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

Bak, Maarten; Weltens, Irene; Bervoets, Chris; Fruyt, Jürgen De; Samochowiec, Jerzy; Fiorillo, Andrea; Sampogna, Gaia; Bieńkowski, Przemysław; Preuss, W. Ulrich; Misiak, Błażej; Frydecka, Dorota; Samochowiec, Agnieszka; Bak, Emma; Drukker, Marjan; Dom, Geert

doi:10.1016/j.eurpsy.2019.01.014

Cited by 45 publications

(53 citation statements)

References 75 publications

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“…This study has reported varied reduction of PANSS-EC score after 2 h of dosages interventions either in single or combination. PANSS-EC scores decreasing caused by lorazepam, haloperidol, haloperidol and promethazine, haloperidol and midazolam, levomepromazine, aripiprazole, olanzapine, risperidone, ziprasidone, loxapine inhalation, and placebo were 7 points, 7-8 points, 15 points, 8-10 points, 15 points within 90 min, 5-6 points for older subjects, 7-8 points with one exception of smaller reduction points, 7-10 points, 7-8 points that one study has reported the decrease up to 14 points, 3-15 points, 9-11 points, and 2-6 points, respectively [8].…”

Section: Resultsmentioning

confidence: 92%

“…The side effects in cardiovascular condition have been reported to be QT elongation which can increase the risks of arrhythmia, caused by haloperidol for 0-6% of cases and lorazepam for 7% of cases, while in the use of benzodiazepine, no side effects were found [25]. However, hypotension side effects have been reported for 0-17% due to the consumption of haloperidol [8].…”

Section: Resultsmentioning

confidence: 99%

“…Meanwhile, benzodiazepine drugs which are commonly prescribed in treating psychotic agitation are diazepam, lorazepam, clonazepam [6], and midazolam [7], [8]. Midazolam has higher superiority than that in haloperidol in controlling agitation, however, it is extremely sedative which is sleep-inducing effects.…”

Section: Introductionmentioning

confidence: 99%

“…The clonazepam has limited efficacies in handling agitation so that it is not recommended. Lorazepam is benzodiazepine group which is favored in the treatment of agitation; however, in Indonesia, parenteral formulation is not available [7], [8], [9], [10].…”

Section: Introductionmentioning

confidence: 99%

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The Difference Scores of Positive and Negative Syndrome Scale Exited Components in Psychotic Agitation Patients of Haloperidol Injection and those Prescribed with the Injection of Haloperidol and Diazepam

Affandi¹,

Effendy²,

Loebis³

et al. 2020

Open Access Maced J Med Sci

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BACKGROUND: The availability of psychotic medications in primary health care in Indonesia is in a limited number. The center of psychiatric health-care provides varied types of medications. However, the quantities are limited, in which the second generation of psychotic drugs is relatively expensive. Common available drug medications are haloperidol and diazepam. AIM: This study aims to investigate the difference scores of Positive and Negative Syndrome Scale (PANSS-EC) in psychotic agitation patients of haloperidol prescription and those who have been prescribed with haloperidol and diazepam injections at Prof. Dr. M. Ildrem Mental Hospital, Medan North Sumatera, Indonesia. METHODS: This study involved 64 psychotic agitation patients who were divided into two groups. The first group was 32 patients who have been prescribed by 5 mg of haloperidol injections and the second group was 32 patients who have been injected by 5 mg of haloperidol and 10 mg of diazepam. The PANSS-EC score assessment was performed for 1 h due to the side effects of medication consumption. RESULTS: A significant comparison in terms of the decreasing of PANSS-EC scores in psychotic agitation patients who have been injected by the combination of haloperidol and diazepam was confirmed during the assessment of 30 and 60 min (p < 0.001). The extrapyramidal side effects in haloperidol group were found in two subjects, and the reinjections of combination therapy of haloperidol and diazepam were lower than those with one type of drugs medication, which, respectively, were accounted for 56.25% and 84.37%. CONCLUSIONS: Combination therapy of haloperidol and diazepam had more accelerating effects in reducing agitation compared to those prescribed by only haloperidol.

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Section: Resultsmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Difference Scores of Positive and Negative Syndrome Scale Exited Components in Psychotic Agitation Patients of Haloperidol Injection and those Prescribed with the Injection of Haloperidol and Diazepam

Affandi¹,

Effendy²,

Loebis³

et al. 2020

Open Access Maced J Med Sci

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show abstract

“…41 For acute agitation, a recent systematic review of 53 papers concluded that rapid tranquilization can be effectively and safely achieved with haloperidol or with atypical neuroleptics. 42…”

