The pharmacological management of agitated and aggressive behaviour: A systematic review and meta-analysis.
Aggression
/ drug effects
Anti-Anxiety Agents
/ therapeutic use
Antipsychotic Agents
/ therapeutic use
Benzodiazepines
/ adverse effects
Drug Therapy, Combination
Haloperidol
/ therapeutic use
Humans
Hypnotics and Sedatives
/ therapeutic use
Lorazepam
/ therapeutic use
Midazolam
/ therapeutic use
Olanzapine
/ therapeutic use
Promethazine
/ therapeutic use
Psychomotor Agitation
/ drug therapy
Psychotic Disorders
/ drug therapy
Treatment Outcome
Agitation
Agression
Halperidol
Olanzapine
PANNS-EC
Rapid tranquillisation
Journal
European psychiatry : the journal of the Association of European Psychiatrists
ISSN: 1778-3585
Titre abrégé: Eur Psychiatry
Pays: England
ID NLM: 9111820
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
received:
07
01
2019
accepted:
10
01
2019
pubmed:
6
2
2019
medline:
29
5
2019
entrez:
6
2
2019
Statut:
ppublish
Résumé
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. 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. 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. 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.
Identifiants
pubmed: 30721802
pii: S0924-9338(19)30014-8
doi: 10.1016/j.eurpsy.2019.01.014
pii:
doi:
Substances chimiques
Anti-Anxiety Agents
0
Antipsychotic Agents
0
Hypnotics and Sedatives
0
Benzodiazepines
12794-10-4
Promethazine
FF28EJQ494
Haloperidol
J6292F8L3D
Olanzapine
N7U69T4SZR
Lorazepam
O26FZP769L
Midazolam
R60L0SM5BC
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
78-100Informations de copyright
Copyright © 2019 Elsevier Masson SAS. All rights reserved.