One of the most challenging aspects of hospital psychiatry is the management of acute psychotic agitation. Sometimes we have little choice but to administer sedating medications to a combative patient who is putting others at risk of injury. Which medications work most quickly, safely, and effectively? Dr. Carlat and I combed through the literature to name our top choices. You might be surprised that some widely used agents, like olanzapine and ziprasidone, did not make it onto our list.

Agitation in elderly patients with dementia requires a different approach than agitation in young patients. Dr. Eran Metzger describes nonpharmacologic interventions that are highly effective in reducing agitation in patients with behavioral and psychological symptoms of dementia (BPSD).

Lastly, Dr. Shelly Gray urges us to be mindful of medications’ anticholinergic properties because of their potential enduring effects on cognitive functioning, particularly for older patients. Also, watch for the cumulative burden of multiple anticholinergic agents.

Sincerely,

Victoria Hendrick, MD