Section: Managementmentioning

confidence: 99%

Emotions after stroke: A narrative update

Ferro

Santos

2019

International Journal of Stroke

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Aim In this narrative review we aimed to describe how stroke affects emotions and update the readers on the emotional disturbances that occur after stroke. Methods We searched Medline from 1.1.2013 to 1.7.2019, personal files and references of selected publications. All retrieved systematic reviews and randomized controlled trials were included. Other references were selected by relevance. Summary of review The emotional response includes a reactive behavior with arousal, somatic, motivational and motor components, and a distinctive cognitive and subjective affective experience. Emotional category responses and experiences after stroke can show dissociations between the behavioral response and the cognitive and affective experiences. Emotional disturbances that often occur after stroke include fear, anger, emotional indifference, lack of understanding of other emotions, and lack of control of emotional expression. Emotional disturbances limit social reintegration of the persons with stroke and are a source of caregiver burnout. The evidence to support the management of the majority of emotional disorders in stroke survivors is currently weak and of low or very low methodologic quality. An exception are the disorders of emotional expression control where antidepressants can have a strong beneficial effect, by reducing the number and duration of the uncontrollable episodes of crying or laughing. Conclusion Our current knowledge of the emotional disorders that occurs in acute stroke patients and in stroke survivors is heterogeneous and limited. Joint efforts of different research approaches, methodologies and disciplines will improve our current understanding on emotional disorder after stroke and indicate rational pathways to manage them.

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Effect of Sublingual Dexmedetomidine vs Placebo on Acute Agitation Associated With Bipolar Disorder

Preskorn

Zeller

Citrome

et al. 2022

JAMA

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IMPORTANCEAcute agitation is common in patients with bipolar disorder and requires urgent management to relieve distress and to prevent escalation to aggressive behavior.OBJECTIVE To evaluate the effect of orally absorbed, sublingual dexmedetomidine, a selective α 2A -adrenergic receptor agonist on symptoms of acute agitation in patients with bipolar disorder.DESIGN, SETTING, AND PARTICIPANTS Phase 3, randomized, double-blind, placebo-controlled trial conducted in 15 sites in the US with enrollment between February 24, 2020, and April 27, 2020, and final follow-up on May 21, 2020. A total of 380 adults with bipolar I or II disorder were randomized and 362 completed the study. INTERVENTIONS Participants were randomized to 3 groups: sublingual dexmedetomidine 180 μg (n = 127), sublingual dexmedetomidine 120 μg (n = 127), or placebo (n = 126). MAIN OUTCOMES AND MEASURESThe primary efficacy end point was the mean change from baseline at 2 hours for the Positive and Negative Syndrome Scale-Excited Component (PEC) total score. The range of possible total scores is 5 (absence of agitation) to 35 (extremely severe). The secondary end point was the earliest time of a statistically significant change in PEC total score from baseline for the drug vs placebo. On the primary efficacy end point, to account for multiplicity associated with comparing 2 sublingual dexmedetomidine doses with placebo, the 2-sided significance level for each dose vs placebo was set at .025. RESULTSOf 380 patients randomized (mean age, 45.6 years; 54.8% women; and 56.1% Black individuals), 378 (99.5%) self-administered the study medication and completed the study. Baseline agitation was mild to moderate, with an overall mean PEC total score of 18.0. Two hours after taking the medication, the mean changes from baseline in PEC total score were −10.4 for sublingual dexmedetomidine 180 μg, −9.0 for sublingual dexmedetomidine 120 μg, and −4.9 for placebo. Least-square mean differences from placebo in the sublingual dexmedetomidine groups at 2 hours were −5.4 (97.5% CI, −6.6 to −4.2) for 180 μg and −4.1 (97.5% CI, −5.3 to −2.9) for 120 μg (both doses P < .001 vs placebo). Treatment effects began 20 minutes after taking the medication among patients in the sublingual dexmedetomidine groups (least-square mean difference for 180 μg, −1.1 [97.5% CI, −2.0 to −0.2]; P = .007; for 120 μg, −1.0 [97.5% CI, −1.9 to −0.1]; P = .009). Adverse events occurred in 35.7% of patients taking 180 μg of dexmedetomidine, 34.9% taking 120 μg, and 17.5% taking placebo. The most common adverse events (Ն5%) in the respective 180 μg, 120 μg, and placebo groups were somnolence (21.4% and 20.6% vs 4.8%); dry mouth (4.8% and 7.1% vs 0.8%); hypotension (6.3% and 4.8% vs 0%); and dizziness (5.6% and 5.6% vs 0.8%).CONCLUSIONS AND RELEVANCE Among patients with mild to moderate agitation associated with bipolar disorder, treatment with a sublingual film formulation of dexmedetomidine 120 μg or 180 μg, compared with placebo, resulted in significantly greater reduction in the agitation score...

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

Cited by 45 publications

References 75 publications

The Difference Scores of Positive and Negative Syndrome Scale Exited Components in Psychotic Agitation Patients of Haloperidol Injection and those Prescribed with the Injection of Haloperidol and Diazepam

The Difference Scores of Positive and Negative Syndrome Scale Exited Components in Psychotic Agitation Patients of Haloperidol Injection and those Prescribed with the Injection of Haloperidol and Diazepam

Emotions after stroke: A narrative update

Effect of Sublingual Dexmedetomidine vs Placebo on Acute Agitation Associated With Bipolar Disorder

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