Bobo, William V. 2017. The Diagnosis and Management of Bipolar I and II Disorders: Clinical Practice Update. Mayo Clinic Proceedings, Vol. 92, Issue. 10, p. 1532.
San, L. Estrada, G. Oudovenko, N. and Vieta, E. 2017. Rationale and design of the PLACID study: a randomised trial comparing the efficacy and safety of inhaled loxapine versus IM aripiprazole in acutely agitated patients with schizophrenia or bipolar disorder. BMC Psychiatry, Vol. 17, Issue. 1,
Remington, Gary Addington, Donald Honer, William Ismail, Zahinoor Raedler, Thomas and Teehan, Michael 2017. Guidelines for the Pharmacotherapy of Schizophrenia in Adults. The Canadian Journal of Psychiatry, Vol. 62, Issue. 9, p. 604.
de Berardis, Domenico Fornaro, Michele Orsolini, Laura Iasevoli, Felice Tomasetti, Carmine de Bartolomeis, Andrea Serroni, Nicola Valchera, Alessandro Carano, Alessandro Vellante, Federica Marini, Stefano Piersanti, Monica Perna, Giampaolo Martinotti, Giovanni and Di Giannantonio, Massimo 2017. The Role of Inhaled Loxapine in the Treatment of Acute Agitation in Patients with Psychiatric Disorders: A Clinical Review. International Journal of Molecular Sciences, Vol. 18, Issue. 2, p. 349.
Allen, Michael H. Citrome, Leslie Pikalov, Andrei Hsu, Jay and Loebel, Antony 2017. Efficacy of lurasidone in the treatment of agitation: A post hoc analysis of five short-term studies in acutely ill patients with schizophrenia. General Hospital Psychiatry, Vol. 47, p. 75.
Roncero, Carlos Ros-Cucurull, Elena Grau-López, Lara Fadeuilhe, Christian and Casas, Miguel 2016. Effectiveness of Inhaled Loxapine in Dual-Diagnosis Patients. Clinical Neuropharmacology, Vol. 39, Issue. 4, p. 206.
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Citrome, Leslie Du, Yangchun Risinger, Robert Stankovic, Srdjan Claxton, Amy Zummo, Jacqueline Bose, Anjana Silverman, Bernard L. and Ehrich, Elliot W. 2016. Effect of aripiprazole lauroxil on agitation and hostility in patients with schizophrenia. International Clinical Psychopharmacology, Vol. 31, Issue. 2, p. 69.
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Volavka, J. Van Dorn, R.A. Citrome, L. Kahn, R.S. Fleischhacker, W.W. and Czobor, P. 2016. Hostility in schizophrenia: An integrated analysis of the combined Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and the European First Episode Schizophrenia Trial (EUFEST) studies. European Psychiatry, Vol. 31, p. 13.
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Garriga, Marina Pacchiarotti, Isabella Kasper, Siegfried Zeller, Scott L. Allen, Michael H. Vázquez, Gustavo Baldaçara, Leonardo San, Luis McAllister-Williams, R. Hamish Fountoulakis, Konstantinos N. Courtet, Philippe Naber, Dieter Chan, Esther W. Fagiolini, Andrea Möller, Hans Jürgen Grunze, Heinz Llorca, Pierre Michel Jaffe, Richard L. Yatham, Lakshmi N. Hidalgo-Mazzei, Diego Passamar, Marc Messer, Thomas Bernardo, Miquel and Vieta, Eduard 2016. Assessment and management of agitation in psychiatry: Expert consensus. The World Journal of Biological Psychiatry, Vol. 17, Issue. 2, p. 86.
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Violent behavior associated with mental disorders is a common reason for admission to a psychiatric inpatient unit. Once hospitalized, patients may continue to be intermittently agitated and have persistent aggressive behaviors, preventing their discharge back into the community. Managing agitation quickly with effective pharmacological agents can avoid further escalation to aggression and violence. In the acute setting, this usually involves the parenteral use of antipsychotics, with or without benzodiazepines. Within the past decade, short-acting intramuscular formulations of second-generation antipsychotics have become available and provide a means to induce calm with a substantially lower risk of acute dystonia or akathisia compared with haloperidol. New alternative formulations that avoid injections include inhalation and sublingual administration. Longer-term management of persistent aggressive behavior by reducing the frequency and intensity of future episodes of agitation is more complex. In contrast to agitation associated with schizophrenia or bipolar mania, no agents have yet been approved by regulatory agencies for the treatment of persistent aggressive behavior. The strongest evidence supports the use of clozapine as an antihostility agent, followed by olanzapine. Adjunctive strategies with anticonvulsants and beta-adrenergic agents may also be worthwhile to consider.
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