Academic journal article General Psychiatry

Efficacy of Atypical Antipsychotics in the Management of Acute Agitation and Aggression in Hospitalized Patients with Schizophrenia or Bipolar Disorder: Results from a Systematic Review

Academic journal article General Psychiatry

Efficacy of Atypical Antipsychotics in the Management of Acute Agitation and Aggression in Hospitalized Patients with Schizophrenia or Bipolar Disorder: Results from a Systematic Review

Article excerpt

Summary: Acute agitation and aggression are common symptoms in patients with bipolar disorder and schizophrenia. In this review, we discuss the prevalence, clinical assessment strategies, treatment options, and current Western and Chinese guidelines for the management of acute agitation and aggression in patients with bipolar disorder or schizophrenia. Among available approaches, we discuss in detail recent evidence supporting the use of intramuscular (IM) antipsychotics and some recently approved oral atypical antipsychotics for the management of acute aggression and agitation in hospitalized patients with bipolar disorder or schizophrenia presenting with acute agitation or aggression, highlighting some differences between individual antipsychotic agents.

Keywords: Schizophrenia; Bipolar disorder; Antipsychotic; Aggression; Agitation

[Shanghai Arch Psychiatry. 2016; 28(5): 241-252.

1. Introduction

Bipolar disorder and schizophrenia are relatively common psychiatric disorders that are predicted to affect approximately 1-2% and 1% of the population, respectively [1,2]. Although the symptoms of these two disorders can vary dramatically, acute agitation and aggression are relatively common among patients with either condition. The purpose of this review is to outline the diagnosis, clinical assessment, and treatment of hospitalized schizophrenia and bipolar disorder patients with acute agitation or aggression, and to present the latest evidence describing the use of atypical antipsychotics in these patient populations.

Several major English databases (MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials) were searched up to March 2016 using the following key words: ("schizophrenia" OR "bipolar disorder") AND ("agitation" OR "aggression" OR "hostility") AND ("antipsychotic" OR "atypical antipsychotic"). The abstracts of all records were scanned for relevance, and full-text of all potentially relevant articles was evaluated for inclusion. The reference lists of all full-text publications were searched for additional studies. Only English language articles were included.

2. Prevalence and correlates of agitation, aggression, violence and hostility in patients with bipolar disorder or schizophrenia

Agitation

Agitation, or "psychomotor agitation", is a poorlydefined psychomotor activity accompanying physical or mental unease. It often occurs in patients with psychoses, including schizophrenia, and in acutely exacerbated bipolar disorder [3,4], often marking the beginning of a behavioral emergency, i.e., a situation with the potential to rapidly escalate. Thus, agitation can lead to, but is characterized separate from, physical aggression [5]. Agitation is characterized by the following hallmarks: motor restlessness, increased responsiveness to stimuli, irritability and excitement, excitement, restlessness, anxiety, psychic and motor tension, as well as excessive, inappropriate, and purposeless verbal and/or motor activity [3].

Aggression and violence

Aggression is a significant public health problem, and a number of studies have suggested that patients with schizophrenia and bipolar disorder have an increased risk of violent behavior compared with most other psychiatric patients [6,7]. There are two general subtypes of aggression: instrumental aggression, which is goal-directed and generally controlled, and reactive aggression, which involves an emotional reaction to a perceived threat or frustration, which is the most prevalent form [8,9].

A number of studies have assessed the prevalence of aggression in patients with schizophrenia, and it is generally more common in the inpatient setting than in the general population. Zhou et al. performed a metaanalysis of 19 studies comprising 3941 hospitalized schizophrenia patients in China [10], and revealed that the prevalence of aggressive behavior was 15.3-53. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.