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Benzodiazepines for psychosis-induced aggression or agitation

  1. Donna Gillies1,*,
  2. Stephanie Sampson2,
  3. Alison Beck3,
  4. John Rathbone4

Editorial Group: Cochrane Schizophrenia Group

Published Online: 30 APR 2013

Assessed as up-to-date: 1 JUN 2012

DOI: 10.1002/14651858.CD003079.pub3


How to Cite

Gillies D, Sampson S, Beck A, Rathbone J. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD003079. DOI: 10.1002/14651858.CD003079.pub3.

Author Information

  1. 1

    Western Sydney and Nepean Blue Mountains Local Health Districts - Mental Health, Parramatta, NSW, Australia

  2. 2

    The University of Nottingham, Cochrane Schizophrenia Group, Nottingham, UK

  3. 3

    South London and Maudsley NHS Foundation Trust, Trust HQ, London, UK

  4. 4

    The University of Sheffield, HEDS, ScHARR, Sheffield, UK

*Donna Gillies, Western Sydney and Nepean Blue Mountains Local Health Districts - Mental Health, Cumberland Hospital, Locked Bag 7118, Parramatta, NSW, 2150, Australia. Donna_Gillies@wsahs.nsw.gov.au.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 30 APR 2013

SEARCH

References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Alprazolam 1992, USA {published data only}
  • Barbee JG, Mancuso DM, Freed CR, Todorov AA. Alprazolam as a neuroleptic adjunct in the emergency treatment of schizophrenia. American Journal of Psychiatry 1992;149:506-10.
Clonazepam 1993, CA {published data only}
  • Chouinard G, Annable L, Turnier L, Holobow N, Szkrumelak N. A double-blind randomized clinical trial of rapid tranquilization with I.M. clonazepam and I.M. haloperidol in agitated psychotic patients with manic symptoms [presented at the 143rd annual meeting of the American Psychiatric Association, NY, May 12-17, 1990, and at the 42nd annual meeting of the Canadian Psychiatric Association, Montreal, Quebec, September 17, 1992]. Canadian Journal of Psychiatry 1993;38:S114-S121.
Clonazepam 1999, CHN {published data only}
  • Qu HF, Zhang Z, Xu B. Comparison of the effects of clonazepam and haloperidol in the treatment of psychotic breakdown behavior. Health Psychology Journal 1999;7(2):134-5.
Clonazepam 2003, CHN {published data only}
  • Yang X, Wang Z, Ling Z. A randomly controlled comparison of risperidone added with intramuscular clonazepam in the treatment of excitement of schizophrenia. Shanghai Archives of Psychiatry 2003;15(2):98-9.
Clonazepam 2004, CHN {published data only}
  • Wang G, Cai ZJ, Wang LF. A multicenter study of risperidone treatment for acute agitation in patients with schizophrenia. Chinese Journal of Psychiatry 2004;37(2):88-91.
Clonazepam 2005, CHN {published data only}
  • Han Z, Wang L, Wang J. Efficacy of risperidone, clonazepam in the treatment of excitement state of schizophrenia. Ningxia Medical Journal 2005;27(9):631-2.
Clonazepam 2007, CHN {published data only}
  • Zhang HS. Study of olanzapine combined with clonazepam in treatment of schizophrenia with acute psychomotor excitation. Linchuang Jingshen Yixue Zazhi 2007;17(4):239-40.
Diazepam 1979, IL {published data only}
Flunitrazepam 1999, IL {published data only}
  • Dorevitch A, Katz N, Zemishlany Z, Aizenberg D, Weizman A. Intramuscular flunitrazepam versus intramuscular haloperidol in the emergency treatment of aggressive psychotic behavior. American Journal of Psychiatry 1999;156:142-4.
Lorazepam 1989, USA {published data only}
  • Garza-Trevino ES, Hollister LE, Overall JE, Alexander WF. Efficacy of combinations of intramuscular antipsychotics and sedative-hypnotics for control of psychotic agitation [presented in part at the 141st annual meeting of the American Psychiatric Association, Montreal, May 7-12, 1988, and at the 142nd annual meeting of the American Psychiatric Association, San Fransisco, May 6-11, 1989]. American Journal of Psychiatry 1989;146:1598-601.
Lorazepam 1991, USA {published data only}
  • Salzman C, Solomon D, Miyawaki E, Glassman R. Parenteral lorazepam versus parenteral haloperidol for the control of psychotic disruptive behavior. Journal of Clinical Psychiatry 1991;52(4):177-80.
  • Solomon DA, Miyawaki E, Salzman C. Benzodiazepine augmentation of the treatment of disruptive psychotic behaviour [Review]. Progress in Drug Research 1990;35:139-49.
Lorazepam 1997, USA {published data only}
  • Battaglia J, Moss S, Rush J, Kang J, Mendoza R, Leedom L. Haloperidol, lorazepam, or both for psychotic agitation? A multicenter, prospective, double-blind, emergency department study. American Journal of Emergency Medicine 1997;15:335-40.
Lorazepam 1997a, USA {published data only}
