Once a drug and a route of administration have been determined, treatment should be initiated at a moderate dose and titrated up or down. Agitation and insomnia can be managed with benzodiazepines. Lorazepam [Ativan®], which is readily absorbed parenterally, is particularly useful. Using anti-psychotics primarily for their sedative property may result in excessive side effects and lead to patient non-compliance.
Careful attention should be paid to the development of side effects. For newer generation antipsychotics sedation is most common. One must monitor long term for weight gain, elevated lipid levels (cholesterol and triglycerides) as well as for diabetes. Older drugs have a high incidence of extrapyramidal effects. Immediate interventions to reduce these symptoms through dose reduction, switching medications or adding an antiparkinsonian drug should be initiated. Akathesia (motor restlessness) is a frequently overlooked side effect that is often troubling to the patient and can result in medication non-compliance. If the clinician mistakes akathesia for psychotic agitation, he or she may increase the dose of anitpsychotic and inadvertently worsen the condition.