psychiatric disorders
Behavioral Emergencies
Chemical Restraints
Drug therapy, if used, should target control of specific symptoms. Patients can usually be rapidly calmed or tranquilized using Benzodiazepines Antipsychotics (typically a conventional antipsychotic, but a 2nd-generation drug may be used) These drugs are better titrated and act more rapidly and reliably when administered IV (see table Drug Therapy for Agitated or Violent Patients ), but IM administration may be necessary when IV access cannot be achieved in struggling patients. Both classes of drug are effective sedatives for agitated, violent patients. Benzodiazepines are probably preferred for stimulant drug overdoses and for alcohol and benzodiazepine drug withdrawal syndromes, and antipsychotics are preferred for clear exacerbations of known mental disorders. Sometimes a combination of both drugs is more effective; when large doses of one drug have not had the full desired effect, using another drug class instead of continuing to increase the dose of the first drug may limit adverse effects. Parenteral benzodiazepines, particularly in the doses sometimes needed for extremely violent patients, may cause respiratory depression. Airway Establishment and Control with intubation and assisted ventilation may be required. The benzodiazepine antagonist, Benzodiazepines sometimes lead to further disinhibition of behavior. -receptor antagonists, at therapeutic as well as toxic doses, can have acute extrapyramidal adverse effects (see table Treatment of Acute Adverse Effects of Antipsychotics ), including acute dystonia and akathisia (an unpleasant sensation of motor restlessness). These adverse effects may be dose dependent and may resolve once the drug is stopped. , can cause long QT interval syndrome and ultimately increase the risk of fatal arrhythmias. Neuroleptic Malignant Syndrome is also a possibility. For other adverse effects, see Adverse effects of antipsychotic drugs . 