REVIEW ER 'S CONCLUSIONS We found no significant evidence to support the use of clotiapine rather than other ' st and ard ' or ' non-st and ard ' treatments for the management of  acute psychotic illness .
BACKGROUND Acute psychotic illness , especially when associated with agitated or violent behaviour , requires urgent pharmacological tranquillisation or sedation .
Clotiapine , a dibenzothiazepine neuroleptic , is being used for this purpose in several countries .
OBJECTIVES To estimate the effects of clotiapine when compared to other ' st and ard ' or ' non-st and ard ' treatments of acute psychotic illness in controlling disturbed behaviour and reducing psychotic symptoms .
Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine
Abstract Objective To compare two widely used drug treatments for people with aggression or agitation due to mental illness . Design Pragmatic , r and omised clinical trial . Setting Three psychiatric emergency rooms in Rio de Janeiro , Brazil . Subjects 301 aggressive or agitated people . Interventions Open treatment with intramuscular midazolam or intramuscular haloperidol plus promethazine . Main outcome measures Patients tranquil or se date d at 20 minutes . Secondary outcomes : patients tranquil or asleep by 40 , 60 , and 120 minutes ; restrained or given extra drugs within 2 hours ; severe adverse events ; another episode of agitation or aggression ; needing extra visits from doctor during first 24 hours ; overall antipsychotic load in first 24 hours ; and not discharged by two weeks . Results 151 patients were r and omised to midazolam , and 150 to haloperidol-promethazine mix . Follow up for the primary outcome was available for 298 ( 99 % ) : 134/151 ( 89 % ) of patients given midazolam were tranquil or asleep after 20 minutes compared with 101/150 ( 67 % ) of those given haloperidol plus promethazine ( relative risk 1.32 ( 95 % confidence interval 1.16 to 1.49 ) ) . By 40 minutes , midazolam still had a statistically and clinical ly significant 13 % relative advantage ( 1.13 ( 1.01 to 1.26 ) ) . After 1 hour , about 90 % of both groups were tranquil or asleep . One important adverse event occurred in each group : a patient given midazolam had transient respiratory depression , and one given haloperidol-promethazine had a gr and e mal seizure . Conclusions Both treatments were effective . Midazolam was more rapidly sedating than haloperidol-promethazine , reducing the time people are exposed to aggression . Adverse effects and re sources to deal with them should be considered in the choice of the treatment
REVIEW ER 'S CONCLUSIONS We found no significant evidence to support the use of clotiapine rather than other ' st and ard ' or ' non-st and ard ' treatments for the management of  acute psychotic illness .
BACKGROUND Acute psychotic illness , especially when associated with agitated or violent behaviour , requires urgent pharmacological tranquillisation or sedation .
Clotiapine , a dibenzothiazepine neuroleptic , is being used for this purpose in several countries .
OBJECTIVES To estimate the effects of clotiapine when compared to other ' st and ard ' or ' non-st and ard ' treatments of acute psychotic illness in controlling disturbed behaviour and reducing psychotic symptoms .