정신과 치료 상황에서 벌어지는 급성 초조 및 폭력 행동의 약물학적 치료 방안
Pharmacological Management of Acute Agitation and Violent Behavior in Psychiatric Settings
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Objectives This article examined the management of acute agitation and violent behavior in psychiatric settings, focusing on the dilemma in choosing between patient autonomy and safety. It explored the shift from coercive measures to less invasive pharmacological interventions and the emerging role of technology in predicting and managing such behaviors. Methods A comprehensive narrative review of current literature and clinical guidelines was conducted, the efficacy and safety of various pharmacological agents, including typical and atypical antipsychotics, and benzodiazepines was analyzed. Further, non-pharmacological approaches, risk assessment tools, and the potential of emerging technologies like alternative routes of drug administration and wearable sensor technology was also reviewed. Results Traditional methods like physical restraint and coercion are being increasingly scrutinized due to ethical concerns. Pharmacological interventions, particularly parenteral and alternative routes of administration (e.g., inhaled, sublingual), offer a faster onset and avoid invasiveness but vary in efficacy and safety. Haloperidol and lorazepam remain the most common agents, while newer agents like inhaled loxapine and sublingual dexmedetomidine show promise. Emerging technologies present a proactive approach to predicting and managing agitation, although challenges related to cost, data security, and patient acceptance persist. Conclusion Managing acute agitation requires balancing patient rights with safety. While pharmacological options have evolved, ethical considerations and practical limitations remain. Integrating less coercive pharmacological strategies with technological advancements offers a potential path forward, emphasizing the need for ongoing research, policy development, and training to optimize patient care and safety in psychiatric settings.
Abstract
Objectives This article examined the management of acute agitation and violent behavior in psychiatric settings, focusing on the dilemma in choosing between patient autonomy and safety. It explored the shift from coercive measures to less invasive pharmacological interventions and the emerging role of technology in predicting and managing such behaviors. Methods A comprehensive narrative review of current literature and clinical guidelines was conducted, the efficacy and safety of various pharmacological agents, including typical and atypical antipsychotics, and benzodiazepines was analyzed. Further, non-pharmacological approaches, risk assessment tools, and the potential of emerging technologies like alternative routes of drug administration and wearable sensor technology was also reviewed. Results Traditional methods like physical restraint and coercion are being increasingly scrutinized due to ethical concerns. Pharmacological interventions, particularly parenteral and alternative routes of administration (e.g., inhaled, sublingual), offer a faster onset and avoid invasiveness but vary in efficacy and safety. Haloperidol and lorazepam remain the most common agents, while newer agents like inhaled loxapine and sublingual dexmedetomidine show promise. Emerging technologies present a proactive approach to predicting and managing agitation, although challenges related to cost, data security, and patient acceptance persist. Conclusion Managing acute agitation requires balancing patient rights with safety. While pharmacological options have evolved, ethical considerations and practical limitations remain. Integrating less coercive pharmacological strategies with technological advancements offers a potential path forward, emphasizing the need for ongoing research, policy development, and training to optimize patient care and safety in psychiatric settings.