Correll Christoph U, Yu Xin, Xiang Yutao, Kane John M, Masand Prakash
Duke-NUS Medical School 26 East 63 Street, New York, NY, USA. E-mail:
Ann Clin Psychiatry. 2017 May;29(2):92-107.
Schizophrenia and bipolar disorders are chronic illnesses that commonly present with symptoms of acute agitation and aggression. These symptoms must be managed rapidly to prevent potential harm to the patient and others, including their caregivers, peers, and health care workers. A number of treatment options are available to clinicians to manage acute agitation and aggression, including non-pharmacologic behavioral and environmental de-escalation strategies, as well as biological treatment options such as pharmacologic agents and electroconvulsive therapy. We summarize the available biological treatment options for patients with schizophrenia or bipolar disorder presenting with acute agitation or aggression in the inpatient setting, focusing on antipsychotics.
The following searches were used in PubMed to obtain the most relevant advances in treating schizophrenia or bipolar disorder with acute agitation and aggression: (agitation, agitated, aggression, aggressive, hostile, hostility, violent, or violence) and (schizophr*, psychosis, psychot*, psychos*, mania, manic, or bipolar) and (pharmacologic, antipsychotic, neuroleptic*, antiepileptic*, anti-seizure*, mood stabilizer*, lithium, benzodiazepine*, beta blocker, beta-blocker, alpha2, alpha-2, histamine, electroconvulsive, ECT, shock, or transcranial). Individual searches were performed for each drug class. The studies were limited to peer-reviewed, English-language, and human studies. Most were placebo-controlled randomized controlled trials (RCTs) or meta-analyses.
Among pharmacologic agents, antipsychotics, benzodiazepines, anticonvulsants, and lithium have been studied in randomized trials. Some typical and, more recently, atypical antipsychotics are available as both oral and short-acting intramuscular (IM) formulations, with 1 typical antipsychotic also available as an inhalable formulation.
Among the pharmacologic agents studied in RCTs, atypical antipsychotics have the best evidence to support efficacy both in oral and short-acting IM formulations, as well as in one instance in an inhalable formulation.
精神分裂症和双相情感障碍是慢性疾病，常伴有急性激越和攻击症状。必须迅速处理这些症状，以防止对患者及包括其护理人员、同伴和医护人员在内的其他人造成潜在伤害。临床医生有多种治疗选择来处理急性激越和攻击，包括非药物行为和环境缓和策略，以及生物治疗选择，如药物制剂和电休克治疗。我们总结了住院环境中出现急性激越或攻击的精神分裂症或双相情感障碍患者可用的生物治疗选择，重点是抗精神病药物。
在PubMed中进行了以下检索，以获取治疗伴有急性激越和攻击的精神分裂症或双相情感障碍的最相关进展：（激越、烦躁不安、攻击、攻击性、敌意、敌对、暴力或暴力行为）以及（精神分裂症*、精神病、精神*、心理*、躁狂症、躁狂、或双相情感障碍）以及（药理学、抗精神病药物、抗精神病药*、抗癫痫药*、抗惊厥药*、心境稳定剂*、锂、苯二氮䓬*、β受体阻滞剂、β-阻滞剂、α2、α-2、组胺、电休克、ECT、休克或经颅）。对每种药物类别进行单独检索。研究限于同行评审、英文和人体研究。大多数是安慰剂对照随机对照试验（RCT）或荟萃分析。
在药物制剂中，抗精神病药物、苯二氮䓬类药物、抗惊厥药物和锂已在随机试验中进行了研究。一些典型抗精神病药物以及最近的非典型抗精神病药物有口服和短效肌内注射（IM）剂型，1种典型抗精神病药物还有吸入剂型。
在RCT中研究的药物制剂中，非典型抗精神病药物在口服和短效IM剂型以及一种吸入剂型中，有最佳证据支持其疗效。
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