title: Rapid tranquilization of severely agitated patients with schizophrenia spectrum disorders: a naturalistic, rater-blinded, randomized, controlled study with oral haloperidol, risperidone, and olanzapine.
abstract: BACKGROUND
  Agitation is a major problem in acute schizophrenia. Only a few studies have tested antipsychotic agents in severely agitated patients, mainly because of legal issues. Furthermore, most studies were limited to the first 24 hours. We aimed to investigate the efficacy of oral haloperidol, risperidone, and olanzapine in reducing psychotic agitation in severely agitated patients with schizophrenia or schizophreniform or schizoaffective disorder over 96 hours using a prospective, randomized, rater-blinded, controlled design within a naturalistic treatment regimen.
  
  
  METHODS
  In total, 43 severely agitated patients at acute care psychiatric units were enrolled. Participants were randomly assigned to receive either daily haloperidol 15 mg, olanzapine 20 mg, or risperidone 2 to 6 mg over 5 days. Positive and Negative Syndrome Scale psychotic agitation subscale score was the primary outcome variable. A mixed-model analysis was applied.
  
  
  RESULTS
  All drugs were effective for rapid tranquilization within 2 hours. Over 5 days, the course differed between agents (P < 0.001), but none was superior. Dropouts occurred only in the risperidone and olanzapine groups. Men responded better to treatment than did women during the initial 2 hours (P = 0.046) as well as over the 5-day course (P < 0.001). No difference between drug groups was observed regarding diazepam or biperiden use.
  
  
  CONCLUSIONS
  Oral haloperidol, risperidone, and olanzapine seem to be suitable for treating acute severe psychotic agitation in schizophrenia spectrum disorders. Response to oral antipsychotics demonstrated a gender effect with poorer outcome in women throughout the study.
authors.affiliation: From the *University Hospital of Psychiatry, Bern; †Department of Psychology, University of Fribourg, Fribourg; and ‡Nursing and Social Education Research Unit, University Hospital of Psychiatry Bern, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Walther
authors.forename: Franz
authors.initials: F
authors.lastname: Moggi
authors.forename: Helge
authors.initials: H
authors.lastname: Horn
authors.forename: Konstantin
authors.initials: K
authors.lastname: Moskvitin
authors.forename: Christoph
authors.initials: C
authors.lastname: Abderhalden
authors.forename: Nadja
authors.initials: N
authors.lastname: Maier
authors.forename: Werner
authors.initials: W
authors.lastname: Strik
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Müller
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D001569:Benzodiazepines / Q000008:administration & dosage*; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D018967:Risperidone / Q000008:administration & dosage*; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D012737:Sex Factors; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D006220:Haloperidol; D018967:Risperidone; D000077152:Olanzapine