Maarten Bak1, Irene Weltens2, Chris Bervoets3, Jürgen De Fruyt4, Jerzy Samochowiec5, Andrea Fiorillo6, Gaia Sampogna7, Przemyslaw Bienkowski8, W Ulrich Preuss9, Blazej Misiak10, Dorota Frydecka11, Agnieszka Samochowiec12, Emma Bak13, Marjan Drukker14, Geert Dom15. 1. Department of Psychiatry & Neuropsychology, Maastricht University, the Netherlands; Mondriaan Maastricht, the Netherlands. Electronic address: m.bak@maastrichtuniversity.nl. 2. Department of Psychiatry & Neuropsychology, Maastricht University, the Netherlands; Mondriaan Maastricht, the Netherlands. 3. Department of Psychiatry, University Psychiatric Centre KULeuven, Louvain, Belgium. 4. Department of Psychiatry, General Hospital Sint Jan Brugge-Oostende AV, Brugge, Belgium. 5. Department of Psychiatry Pomeranian Medical University in Szczecin, Poland. 6. Department of Psychiatry, University of Naples SUN, Naples, Italy. 7. WHO Collaborating Centre for Research and Training in Mental Health, University of Naples SUN, Naples, Italy. 8. Department of Psychiatry, Medical University of Warsaw, Poland. 9. Vitos-Klinik Herborn Psychiatry und Psychotherapy, Martin-Luther-University Halle-Wittenberg, Germany. 10. Department of Genetics, Wroclaw Medical University, Wroclaw, Poland. 11. Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland. 12. Institute of Psychology, Dept of Clinical Psychology, Szczecin University, Poland. 13. Medical Student, Maastricht University, Maastricht, the Netherlands. 14. Department of Psychiatry & Neuropsychology, Maastricht University, the Netherlands. 15. Antwerp University (UA), Collaborative Psychiatric Research Institute (CAPRI), Edegem, Belgium.
Abstract
INTRODUCTION: Non-pharmacological interventions preferably precede pharmacological interventions in acute agitation. Reviews of pharmacological interventions remain descriptive or compare only one compound with several other compounds. The goal of this study is to compute a systematic review and meta-analysis of the effect on restoring calmness after a pharmacological intervention, so a more precise recommendation is possible. METHOD: A search in Pubmed and Embase was done to isolate RCT's considering pharmacological interventions in acute agitation. The outcome is reaching calmness within maximum of 2 h, assessed by the psychometric scales of PANSS-EC, CGI or ACES. Also the percentages of adverse effects was assessed. RESULTS: Fifty-three papers were included for a systematic review and meta-analysis. Most frequent studied drug is olanzapine. Changes on PANNS-EC and ACES at 2 h showed the strongest changes for haloperidol plus promethazine, risperidon, olanzapine, droperidol and aripiprazole. However, incomplete data showed that the effect of risperidon is overestimated. Adverse effects are most prominent for haloperidol and haloperidol plus lorazepam. CONCLUSION: Olanzapine, haloperidol plus promethazine or droperidol are most effective and safe for use as rapid tranquilisation. Midazolam sedates most quickly. But due to increased saturation problems, midazolam is restricted to use within an emergency department of a general hospital.
INTRODUCTION: Non-pharmacological interventions preferably precede pharmacological interventions in acute agitation. Reviews of pharmacological interventions remain descriptive or compare only one compound with several other compounds. The goal of this study is to compute a systematic review and meta-analysis of the effect on restoring calmness after a pharmacological intervention, so a more precise recommendation is possible. METHOD: A search in Pubmed and Embase was done to isolate RCT's considering pharmacological interventions in acute agitation. The outcome is reaching calmness within maximum of 2 h, assessed by the psychometric scales of PANSS-EC, CGI or ACES. Also the percentages of adverse effects was assessed. RESULTS: Fifty-three papers were included for a systematic review and meta-analysis. Most frequent studied drug is olanzapine. Changes on PANNS-EC and ACES at 2 h showed the strongest changes for haloperidol plus promethazine, risperidon, olanzapine, droperidol and aripiprazole. However, incomplete data showed that the effect of risperidon is overestimated. Adverse effects are most prominent for haloperidol and haloperidol plus lorazepam. CONCLUSION:Olanzapine, haloperidol plus promethazine or droperidol are most effective and safe for use as rapid tranquilisation. Midazolam sedates most quickly. But due to increased saturation problems, midazolam is restricted to use within an emergency department of a general hospital.
Authors: Sheldon H Preskorn; Scott Zeller; Leslie Citrome; Jeffrey Finman; Joseph F Goldberg; Maurizio Fava; Rishi Kakar; Michael De Vivo; Frank D Yocca; Robert Risinger Journal: JAMA Date: 2022-02-22 Impact factor: 157.335
Authors: Maurizio Pompili; Giuseppe Ducci; Alessandro Galluzzo; Gianluca Rosso; Claudia Palumbo; Domenico De Berardis Journal: Int J Environ Res Public Health Date: 2021-04-20 Impact factor: 3.390