Initial management of acute agitation in schizophrenia involves

• A. Intramuscular antipsychotic (e.g., haloperidol) with benzodiazepine if needed; ensure safety
• B. Oral antipsychotic only
• C. Lithium therapy
• D. Electroconvulsive therapy as first-line savior

Answer: (A)

Rapid control of agitation in schizophrenia hinges on immediate calming and safety. The best initial approach is a parenteral antipsychotic given intramuscularly so effects come on quickly even if the patient won’t or can’t take pills. Haloperidol is a classic choice for rapid tranquilization. Often, a benzodiazepine such as lorazepam is added if needed to enhance sedation and help quell agitation, with the goal of safely bringing the patient to a level where assessment and further treatment can proceed. At the same time, prioritize safety: protect staff, assess for medical problems (infection, metabolic issues, substance use/withdrawal), monitor vital signs, and be prepared to manage airway or respiratory issues if sedation deepens.

Oral antipsychotics alone would not address the acute agitation promptly, lithium is not used for immediate agitation, and electroconvulsive therapy is not a first-line or immediate management for acute agitation.