  • Foster S, Kessel J, Berman ME, Simpson GM. Efficacy of lorazepam and haloperidol for rapid tranquilization in a psychiatric emergency room setting. International Clinical Psychopharmacology 1997;12:175-9.
Lorazepam 1998, SA {published data only}
  • Subramaney U, Brook S, Berk M. A prospective randomised double-blind controlled study of the efficacy of lorazepam versus clothiapine in the control of acutely behaviourally disturbed patients. South African Medical Journal 1998;88(3):307-10.
Lorazepam 1998, USA {published data only}
  • Bieniek SA, Ownby RL, Penalver A, Dominguez RA. A double-blind study of lorazepam versus the combination of haloperidol and lorazepam in managing agitation. Pharmacotherapy 1998;18:57-62.
Lorazepam 2001, RO & USA {published data only}
  • Battaglia J, Lindborg SR, Alaka K, Meehan K, Wright P. Calming versus sedative effects of intramuscular olanzapine in agitated patients. American Journal of Emergency Medicine 2003;21(3):192-8.
  • Breier A, Meehan K, Birkett M, David S, Ferchland I, Sutton V, et al. A double-blind, placebo-controlled dose-response comparison of intramuscular olanzapine and haloperidol in the treatment of acute agitation in schizophrenia. Archives of General Psychiatry 2002;59(5):441-8. [DOI: 10.1001/archpsyc.59.5.441]
  • David SR, Battaglia J, Alaka K, Meehan K, Wright P. Calming versus sedative effects of IM olanzapine in agitated patients. 11th Association of European Psychiatrists Congress. Stockholm, Sweden, May 4-8, 2002; Vol. 17, issue Suppl 1:104s.
  • David SR, Jones B, Alaka K, Meehan K, Wright P, Taylor CC, et al. The efficacy of intramuscular olanzapine in acutely agitated patients. 155th Annual Meeting of the American Psychiatric Association. Philadelphia, PA, USA, May 18-23, 2002.
  • Meehan KZ. A double-blind, randomized comparison of the efficacy and safety of intramuscular injections of olanzapine, lorazepam, or placebo in treating acutely agitated patients diagnosed with bipolar mania. Journal of Clinical Psychopharmacology 2001;21(4):389-97.
Lorazepam 2004, IN {published data only}
  • Alexander J. Lorazepam versus a combination of haloperidol and promethazine in the acute management of agitation and aggression - a randomized controlled trial. MD Thesis. Vellore, India: Christian Medical College 2003.
  • Alexander J, John T, Tharyan P, Adams CE. TREC-India. A second arm of TREC. Schizophrenia Research 2002;53(3 Suppl. 1):236. [MEDLINE: 73085373; : PMID 4405388]
  • Alexander J, Tharyan P, Adams CE, John T, Mol C, Philip J. Rapid tranquillisation of violent or agitated patients in a psychiatric emergency setting: a pragmatic randomised trial of intramuscular lorazepam versus haloperidol plus promethazine. British Journal of Psychiatry 2004;185:63-9.
Lorazepam 2006, USA {published data only}
  • Veser F, Zealburg J, Veser B, Zhu Y, Gharabawi G. Oral risperidone in the management of agitated behavior in emergency settings. Journal of the European College of Neuropsychopharmacology 2002;12(Suppl 3):S313.
  •  Veser FH, Veser BD, McMullan JT, Zealberg J, Currier GW. Risperidone versus haloperidol, in combination with lorazepam, in the treatment of acute agitation and psychosis: a pilot, Randomized, double-blind, placebo-controlled trial. Journal of Psychiatric Practice 2006;12(2):103-8.
Midazolam 2003, BZ {published data only}
  • Huf G, Coutinho ESF, Adams CE. The pharmacological management of agitated patients in emergency psychiatric hospitals in Rio de Janeiro, Brazil: the results of two pragmatic randomized clinical trials. 5th European Congress on Violence in Clinical Psychiatry.  Amsterdam, The Netherlands. 2007, 25-27 October 2007.
  • Huf G, Coutinho ESF, Adams CE. TREC III. The protocol and progress of TREC. Schizophrenia Research 2002;53(3 Suppl. 1):187. [MEDLINE: 73085373; : PMID 4405388]
  • Huf G, Coutinho ESF, Adams CE. TREC-Rio trial: a randomised controlled trial for rapid tranquillisation for agitated patients in emergency psychiatric rooms. BMC Psychiatry 2002;2(11):4. [: EMBASE 2002383527]
  • Huf G, Coutinho ESF, Fagundes HM Jr, Carvalho AL, Ramos FA, Keusen AL, et al. TREC II. Current practices in managing acutely disturbed patients at three hospitals in Rio de Janeiro, Brazil. Schizophrenia Research 2002;53(3):236-7. [MEDLINE: 73085373; : PMID 4405388]
  • TREC Collaborative Group. Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine. BMJ 2003;327(7417):708-13. [: EMBASE: 2003210869]
Midazolam 2006, AU {published data only}
  • Knott JC, Taylor D, Castle DJ. Randomized clinical trial comparing intravenous midazolam and droperidol for sedation of the acutely agitated patient in the emergency department. Annals of Emergency Medicine 2006;47(1):61-7.
Midazolam 2011, BZ {published data only}
