Psychiatric Quarterly [psaq] ph259-psaq-482360 June 8, 2004 23:46 Style ﬁle version June 4th, 2002
Psychiatric Quarterly, Vol. 75, No. 3, Fall 2004 (
NEW TREATMENTS FOR AGITATION
Leslie Citrome, M.D., M.P.H.
Acute agitation is a frequent reason for emergency psychiatric intervention.
It is important to intervene early to avoid escalation of agitation to aggres-
sion. Reducing risk by using effective treatments will result in fewer instances
of seclusion and restraint, and fewer injuries to staff and patients. This pa-
per will ﬁrst review the epidemiology of aggressive behavior and mental disor-
ders, followed by a discussion of assessment and diagnostic considerations. The
pathophysiology of safety risk is discussed within the context of the model of
the “triune brain.” Pharmacological treatment strategies for acute episodes of
agitated behavior will be discussed in detail. This includes newer formulations
of novel antipsychotics such as liquids and rapidly disintegrating tablets, as
well as intramuscular preparations.
KEY WORDS: agitation; aggression; antipsychotics.
The term “agitation” is generally meant to describe excessive motor
or verbal activity. Agitated behavior is potentially dangerous. It may
The author is Professor of Psychiatry, New York University; and Director, Clinical
Research and Evaluation Facility, Nathan S. Kline Institute for Psychiatric Research.
Address correspondence to Leslie Citrome, M.D., M.P.H., Nathan S. Kline Institute
for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962; e-mail:
2004 Human Sciences Press, Inc.