Treating Agitation in Psychotic and Bipolar Disorders: What Works?

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Agitation is a “common and important clinical management problem” in both major psychotic and mood disorders (eg, schizophrenia, schizoaffective, and bipolar—especially during the manic phase).¹ An estimated 90% of people who suffer from schizophrenia and bipolar disorder experience agitation at one point or another in their lives, with an average of 12 episodes of acute agitation annually.¹

There are multiple definitions of agitation, but the term is “generally used to describe excessive verbal or motor activity with a range of symptoms that may vary in intensity from mild to severe.”¹ Due to the absence of a consensus definition, “agitation” is often used interchangeably with other words, such as anxiety, hyperactivity, disruptive behavior, and non-purposeful behavior.² Agitation is characterized by motor restlessness, irritability, inappropriate or purposeless psychomotor activity, heightened responsiveness to stimuli, and severe emotional and physical distress.^3,4 Agitated patients are at risk of causing harm to themselves or others, because the intensity of their agitation can rapidly escalate. However, it is important to recognize that although aggression is often preceded by agitation, agitation does not necessarily entail aggression.⁴

In both acute and long-term settings, effective management of agitation is a critical target. The potential of agitation to escalate into aggression, putting patients, staff, and others at risk, makes it imperative to address agitated behavior rapidly and efficiently.⁵ While behavioral de-escalation techniques have been shown to be valuable and effective in reducing agitation, severe cases may require urgent pharmacological treatment for disturbed behavior when psychological and behavioral approaches have failed.¹ Current therapies utilize antipsychotics, which are administered either with or without supplemental benzodiazepines. These therapies can be administered in oral, intramuscular, or inhaled formulations.¹