Rapid tranquilization of severely agitated patients with schizophrenia spectrum disorders: a naturalistic, rater-blinded, randomized controlled study with oral haloperidol, risperidone, and olanzapine

Walther, Sebastian; Moggi, Franz; Horn, Helge; Moskvitin, Konstantin; Maier, Nicole; Abderhalden, Christoph; Strik, Werner; Müller, Tobias

doi:10.1055/s-0033-1353338

Cited by 11 publications

(19 citation statements)

References 21 publications

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“…These RCTs were cited 20 times in total, in three SRs 31,32,58 (the fourth SR 57 reported only on nonconsenting patients). Fourteen RCTs reported on nonconsenting patients 17,66,76–87 . These were cited 22 times overall in three SRs 31,57,58 (the fourth SR 32 reported only on consenting patients).…”

Section: Resultsmentioning

confidence: 99%

“…Nonconsenting patients: Knott 17 Baldacara 77 Calver 84 Chan 66 Dorevitch 79 Huf 80 Foster 85 Nobay 86 Walther 87 …”

Section: Resultsmentioning

confidence: 99%

“…• Knott 17 • Baldacara 77 • Calver 84 • Chan 66 • Dorevitch 79 • Huf 80 • Foster 85 • Nobay 86 • Walther 87 Mixed consent:…”

Section: Gillies 31unclassified

“…Fourteen RCTs reported on nonconsenting patients. 17,66,[76][77][78][79][80][81][82][83][84][85][86][87] These were cited 22 times overall in three SRs 31,57,58 (the fourth SR 32 reported only on consenting patients). One RCT 88 reported on mixed consent, and this was included in two SRs.…”

Section: Rctsmentioning

confidence: 99%

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Interrogating systematic review recommendations for effective chemical restraint

Muir‐Cochrane

Oster

Grimmer

2020

Evaluation Clinical Practice

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Section: Resultsmentioning

confidence: 99%

“…Nonconsenting patients: Knott 17 Baldacara 77 Calver 84 Chan 66 Dorevitch 79 Huf 80 Foster 85 Nobay 86 Walther 87 …”

Section: Resultsmentioning

confidence: 99%

“…• Knott 17 • Baldacara 77 • Calver 84 • Chan 66 • Dorevitch 79 • Huf 80 • Foster 85 • Nobay 86 • Walther 87 Mixed consent:…”

Section: Gillies 31unclassified

Section: Rctsmentioning

confidence: 99%

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Interrogating systematic review recommendations for effective chemical restraint

Muir‐Cochrane

Oster

Grimmer

2020

Evaluation Clinical Practice

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“…In another trial, oral formulations of olanzapine, haloperidol, and risperidone were compared. None of these drugs was found to be significantly superior to the others (30), so the choice of drug can be based on the adverse-effect profile and the patient's preferences. A review of six RCTs on orally administered antipsychotic drugs for the treatment of psychomotor agitation led to the conclusion that these are all comparably effective to haloperidol and to parenteral formulations (31).…”

Section: Antipsychotic Drugs For Oral Administrationmentioning

confidence: 99%

The Use of Rapid Tranquilization in Aggressive Behavior

Hirsch¹,

Steinert²

2019

Deutsches Ärzteblatt International

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ggressive behavior can be considered pathological only when it arises in the context of disease. It is thus not necessarily an indication for medical treatment. Not only emergency medical personnel and psychiatrists, but also family physicians are often confronted with the question of how to treat aggressive behavior. In one study, psychiatric emergencies accounted for 11.8% of all emergency medical interventions outside the hospital. Psychomotor agitation made up 28% of all psychiatric emergencies, second only to alcohol intoxication (33%) (1). Psychomotor agitation in the context of mental illness and intoxication constitutes a medical emergency. Affected patients can injure themselves or others. In a retrospective survey of six German psychiatric hospitals, 1.7 to 5 aggressive attacks per patient-year were reported (2). In one hospital in the federal state of North Rhine-Westphalia, 171 of the 2210 patients admitted within a 1-year period were involved in aggressive attacks, and a total of 441 episodes of aggressive behavior were reported (3). Psychomotor agitation carries the risk of somatic complications, including electrolyte disturbances, rhabdomyolysis, and lactic acidosis (4, 5). The goal of pharmacotherapy is to calm the patient. Amnesia and deep sedation should be avoided in order not to compromise the patient's ability to participate in joint decision-making about further treatment. Deep sedation also puts patients at risk of cardiorespiratory depression, aspiration, and other complications. No data on this topic are available from Germany, but an Australian study has shown that 16 agitated patients who were pharmacologically sedated (9% of the patients so treated) sustained complications such as hypotension and hypoxemia (6). The health-related causes of aggressive behavior include nearly all kinds of mental disorders, and various somatic illnesses as well. In an emergency, the history should be rapidly obtained from someone who has observed the behavior, and an initial, orienting physical examination should be performed. Intoxications, withdrawal syndromes, a postictal state, and rapidly reversible causes such as hypoglycemia should be ruled out (7). The patient's permission for pharmacotherapy should be obtained whenever possible. In Germany, when the patient refuses treatment, the physician must determine whether coercive emergency treatment is permissible and required, as per the concept of a Summary Background: Psychomotor agitation and aggressiveness in the context of mental illness are medical emergencies. In a survey of six German psychiatric hospitals, 1.7 to 5 aggressive attacks per patient-year were reported. If talking to the patient has no calming effect, intervention with drugs is required. In this article, we review the evidence on tranquilizing drugs and discuss clinically relevant ethical and practical questions, e.g., with respect to involuntary medication. Method: This review is based on pertinent articles retrieved by a selective search in MEDLINE, supplemented by a reference sear...

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Haloperidol for psychosis-induced aggression or agitation (rapid tranquillisation)

Ostinelli

Brooke-Powney

et al. 2017

Cochrane Database of Systematic Reviews

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Rapid tranquilization of severely agitated patients with schizophrenia spectrum disorders: a naturalistic, rater-blinded, randomized controlled study with oral haloperidol, risperidone, and olanzapine

Cited by 11 publications

References 21 publications

Interrogating systematic review recommendations for effective chemical restraint

Interrogating systematic review recommendations for effective chemical restraint

The Use of Rapid Tranquilization in Aggressive Behavior

Haloperidol for psychosis-induced aggression or agitation (rapid tranquillisation)

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