Clinical Update

Principles of Verbal De-Escalation

Topics: aggression | Agitation | Emergency Department | Free Articles | verbal de-escalation

When our patients become agitated and threatening, we often think first about chemical or physical restraints—especially when staff’s physical safety seems at imminent risk. But it’s important to remember that coercive interventions can be humiliating and may lead to more agitation and violence. In fact, research indicates that restraints are corr

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Research Update

Quetiapine vs First-Generation Antipsychotics for Aggression

Topics: Agitation | Emergency Department | First Generation Antipsychotics (FGAs) | Quetiapine | Second Generation Antipsychotics (SGAs)

REVIEW OF: Yip L et al,  J Child Adolesc Psychopharmacol 2020;30(9):534–541 Acute agitation and aggression can lead to injury in the pediatric emergency department setting. Unfortunately, efficacy data for pharmacologic treatments are sparse. Most clinicians choose first-generation antipsychotics (FGA) over second-generation antipsychotics (SG

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Expert Q&A

Treating Agitation in Patients with Dementia

Topics: Agitation | Alzheimers | Antipsychotics | Benzodiazepines | BPSD (behavioral and psychological symptoms of dementia) | Dementia | Lewy Body Dementia | Parkinson’s Disease | Pharmacotherapy | Sundowning

CHPR: Can you tell us about yourself and your background? Dr. Metzger: I’m the medical director of psychiatry at Hebrew SeniorLife and an assistant professor of psychiatry at Harvard Medical School. My work also includes training residents and geriatric medicine fellows who rotate through our facility. CHPR: You participated in the psychopharmacol

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Clinical Update

Medications to Rapidly Treat Psychotic Agitation

Topics: Agitation | Antipsychotics | Aripiprazole | Benzodiazepines | Chlorpromazine | De-escalation | Diphenhydramine | Droperidol | Emergency | Haloperidol | Hydroxyzine | olanzapine | Pharmacotherapy | Promethazine | Psychosis | Quetiapine | Risperidone | Violence | Ziprasidone

If you work in an emergency department (ED) or psychiatric inpatient unit, you’ve encountered agitated and even violent patients. We can help many patients settle down by listening empathically, validating their emotions, and offering oral medications, but even with our best efforts, these interventions do not always work. Medications help reduce agit

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In Brief

Note From the Editor-in-Chief

Topics: Agitation | Anticholinergics | Cognitive functioning | Dementia | Geriatrics | Psychotherapy

One of the most challenging aspects of hospital psychiatry is the management of acute psychotic agitation. Sometimes we have little choice but to administer sedating medications to a combative patient who is putting others at risk of injury. Which medications work most quickly, safely, and effectively? Dr. Carlat and I combed through the literature to n

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Managing Substance-Related Agitation

Topics: Agitation | Substance Use Disorder | Withdrawal

In emergency departments, psychiatrists are often consulted on patients presenting with agitation. In many cases, these patients are under the influence of substances—either from intoxication or withdrawal. It is important to recognize when a patient is under these effects, as acute management of the agitation will vary drastically depending on which

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Clinical Update

Take a Breather: A Mindful Tactic for Borderline Dysphoria

Topics: Agitation | Behavior therapy | Borderline Personality Disorder | BPD | Crisis intervention | Mindfulness | Psychotherapy | Self-injury | Therapy during medication appointment | Therapy with Med Management

Managing the intense, explosive dysphoria experienced by patients with borderline personality disorder (BPD) is one of the tougher challenges we face. These complex states, with elements of anxiety, rage, depression, and shame, are hard for patients to tolerate, let alone examine. Worse, they can generate dangerous solutions: suicide, self-harm, and o

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Clinical Update

Nuedexta in Agitated Dementia

Topics: Agitation | Dementia | Generics | Nuedexta | Pharmaceutical Industry | pseudobulbar affect

Treating agitation in dementia is no easy task. Behavioral interventions are first line, but they are difficult to implement and often insufficient. Psychotropics show modest benefits, but they are prone to causing adverse events. Benzodiazepines can precipitate falls, disinhibition, and confusion. Antipsychotics have a black box warning about an increa

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