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EV0548

The Psychopharmacology of Agitation in an Inpatient Psychiatric Setting

PSYCHOPHARMACOLOGY OF AGITATION IN INPATIENT PSYCHIATRIC SETTING

Most patients admitted to an emergency psychiatric ward are agitated, and the most commonly used treatment is a combination of haloperidol and a benzodiazepine.

The aim of the study was to examine treatment options for acute agitation in psychiatric inpatients. All adult admissions to the male emergency psychiatric ward at Skopje Psychiatric Hospital over a six-month period were retrospectively reviewed; the relationship between agitation and diagnosis, as well as treatment selection for resolving agitation, was evaluated. Diagnoses were established according to ICD-10 criteria, and patients ranged in age from 20 to 76 years (mean age: 41.4 years). Of 107 admissions, agitation was identified in 93 (87%), while 14 patients (13%) were not agitated. The diagnostic distribution among agitated patients was as follows: schizophrenia spectrum disorder in 64 patients (68.8%), personality disorder with co-occurring substance abuse in 21 patients (22.6%), intellectual disability in 5 patients (5.4%), and bipolar disorder in 3 patients (3.2%). Medications prescribed for agitation included typical antipsychotics (primarily haloperidol), benzodiazepines, and atypical antipsychotics (clozapine and olanzapine); the distribution was haloperidol plus a benzodiazepine in 48 patients (51.6%), clozapine in 16 patients (17.2%), olanzapine plus a benzodiazepine in 10 patients (10.7%), a benzodiazepine in 10 patients (10.7%), olanzapine in 5 patients (5.5%), and clozapine plus a benzodiazepine in 4 patients (4.3%). The authors emphasize that treatment selection for an agitated patient depends on the patient's clinical presentation, medication availability, and the clinician's experience; the choice of psychotropic medication should be individualized, with tolerability as the primary consideration, followed by efficacy.

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