  • Baldacara L, Sanches M, Cordeiro DC, Jackoswksi AP. Rapid tranquilization for agitated patients in emergency psychiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone. Revista Brasileire da Psiquiatria 2011;33(1):30-9.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Arana 1986 {published data only}
  • Arana GW, Ornsteen ML, Kanter F, Friedman HL, Greenblatt DJ, Shader RI. The use of benzodiazepines for psychotic disorders: a literature review and preliminary clinical findings. Psychopharmacology Bulletin 1986;22(1):77-87.
Davis 2008b {published data only}
  • Davis JM, Wang B, He Y, Jin H, Hu Q, Zhang M. The emergency treatment of acutely agitated psychotic schizophrenia patients. International Journal of Neuropsychopharmacology 2008;11(Supplement 1):163.
Guz 1972 {published data only}
  • Guz I, Moraes R, Sartoretto JN. The therapeutic effects of lorazepam in psychotic patients treated with haloperidol: a double blind study. Therapuetic Research Press 1972;14(12):767-74.
Hankoff 1962 {published data only}
Hanlon 1970 {published data only}
  • Hanlon TE, Ota KY, Kurland AA. Comparative effects of fluphenazine, fluphenazine-chlordiazepoxide and fluphenazine-imipramine. Diseases of the Nervous System 1970;31(3):171-7.
Kang 2006 {published data only}
  • Kang MX. Clinical study on efficacy of quetiapine combined with clonazepam treated with acute agitation in schizophrenia patients. Linchuang Jingshen Yixue Zazhi 2006;16(4):221-2.
Lenox 1992 {published data only}
  • Lenox RH, Newhouse PA, Creelman WL, Whitaker TM. Adjunctive treatment of manic agitation with lorazepam versus haloperidol: a double-blind study. Journal of Clinical Psychiatry 1992;53(2):47-52.
Martel 2005 {published data only}
  • Martel M, Sterzinger A, Miner J, Clinton J, Biros M. Management of acute undifferentiated agitation in the emergency department: a randomized double-blind trial of droperidol, ziprasidone, and midazolam. Academic Emergency Medicine 2005;12(12):1167-72.
Mei 2006 {published data only}
  • Mei Y, Pan JPM. Clinical observation on acute excitation of schizophrenia treated with QIWEI combined with clonazepam. Chinese Nursing Research 2006;20(5):1176-7.
  • Wang DB, Xu SQ, Tang QP, Ying YF, Mei YT, He FX. Treatment of 80 cases of schizophrenia manifesting acute erethitic symptoms with quetiapine combined with clonazepam. Herald of Medicine 2005;24(8):687-8.
Nestoros 1982 {published data only}
Nobay 2004 {published data only}
  • Nobay F, Simon BC, Levitt MA, Dresden GM. A prospective, double-blind, randomized trial of midazolam versus haloperidol versus lorazepam in the chemical restraint of violent and severely agitated patients. Academic Emergency Medicine 2004;11(7):744-9.
Simpson 2003b {published data only}
  • Currier GW, Simpson GM. Risperidone liquid concentrate and oral lorazepam versus intramuscular haloperidol and intramuscular lorazepam for treatment of psychotic agitation. Journal of Clinial Psychiatry 2001;62(3):135-7.
  • Simpson GM, Morein JD, Reyes-Harde M, Gharabawi G. A pragmatic and convenient approach for the management or acute agitation: results from a series of clinical studies. Proceedings of the 16th European College of Neuropsychopharmacology Congress. Czech Republic, 2003; Vol. September:20-4.
Tang 2007 {published data only}
  • Tang Q, Yang L, Lai G, Zhand J. A clinical study of risperidone oral solution combined with clonazepam injection in the treatment of acute excitement phase schizophrenia patient. Shanghai Archives of Psychiatry 2007;19(3):153-5.
Wan Zhili 2005 {published data only}
  • Wan Z, Zhong Z. Curative effect of risperidone with BDZs in the treatment of excitement and agitation with schizophrenia in acute phase. Chinese Journal of Health Psychology 2005;13(1):23-4.
Wyant 1990 {published data only}
  • Wyant M, Diamond BI, O'Neal E, Sloan A, Borison RL. The use of midazolam in acutely agitated psychiatric patients. Psychopharmacology Bulletin 1990;26(1):126-9.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Ahmed 2010
Ahmed 2011
  • Ahmed U, Rehman F, Jones H, Adams CE. Risperidone for psychosis induced aggression or agitation. Cochrane Database of Systematic Reviews 2011, Issue 11. [DOI: 10.1002/14651858.CD009412]
Allen 2000
  • Allen MH. Managing the agitated psychotic patient: a reappraisal of the evidence. Journal of Clinical Psychiatry 2000;61(Suppl 14):11-20.
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TREC-II Brazil
  • TREC Collaborative Group. Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine. BMJ 2003;327(7417):708-13. [EMBASE: 2003210869]
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References to other published versions of this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Gillies 2005