LNSLNS

A detailed laboratory analysis is usually not feasible in the emergency situations that we describe (1), in which an unknown patient with severe mental or somatic illness is presented to a rescue service, an emergency department, or a psychiatric clinic, posing an acute danger. Nonetheless, such situations often require therapy to be immediately initiated, while results from therapeutic drug monitoring can sometimes take several days. Furthermore, as patients are often uncooperative and do not agree to blood sampling, physicians have to limit themselves to a short physical examination, medical history (often reported by others), and, if possible, a blood glucose test (2). In the further course of treatment, laboratory tests including therapeutic drug monitoring are certainly indicated, in particular if relapsing aggressive behavior occurs despite the therapy and if high-dose monotherapy or antipsychotic polypharmacy appear necessary (3, 4).

DOI: 10.3238/arztebl.2019.0691b

Dr. med. Sophie Hirsch, B. Sc.

Prof. Dr. med. Tilman Steinert

ZfP Südwürttemberg

Klinik für Psychiatrie und Psychotherapie I der Universität Ulm

sophie.hirsch@zfp-zentrum.de; tilman.steinert@zfp-zentrum.de

Conflict of interest statement

The authors declare that no conflict of interest exists.

1.
Hirsch S, Steinert T: The use of rapid tranquilization in aggressive behavior. Dtsch Arztebl Int 2019; 116: 445–52 VOLLTEXT
2.
Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e. V. (DGPPN): Verhinderung von Zwang: Prävention und Therapie aggressiven Verhaltens bei Erwachsenen. S3-Leitlinie 2018. www.awmf.org/uploads/tx_szleitlinien/038–022l_S3_Verhinderung-von-Zwang-Praevention-Therapie-aggressiven-Verhaltens_2018–11.pdf (last accessed on 5 August 2019)
3.
Meyer JM: A rational approach to employing high plasma levels of antipsychotics for violence associated with schizophrenia: case vignettes. CNS Spectr 2014; 19: 432–8 CrossRef MEDLINE
4.
Morrissette DA, Stahl SM: Treating the violent patient with psychosis or impulsivity utilizing antipsychotic polypharmacy and high-dose monotherapy. CNS Spectr 2014; 19: 439–48 CrossRef MEDLINE
1.Hirsch S, Steinert T: The use of rapid tranquilization in aggressive behavior. Dtsch Arztebl Int 2019; 116: 445–52 VOLLTEXT
2.Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e. V. (DGPPN): Verhinderung von Zwang: Prävention und Therapie aggressiven Verhaltens bei Erwachsenen. S3-Leitlinie 2018. www.awmf.org/uploads/tx_szleitlinien/038–022l_S3_Verhinderung-von-Zwang-Praevention-Therapie-aggressiven-Verhaltens_2018–11.pdf (last accessed on 5 August 2019)
3.Meyer JM: A rational approach to employing high plasma levels of antipsychotics for violence associated with schizophrenia: case vignettes. CNS Spectr 2014; 19: 432–8 CrossRef MEDLINE
4.Morrissette DA, Stahl SM: Treating the violent patient with psychosis or impulsivity utilizing antipsychotic polypharmacy and high-dose monotherapy. CNS Spectr 2014; 19: 439–48 CrossRef MEDLINE

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