Abstract
BackgroundConventional antipsychotics augmented with benzodiazepines have been the standard acute treatment for psychiatric emergencies for more than 50 years. The inability of patients to give informed consent limits randomised, controlled studies. This observational study on immediate therapy for aggression and impulse control in acutely agitated patients (IMPULSE) evaluated the short-term effectiveness and tolerability of atypical and typical antipsychotic medications (AP) in a non-interventional setting.MethodsThis was a comparative, non-randomised, prospective, open-label, observational study. Treatment over the first 5 days was classified according to whether any olanzapine, risperidone, or haloperidol was included or not. Documentations (PANSS-excited component, CGI-aggression, CGI-suicidality, tranquilisation score) were at baseline (day 1) and days 2–6 after start of AP.ResultsDuring the short treatment-period, PANSS-EC and CGI-aggression scores improved in all cohorts. 68.7% of patients treated with olanzapine, 72.2% of patients treated with risperidone, and 83.3% of patients treated with haloperidol received concomitant benzodiazepines (haloperidol vs. non-haloperidol: p < 0.001). More patients treated with olanzapine (73.8%) were fully alert according to a tranquilisation score and active at day 2 than patients treated with risperidone (57.1%) or haloperidol (58.0%).ConclusionCurrent medication practices for immediate aggression control are effective with positive results present within a few days. In this study, concomitant benzodiazepine use was significantly more frequent in patients receiving haloperidol.
Highlights
Conventional antipsychotics augmented with benzodiazepines have been the standard acute treatment for psychiatric emergencies for more than 50 years
Oral antipsychotic medication was used in the majority of cases, but parenteral acute or depot formulations were used as well
Immediate control of aggressive and impulsive behaviour can be effectively achieved through administration of antipsychotic medications, which are often administered without knowing the definite diagnosis in this specific setting
Summary
Conventional antipsychotics augmented with benzodiazepines have been the standard acute treatment for psychiatric emergencies for more than 50 years. The inability of patients to give informed consent limits randomised, controlled studies This observational study on immediate therapy for aggression and impulse control in acutely agitated patients (IMPULSE) evaluated the short-term effectiveness and tolerability of atypical and typical antipsychotic medications (AP) in a non-interventional setting. Behavioural emergencies occur in approximately 1% to 20% of psychiatric patients admitted to hospitals and necessitate physical restraint, seclusion and involuntary (parenteral) medication [1,2,3]. Serious injuries to both patients and staff can occur. The inability of acutely agitated patients to give informed consent limits the possibility to conduct randomised, controlled studies evaluating the effectiveness of different treatment options [2]. The most important side-effects of acute typical antipsychotic treatment are acute dystonic reac-
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