Pharmacological management of acute agitation in psychiatric patients: an umbrella review

Abstract

Abstract Background the main characteristics present in patients with psychomotor agitation include restlessness, excessive motor activity, irritability, heightened responsiveness to internal and external stimuli, and unstable clinical condition. This umbrella review evaluates the efficacy and safety of pharmacological interventions for patients with psychiatric disorders presenting psychomotor agitation, aged 18 years or older. A comprehensive literature search was conducted to identify umbrella reviews that met the inclusion criteria of our study, and none were found that specifically investigated the efficacy and safety of pharmacological interventions for agitated psychiatric patients with both psychological and behavioral symptoms. The primary objective is to determine the efficacy and safety of pharmacological interventions for managing agitated psychiatric patients in both inpatient and emergency department settings. Secondary objectives include assessing the safety and efficacy of pharmacological interventions by specific diagnosis, including psychotic disorders, mood disorders, personality disorders, and substance use disorders. Method a comprehensive literature search for published and unpublished meta-analyses and systematic reviews assessing the efficacy and safety of pharmacological treatment for agitation in psychiatric inpatients and emergency department patients was conducted across various databases (PubMed, Ovid MEDLINE, EMBASE, PSYCINFO). Included reviews comprised those that incorporated randomized controlled trials (RCTs) or non-randomized controlled trials (NRCTs) comparing the efficacy and safety of pharmacological interventions for agitated psychiatric patients (with both psychological and behavioral symptoms). Results a total of 20 meta-analyses and systematic reviews met the inclusion criteria for this umbrella review. The results are presented by grouping medications into drug classes, providing information on the most used dosage, median dose, average dose, and dose range for each medication. Furthermore, medications most frequently used for specific psychiatric diagnoses, such as psychotic disorders, bipolar disorder, personality disorders, and substance use disorders, are also highlighted. Conclusion this umbrella review offers a comprehensive overview of the pharmacological management of agitation in patients with psychiatric disorders. Among the most frequently used medications in the reviewed studies were haloperidol, olanzapine, and lorazepam. The findings underscore the importance of tailored treatment approaches and the need for further research to refine the management of agitation in psychiatric settings.