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Oral atypical antipsychotics for agitated patients in emergency situations

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Support for the use of atypical antipsychotics for treating agitated patients in emergency situations comes from a recent review of published studies.

Five trials were identified with a total of 711 subjects. Atypical antipsychotics were found to be at least as effective as the classic antipsychotics and/or benzodiazepines and with fewer extrapyramidal side effects. A lack of consistency among the studies meant that it was not possible to perform meta-analysis. Instead improvement rates were reported. Risperidone, ziprasidone and olanzapine were all identified as potential atypical antipsychotics which could be used.

A further review in the same report looked at 11 trials only comparing classic antipsychotics with benzodiazepines and/or a combination of both. This review, with 701 subjects, was less conclusive but found that combination treatment might be superior to either agent alone, and suggested combining haloperidol with lorazepam as an effective approach.

Overall the review recommended oral treatment over intramuscular treatment as being more appropriate for the treatment of agitated patients in emergency settings. The onset of action of intramuscular drugs was not significantly faster to warrant their use as a first intervention, and it recommended that they should be reserved for patients for whom it is the only feasible alternative.

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