Treatments for aggression and agitation

How is aggression and agitation relevant to schizophrenia?

Agitation and/or aggression are sometimes observed during a psychiatric emergency such as in onset of acute psychosis. Agitation typically includes irritability and restlessness, motor or verbal hyperactivity, uncooperativeness, and occasionally aggressive gestures or behaviour. This can pose a risk both to the individual, as well as the attending health care professionals, and so is important to manage this behaviour and prevent potential harm. A number of pharmacological therapies have been tested for quickly alleviating agitated or aggressive behaviour in people with schizophrenia.

What is the evidence for treatments for aggression and agitation?

Moderate to high quality evidence suggests both antipsychotics haloperidol and aripiprazole are effective for reducing agitation in the immediate to short-term, although aripiprazole has less side effects (e.g. movement disorder) than haloperidol. Moderate quality evidence suggests some benefit of other antipsychotics chlorpromazine, olanzapine, ziprasidone and risperidone, and benzodiazepine lorazepam. Moderate to low quality evidence suggests clozapine may be more effective than other agents for reducing aggression in acutely unwell patients. Moderate to low quality evidence suggests a medium effect of 5 to 10mg of aerosol loxapine for reducing agitation.
March 2019
Last updated at: 3:35 am, 1st April 2019
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