Use of antipsychotics and/or benzodiazepines as rapid tranquilization in in-patients of mental facilities and emergency departments a review of the clinical effectiveness and guidelines
In 2010, a previous Rapid Response Report found six systematic reviews (SRs), one meta-analysis (MAs), three randomized controlled trials (RCTs), one major clinical practice guideline (CPG), and five supplementary guideline sources. Based on the available literature, antipsychotics and benzodiazepin...
| Corporate Authors: | , |
|---|---|
| Format: | eBook |
| Language: | English |
| Published: |
Ottawa (ON)
CADTH Rapid Response Service
2015, 29 October 2015
|
| Series: | Rapid response report: summary with critical appraisal
|
| Subjects: | |
| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | In 2010, a previous Rapid Response Report found six systematic reviews (SRs), one meta-analysis (MAs), three randomized controlled trials (RCTs), one major clinical practice guideline (CPG), and five supplementary guideline sources. Based on the available literature, antipsychotics and benzodiazepines appeared to be effective in mediating the symptoms of agitation or aggression. Further, guidelines appeared to vary on the choice of drugs for rapid tranquilization, but they recommended using a combination of an IM antipsychotic (haloperidol) and an IM benzodiazepine (lorazepam) to effectively cope with agitated patients. The purpose of this Rapid Response report is to update the previous review to assess the extent to which there have been advances in the evidence informing the clinical efficacy of antipsychotics and benzodiazepines for rapid tranquilization of in-patients of mental facilities and emergency departments One such strategy is rapid tranquilization, the aim for which is to use psychotropic medications "to calm/lightly sedate the service user, reduce the risk to self and/or others and achieve an optimal reduction in agitation and aggression." Ideally, medications for rapid tranquilization should have a rapid onset of action, result in few adverse effects, and have a short duration of action. Empirical evidence suggests that clinicians often prefer to use two major drug classes - benzodiazepines and antipsychotics, either alone or in combination - to manage agitated patients. Intramuscular (IM) injections of these drugs appear attractive as they may offer superior pharmacokinetic properties and more favourable clinical profiles versus their respective oral formulations. Patients with psychotic illnesses may exhibit agitated, threatening, or destructive behaviour that could be dangerous to themselves or others. Researchers have found that as many as 1 in 5 individuals admitted to acute psychiatric units may commit an act of violence while in hospital. Additional research suggests that patients with psychosis who have a history of violence or substance abuse may be at an increased risk of committing violence. To ensure a safe environment, clinical practice guidelines suggest that health care providers first use verbal de-escalation techniques to engage agitated patients. In some cases, however, verbal de-escalation may be ineffective, thereby necessitating the use of alternative management approaches. |
|---|---|
| Item Description: | Update of previous review: Use of antipsychotics and/or benzodiazepines as rapid tranquilization in inpatients of mental facilities and emergency departments, 2010 |
| Physical Description: | 1 PDF file (43 pages) illustration |