Use of antipsychotics and benzodiazepines in patients with psychiatric emergencies: results of an observational trial.
BACKGROUND
Conventional antipsychotics augmented with benzodiazepines have been the standard acute treatment for psychiatric emergencies for more than 50 years. The inability of patients to give informed consent limits randomised, controlled studies. This observational study on immediate therapy for aggression and impulse control in acutely agitated patients (IMPULSE) evaluated the short-term effectiveness and tolerability of atypical and typical antipsychotic medications (AP) in a non-interventional setting.


METHODS
This was a comparative, non-randomised, prospective, open-label, observational study. Treatment over the first 5 days was classified according to whether any olanzapine, risperidone, or haloperidol was included or not. Documentations (PANSS-excited component, CGI-aggression, CGI-suicidality, tranquilisation score) were at baseline (day 1) and days 2-6 after start of AP.


RESULTS
During the short treatment-period, PANSS-EC and CGI-aggression scores improved in all cohorts. 68.7% of patients treated with olanzapine, 72.2% of patients treated with risperidone, and 83.3% of patients treated with haloperidol received concomitant benzodiazepines (haloperidol vs. non-haloperidol: p < 0.001). More patients treated with olanzapine (73.8%) were fully alert according to a tranquilisation score and active at day 2 than patients treated with risperidone (57.1%) or haloperidol (58.0%).


CONCLUSIONS
Current medication practices for immediate aggression control are effective with positive results present within a few days. In this study, concomitant benzodiazepine use was significantly more frequent in patients receiving haloperidol.
Wilhelm
Stefan
S
Medical Department, Lilly Deutschland GmbH, Saalburgstrasse 153, Bad Homburg, Germany. wilhelm_stefan@lilly.com
Schacht
Alexander
A
Wagner
Thomas
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D015897:Comorbidity; D004637:Emergency Services, Psychiatric; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology
D014150:Antipsychotic Agents; D001569:Benzodiazepines