Comparison of intramuscular olanzapine, orally disintegrating olanzapine tablets, oral risperidone solution, and intramuscular haloperidol in the management of acute agitation in an acute care psychiatric ward in Taiwan.
BACKGROUND
The purpose of this study was to compare efficacy and safety among intramuscular olanzapine, intramuscular haloperidol, orally disintegrating olanzapine tablets, and oral risperidone solution for agitated patients with psychosis during the first 24 hours of treatment in an acute care psychiatric ward.


METHODS
Forty-two inpatients from an acute care psychiatric ward of a medical center in central Taiwan were enrolled. They were randomly assigned to 1 of the 4 treatment groups (10-mg intramuscular olanzapine, 10-mg olanzapine oral disintegrating tablet, 3-mg oral risperidone solution, or 7.5-mg intramuscular haloperidol). Agitation was measured by using the excited component of the Positive and Negative Syndrome Scale (PANSS-EC), the Agitation-Calmness Evaluation Scale, and the Clinical Global Impression--Severity Scale during the first 24 hours.


RESULTS
There were significant differences in the PANSS-EC total scores for the 4 intervention groups at 15, 30, 45, 60, 75, and 90 minutes after the initiation of treatment. More significant differences were found early in the treatment. In the post hoc analysis, the patients who received intramuscular olanzapine or orally disintegrating olanzapine tablets showed significantly greater improvement in PANSS-EC scores than did patients who received intramuscular haloperidol at points 15, 30, 45, 60, 75, and 90 minutes after injection.


CONCLUSIONS
These findings suggest that intramuscular olanzapine, orally disintegrating olanzapine tablets, and oral risperidone solution are as effective treatments as intramuscular haloperidol for patients with acute agitation. Intramuscular olanzapine and disintegrating olanzapine tablets are more effective than intramuscular haloperidol in the early phase of the intervention. There is no significant difference in effectiveness among intramuscular olanzapine, orally disintegrating olanzapine tablets, and oral risperidone solution.
Hsu
Wen-Yu
WY
Department of Psychiatry, Lu-Tung Branch of Changhua ChristianHospital, Lukang, Taiwan.
Huang
Si-Sheng
SS
Lee
Bo-Shyan
BS
Chiu
Nan-Ying
NY
D000208:Acute Disease; D000284:Administration, Oral; D000328:Adult; D001569:Benzodiazepines / Q000008:administration & dosage*; D019468:Disease Management; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D019999:Pharmaceutical Solutions; D011446:Prospective Studies; D011567:Psychiatric Department, Hospital; D011569:Psychiatric Status Rating Scales; D011595:Psychomotor Agitation / Q000188:drug therapy* / Q000523:psychology*; D011618:Psychotic Disorders / Q000188:drug therapy / Q000523:psychology; D018967:Risperidone / Q000008:administration & dosage*; D012995:Solubility; D013607:Tablets; D013624:Taiwan; D016896:Treatment Outcome
D019999:Pharmaceutical Solutions; D013607:Tablets; D001569:Benzodiazepines; D006220:Haloperidol; D018967:Risperidone; D000077152:Olanzapine