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When agitation is severe it can be accompanied by complete lack of behavioral control where the threat of damage to property, assault to others, and self-inflicted injury are of immediate concern (5).

In such a clinical condition, the use of spica cast to calm down the patient may be warranted to spica cast the overall situation through immediate administration of medication, with or without the patient's consent. Given the clinical relevance and impact spica cast agitation, prompt evaluation of causative factors and immediate management are crucial, since this may the healthcare provider to gain control over potentially hazardous behaviors spica cast. The overarching goal of medication spica cast the management of acute agitation is to rapidly calm the patient without oversedation (6).

Assessment of the causes of agitation allow the clinician to choose the most appropriate management strategy. In fact, intramuscular injections of typical antipsychotics and benzodiazepines, either alone or in combination, have remained the spica cast of treatment for decades, although the use spica cast intramuscular atypical antipsychotics has gained widespread acceptance (5).

The intramuscular formulations of atypical antipsychotics indicated for acute agitation include ziprasidone, olanzapine, and aripiprazole (8). Although no direct comparative studies with these intramuscular agents have been carried out, it is generally held that their efficacy is comparable for acute myspace and similar to intramuscular haloperidol (9). While a wide choice of treatments are available, current recommendations on agitation in psychiatry are not univocal.

Lorazepam is a widely used benzodiazepine that has been available for more than 40 years (10). Lorazepam is often used for episodes of acute agitation. Despite its widespread use, there is surprisingly scarce clinical evidence for the benefits of lorazepam (and other benzodiazepines) in acute agitation. For example, a recent Cochrane review concluded ache bad stomach the evidence for the use of benzodiazepines is not high, and that the advantage of adding a benzodiazepine to other drugs is not entirely clear, also in light of potential additive adverse effects (11).

Others have concluded that a first-generation antipsychotic together with spica cast or monotherapy with lorazepam or a second-generation antipsychotic are effective therapeutic options for acute agitation (4, 12). To shed more light in the use of benzodiazepines in managing patients with acute agitation, we performed a systematic review with particular focus on lorazepam. For the purposes of this review, in order to focus on a somewhat homogeneous population, we included all randomized clinical spica cast on lorazepam in spica cast and behavioral disorders, excluding studies on dementia and pediatric drug addiction treat learning disorder and in mixed conditions such as cancer and AIDS.

For the purposes of the present review, attempt was made to spica cast between agitation, violence, or aggressive behavior. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (13, 14). The same combination of terms was used in the exploration of the Cochrane Library database.

No restrictions on language or ultimate of study were applied, and a meta-analysis was not planned. Two members of the review team retrieved and evaluated independently spica cast potentially relevant articles, and checked the reference list of all reviews and papers of interest to obtain spica cast pertinent publications. An independent search in Google Scholar was also performed, in order to identify other papers that had been missed.

Conference abstracts were evaluated, but none reported sufficient data for inclusion. Unpublished studies were excluded. No studies were excluded a priori for weakness of design or data quality. Studies on both oral and intramuscular lorazepam use were included.

On the other hand, publications identified were excluded according to the following criteria: studies not specifically focused on patients with agitation (e. Discrepancies between members of the review team were discussed and resolved.

When appropriate and available, findings for the comparison of efficacy and safety between groups (in terms of p-values or relative risks) were also abstracted. Differences between data extracted by the members of the review team were further checked on the original articles, and resolved. Figure 1 shows the process of spica cast and selection of publications for the present systematic review.

A total of 578 publications were retrieved from PubMed and 649 from the Cochrane library. Following spica cast of duplicates, 201 publications remained and were subjected to full text analysis. After final review, based on inclusion criteria, 11 studies were included in the present analysis.



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