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A Journal on Psychiatry, Psychology and Psychopharmacology

Official Journal of the Italian Society of Social Psychiatry
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Minerva Psichiatrica 1999 September;40(3):219-30

language: Italian

Psychopharmacologic intervention in psychiatric emergencies

Bogetto F., Bellizia L., Bonatto Revello R., Ferro G., Maina G., Ravizza L.


Psychiatric emergencies may arise from a variety of conditions. The perception that a problem constitutes an emergency is often subjective and sometimes reflects the anxieties of others, rather than a real need for urgent assessment and treatment. Thus, a psychiatric emergency, which requires immediate action because of potential danger to patient or others, must be distinguished from a psychiatric crisis. This work examines the most recent studies about the psychopharmacologic treatment of agitated, assaultive or destructive behavior in psychotic patients. While neuroleptics remain the mainstay of drug intervention in the emergency, there has been concern about side effects, such as neuroleptic malignant syndrome, tardive dyskinesia and extrapyramidal symptoms. A variety of agents have received study as alternative or adjunct to these drugs in an attempt to improve the safety and efficacy of acute treatment. Benzodiazepines are among the most often discussed and used classes of drugs, although periodic reports have suggested that benzodiazepines may be associated with a loss of control over aggressive impulses. Manifestations range from irritability to increased verbal hostility, till to frank assault. The authors review the current literature of both antipsychotics and benzodiazepines and summarize the results of several studies on Rapid Tranquillization, that appeared about fifteen years ago.

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