Treatment of agitation in the acute psychiatric setting. An observational study of the
effectiveness of intramuscular psychotropic medication
Sammanfattning
Background: Agitation is frequent in the acute psychiatric setting. The observation and treatment
of agitation is important to avoid harm to patients or staff, to reduce distress of the patient, and to
reduce the risk of coercion, especially physical restraint.
Aim: To evaluate the effect of intramuscular treatment with psychotropics on agitation in a non-
selected acute psychiatric population.
Methods: The Positive and Negative Syndrome Scale Excitement Component (PANSS-EC) was
implemented in the acute psychiatric ward at Psychiatric Center Copenhagen to improve assessment
and treatment of agitation. During a period of almost ~2 years the staff was requested to assess
agitation before and after administration of intramuscular injections.
Results: PANSS-EC was obtained at baseline and within 2 hours after injection for 135 injections with
antipsychotics or benzodiazepines administered to 101 acute, non-selected psychiatric patients with
high occurrence of co-morbid substance abuse. Mean PANSS-EC at baseline was 26.53 ± 4.87, and
mean reduction in PANSS-EC was 14.99 ± 8.48 (p < 0.001). For 73% of injections PANSS-EC
decreased with =40% (generally accepted definition of response). In 49% of cases patients were
subjected to physical restraint. Patients subjected to restraint had a significantly higher PANSS-EC
score. Patients who received a subsequent injection had a significantly lower decline in PANSS-EC
score. Besides two cases of acute dystonia following haloperidol injections, no serious side-effects
were observed.
Conclusions: Treatment of agitation with intramuscular injections of psychotropics was in general
effective in this non-selected, highly agitated psychiatric population, and injections were well
tolerated.