The first step in the treatment of agitation and psychosis is to identify and to address the underlying causes. The second step is to implement an environmental or behavioral plan. When these two steps fail, the third step is to use appropiate psychopharmacologic treatment.
The atypical antipsychotic medications are generally the most effective psychopharmacologic agents for both agitation and psychosis.
Treatment failure requires a reassessment of the diagnosis, causes, and adequacy of pharmacotherapy. Trials of alternate pharmacologic agents, whether alone or in combination, are often warranted.
Behavioral emergencies require that prompt attention is devoted to calming the individual; removing any triggers; and when necessary, providing rapidly effective pharmacologic agents.
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