The pharmacological management of agitated and aggressive behaviour: A systematic review and meta-analysis

Maarten Bak*, Irene Weltens, Chris Bervoets, Jurgen De Fruyt, Jerzy Samochowiec, Andrea Fiorillo, Gaia Sampogna, Przemyslaw Bienkowski, W. Ulrich Preuss, Blazej Misiak, Dorota Frydecka, Agnieszka Samochowiec, Emma Bak, Marjan Drukker, Geert Dom

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

20 Citations (Web of Science)

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. (c) 2019 Elsevier Masson SAS. All rights reserved.

Original languageEnglish
Pages (from-to)78-100
Number of pages23
JournalEuropean Psychiatry
Volume57
DOIs
Publication statusPublished - Apr 2019

Keywords

  • Agitation
  • Agression
  • Olanzapine
  • Halperidol
  • Rapid tranquillisation
  • PANNS-EC
  • RANDOMIZED CONTROLLED-TRIAL
  • EMERGENCY PSYCHIATRIC ROOMS
  • RISPERIDONE ORAL SOLUTION
  • RAPID ACUTE TREATMENT
  • INTRAMUSCULAR OLANZAPINE
  • DOUBLE-BLIND
  • PSYCHOTIC AGITATION
  • IM ZIPRASIDONE
  • V. HALOPERIDOL
  • PLACEBO

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