Benzodiazepines for psychosis-induced aggression or agitation

Zaman, Hadar; Sampson, Stephanie; Beck, Alison; Sharma, Tarang; Clay, Fiona J.; Spyridi, Styliani; Zhao, Shuo; Gillies, Donna

doi:10.1002/14651858.cd003079.pub4

Cited by 56 publications

(56 citation statements)

References 94 publications

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“…These studies mostly focus on the first day of treatment and include, for example, the use of short-acting olanzapine IM, short-acting aripiprazole IM, loxapine inhaled, sublingual asenapine and antihistamines. As a recent review towards medication for psychosis-induced aggression or agitation concluded there is only a small amount of evidence and of poor quality [39], future research could compare the effects of medications in emergency situations and long-term treatment. Finally, only studies with hostility scores as outcome measure are included and not the studies using physical violent incidents as an outcome measure, as there were too few of those.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of typical and atypical antipsychotic medication on hostility in patients with psychosis-spectrum disorders: a review and meta-analysis

Faay

Czobor

Sommer

2018

Neuropsychopharmacol

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As violence against self and others is an important outcome in the treatment of patients with psychosis-spectrum disorders and hostility is an important indicator for violence, we set out to evaluate the effects of different types of antipsychotic agents in reducing hostility. We performed a systematic literature search, which provided 18 suitable randomized studies comparing typical to atypical antipsychotics for at least 4 weeks in patients with psychotic disorders. Results showed a small (0.26) but significant effect for atypical as compared to typical antipsychotics, with high heterogeneity, even though the mean dose of typical antipsychotics was higher. This effect size remained similar when separately analyzing sponsored and non-sponsored studies. When differentiating between high and low-dose studies, the high-dose group showed a significant difference between typical and atypical antipsychotics whereas the low-dose group did not. An analysis comparing clozapine to typical antipsychotics showed a moderate effect size (0.415), with low heterogeneity. These results are important for clinicians to help their shared decision making with patients when choosing maintenance treatment, as next to efficacy for psychosis and tolerability, safety for the patient and their environment is an important outcome.

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Section: Discussionmentioning

confidence: 99%

Efficacy of typical and atypical antipsychotic medication on hostility in patients with psychosis-spectrum disorders: a review and meta-analysis

Faay

Czobor

Sommer

2018

Neuropsychopharmacol

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“…However, a recent Cochrane Database Review found little research evidence to support this common practice. 67 Comparing benzodiazepines to placebo found little difference on most outcome measures; adding benzodiazepines to antipsychotics did not further reduce agitation and aggression 4 hours after administration, and the combination of haloperidol and midazolam actually increased aggression 12 hours after administration. In an experimental paradigm that was designed to test aggressive responding during a competitive game, male subjects given diazepam were more likely to select higher shock levels for their opponents than those given placebo.…”

Section: Psychopharmalogical Interventionsmentioning

confidence: 97%

Inpatient aggression in community hospitals

White

Cummings

et al. 2015

CNS Spectr.

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Physical violence is a frequent occurrence in acute community psychiatry units worldwide. Violent acts by patients cause many direct injuries and significantly degrade quality of care. The most accurate tools for predicting near-term violence on acute units rely on current clinical features rather than demographic risk factors. The efficacy of risk assessment strategies to lower incidence of violence on acute units is unknown. A range of behavioral and psychopharmacologic treatments have been shown to reduce violence among psychiatric inpatients.

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“…A recent Cochrane systematic review of the efficacy of BDZs in psychosis-induced aggression or agitation concluded that adding BDZs to other drugs does not appear to be clearly advantageous and increases the risk of unnecessary adverse effects. 78 Further, a recent meta-analysis 69 of 16 RCTs (for a total of 1,045 participants) investigating the efficacy of BDZ augmentation to antipsychotics in the treatment of schizophrenia found no evidence for use of this strategy.…”

Section: Resultsmentioning

confidence: 99%

Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice

Dell’Osso¹,

Albert²,

Atti³

et al. 2015

NDT

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More than half a century after their discovery, benzodiazepines (BDZs) still represent one of the largest and most widely prescribed groups of psychotropic compounds, not only in clinical psychiatry but also in the entire medical field. Over the last two decades, however, there has been an increased focus on the development of antidepressants and antipsychotics on the part of the pharmaceutical industry, clinicians, and researchers, with a reduced interest in BDZs, in spite of their widespread clinical use. As a consequence, many psychiatric residents, medical students, nurses, and other mental health professionals might receive poor academic teaching and training regarding these agents, and have the false impression that BDZs represent an outdated chapter in clinical psychopharmacology. However, recent advances in the field, including findings concerning epidemiology, addiction risk, and drug interactions, as well as the introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with related diagnostic changes, strongly encourage an updated appraisal of the use of BDZs in clinical practice. During a recent thematic event convened with the aim of approaching this topic in a critical manner, a group of young Italian psychiatrists attempted to highlight possible flaws in current teaching pathways, identify the main clinical pros and cons regarding current use of BDZs in clinical practice, and provide an updated overview of their use across specific clinical areas and patient populations. The main results are presented and discussed in this review.

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Benzodiazepines for psychosis-induced aggression or agitation

Cited by 56 publications

References 94 publications

Efficacy of typical and atypical antipsychotic medication on hostility in patients with psychosis-spectrum disorders: a review and meta-analysis

Efficacy of typical and atypical antipsychotic medication on hostility in patients with psychosis-spectrum disorders: a review and meta-analysis

Inpatient aggression in community hospitals

Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice

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