정신과 치료 상황에서 벌어지는 급성 초조 및 폭력 행동의 약물학적 치료 방안

• 영문명: Pharmacological Management of Acute Agitation and Violent Behavior in Psychiatric Settings
• 발행기관: 대한신경정신의학회
• 저자명: 정성훈 김용식
• 간행물 정보: 『신경정신의학』제64권 제3호, 109~121쪽, 전체 13쪽
• 주제분류: 의약학 > 정신과학
• 파일형태: PDF
• 발행일자: 2025.08.31

국문 초록

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.

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키워드

Acute agitation Violence Chemical restraint Human rights Coercive treatment 흥분 폭력 화학적 강박 인권 강압적 치료