Psychiatry & Psychotherapy Podcast How to Manage Aggression with Psychopharmacology in an Inpatient Setting
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Apr 14, 2022 
Michael Cummings, a psychopharmacologist with expertise in treating treatment-resistant patients at a state hospital, unpacks the nuances of aggression and violence in mental health care. He breaks down the three types of aggression: impulsive, predatory, and psychotic. Cummings discusses effective strategies for managing aggression using psychopharmacology, particularly the role of antipsychotics and benzodiazepines. He also highlights the critical connection between sleep quality and mental health, emphasizing its importance in managing agitation.
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Psychomotor Agitation Explained
- Psychomotor agitation is a fight or flight response mediated by the amygdala perceiving a threat.
- It differs from predatory aggression which is silent and calculated, much like different states in cats.
Titrate Antipsychotics Carefully
- Start with lower doses like Haldol 5 mg for acute agitation and titrate frequently.
- Give smaller doses more often to avoid under- or overtreatment and manage agitation effectively.
Delirium’s Brain Mechanism
- Delirium involves fluctuating levels of alertness with transitions between agitation and stupor.
- It reflects brain dysfunction often triggered by inflammation affecting astrocytes' toxin clearance.