Zuclopenthixol acetate in psychiatric emergencies: looking for evidence from clinical trials

Background: Case series and reviews have suggested the effectiveness of zuc lopenthixol acetate in the acute management of disturbed behaviour caused b y serious mental illnesses. This review investigates the trial-based eviden ce for these suggestions. Methods: All randomized clinical trials comparing zuclopenthixol acetate to other 'standard' treatments for the acute manage ment of those with serious mental illnesses were identified and, if possibl e, their results summated. Results: Six trials were identified. All had met hodological problems and one did not meet the minimal methodological inclus ion criteria. The summary data do not demonstrate that zuclopenthixol aceta te is better than 'standard care' for altering behaviour, decreasing the ne ed for supplementary medication, avoiding side-effects. or postponing early discharge against medical advice. One trial, however. presented data that suggested an earlier, more intense level of sedation. Conclusions: Recommen dations of reviews and open studies for the use of zuclopenthixol acetate i n preference to 'standard' treatments in the psychiatric emergency are not supported by evidence from randomized controlled trials. (C) 2000 Elsevier Science B.V. All rights reserved.