Department of Psychiatry & Behavioral Sciences, New York Medical College, Valhalla, New York, USA.
Curr Opin Psychiatry. 2021 May 1;34(3):216-221. doi: 10.1097/YCO.0000000000000685.
Agitation associated with schizophrenia remains an important clinical concern and if not managed effectively, can escalate into aggressive behavior. This is a review of the recent biomedical literature on agitation in individuals with schizophrenia.
Themes in the recent literature include consideration of comorbidities such as cigarette smoking and cannabis use. Surveys reveal that pharmacological approaches to manage agitation have changed little, with haloperidol remaining in common use and intramuscular administration of antipsychotics and/or benzodiazepines being frequently administered to more severely agitated/aggressive individuals. Of note, ketamine has been recently adopted for use in severe agitation in medical emergency departments, but the risk of this medication for people with schizophrenia is unclear. At present, inhaled loxapine remains the only rapidly acting noninjectable FDA-approved treatment for agitation associated with schizophrenia. In development is an intranasal formulation for olanzapine (a well characterized atypical antipsychotic already approved to treat agitation) and a sublingual film for dexmedetomidine (an α2-adrenergic agonist used as an anesthetic and now being repurposed).
Comorbidities can contribute to agitation and can make an accurate differential diagnosis challenging. The ongoing development of rapidly acting novel formulations of antiagitation medications, if successful, may facilitate clinical treatment by providing additional options.
精神分裂症相关的激越仍然是一个重要的临床关注点，如果不能有效管理，可能会升级为攻击行为。本文对精神分裂症患者激越的近期生物医学文献进行了综述。
近期文献的主题包括对共病（如吸烟和大麻使用）的考虑。调查显示，管理激越的药物治疗方法变化不大，氟哌啶醇仍在广泛使用，肌肉注射抗精神病药和/或苯二氮䓬类药物经常用于更严重激越/攻击的个体。值得注意的是，氯胺酮最近被用于医疗急救部门的严重激越，但这种药物对精神分裂症患者的风险尚不清楚。目前，吸入洛沙平仍然是唯一一种快速起效的非注射性 FDA 批准的治疗精神分裂症相关激越的药物。正在开发中的奥氮平鼻内制剂（一种已被广泛认可的用于治疗激越的非典型抗精神病药）和右美托咪定舌下膜（一种用作麻醉剂的α2 肾上腺素能激动剂，现正被重新用于治疗激越）。
共病可导致激越，并使准确的鉴别诊断变得具有挑战性。如果新型快速作用的抗激越药物制剂的开发成功，可能会通过提供更多的选择来促进临床治疗。
