HALOPERIDOL, LORAZEPAM, OR BOTH FOR PSYCHOTIC AGITATION - A MULTICENTER, PROSPECTIVE, DOUBLE-BLIND, EMERGENCY DEPARTMENT STUDY

Rapid tranquilization is a routinely practiced method of calming agita ted psychotic patients by use of neuroleptics, benzodiazepines, or bot h in combination, Although several studies have examined the efficacy of the three approaches, none have compared these treatments in a pros pective, randomized, double-blind, multicenter trial. Ninety eight psy chotic, agitated, and aggressive patients (73 men and 25 women) were p rospectively enrolled during an 18-month period in emergency departmen ts in five university or general hospitals. Patients were randomly ass igned to receive intramuscular injections of lorazepam (2 mg), haloper idol (5 mg), or both in combination, Patients in each treatment group received 1 to 6 injections of the same study drug within 12 hours, bas ed on clinical need, They were evaluated hourly after the first inject ion until at least 12 hours after the last. Efficacy was assessed on t he Agitated Behavior Scale (ABS), a modified Brief Psychiatric Rating Scale (MBPRS), Clinical Global Impressions (CGI) scale, and an Alertne ss Scale. Effective symptom reduction was achieved in each treatment g roup with significant (P < .01) mean decreases from baseline at every hourly ABS evaluation. Significant (P < .05) mean differences on the A BS (hour 1) and MBPRS (hours 2 and 3) suggest that tranquilization was most rapid in patients receiving the combination treatment, Study eve nt incidence (side effects) did not differ significantly between treat ment groups, although patients receiving haloperidol alone tended to h ave more extrapyramidal system symptoms, The superior results produced by the combination treatment support the use of lorazepam plus halope ridol as the treatment of choice for acute psychotic agitation. (C) 19 97 by W.B. Saunders Company.