Treatment of acute agitation in psychotic disorders.

Several psychotic disorders, including schizophrenia, may be associated with symptoms of acute agitation and aggression. While drug treatment of agitation is often essential, non-pharmacological interventions, both environmental and behavioral, also play important roles in the complex management of agitated patients. The most extensively used psychotropic drugs are parenteral formulas of conventional antipsychotics and benzodiazepines. Recently, injection forms of two second generation antipsychotics, olanzapine and ziprasidone, have become available. Both drugs have shown adequate efficacy and tolerability in several double-blind trials of intramuscular administration in acutely agitated psychotic patients. Compared to conventional medication, injection forms of the new antipsychotics may have a faster onset of action and more favorable profile of adverse events. Alternative approaches to injection administration include liquid drug formula, orally disintegrating tablets and wafers, treatment initiation with high doses, or rapid dose escalation. Evidence suggests that second-generation antipsychotics should be among the first-line choices in the treatment of agitation in acute psychosis.

Prevalence of and risk factors for tardive dyskinesia in a Xhosa population in the Eastern Cape of South Africa.

OBJECTIVE: Despite prolonged use of antipsychotic drug treatment, the prevalence of tardive dyskinesia (TD) in a Xhosa population has not been evaluated. This study was undertaken to assess the prevalence and identify possible factors, including antioxidant intake and smoking history, which may increase or reduce the risk of TD. METHOD: One hundred two subjects who had been exposed to typical antipsychotic drugs for at least 6 months and were currently on an antipsychotic were screened for abnormal movements using the Abnormal Involuntary Movement Scale (AIMS) rating scale. Data about current and past antipsychotic therapy, diagnoses, smoking history, and dietary factors were gathered from the patient and from chart view. RESULT: Twenty-eight and four-tenths percent of subjects met criteria for tardive dyskinesia. Years of treatment and total cumulative antipsychotic dose were significant predictors of TD. Subjects with higher total consumption of foods containing antioxidants had lower rates of TD, but only consumption of onions was significantly associated with reduced prevalence. TD was less prevalent in smokers, but this difference did not reach statistical significance. Age, sex, and psychiatric diagnosis did not predict presence of TD. CONCLUSION: The result of this study indicate that TD in this population is more prevalent than previously believed within this local clinical context. Prolonged treatment and total antipsychotic drug exposure are important risk factors for TD in this population. Further study of the role of concurrent medications and dietary factors is indicated.