When haloperidol and midazolam were compared with olanzapine , there was some evidence the combination was superior in terms of improvement , sedation and behaviour .
There were relatively little good data and most trials are too small to highlight differences in either positive or negative effects .
Adding a benzodiazepine to other drugs does not seem to confer clear advantage and has potential for adding unnecessary adverse effects .
Sole use of older antipsychotics unaccompanied by anticholinergic drugs seems difficult to justify .
BACKGROUND Acute psychotic illness , especially when associated with agitated or violent behaviour , can require urgent pharmacological tranquillisation or sedation .
In several countries , clinicians often use benzodiazepines ( either alone or in combination with antipsychotics ) for this outcome .
OBJECTIVES To estimate the effects of benzodiazepines , alone or in combination with antipsychotics , when compared with placebo or antipsychotics , alone or in combination with antihistamines , to control disturbed behaviour and reduce psychotic symptoms .
A double-blind study of lorazepam versus the combination of haloperidol and lorazepam in managing agitation.
STUDY OBJECTIVE To compare the utility of intramuscular lorazepam ( LZ ) with the combination of intramuscular haloperidol ( HDL ) and LZ to control  acutely agitated behavior .  DESIGN R and omized double-blind comparison . SETTING Psychiatric emergency service of a large , university-affiliated , municipal hospital . PATIENTS Twenty subjects treated on the psychiatric emergency service . INTERVENTIONS Patients received an injection of either LZ 2 mg ( 11 patients ) or HDL 5 mg plus LZ 2 mg ( 9 patients ) . The Overt Aggression Scale ( OAS ) , visual analog scales reflecting agitation and hostility , and the Clinical Global Impressions ( CGI ) severity scale were administered at baseline and 30 , 60 , 120 , and 180 minutes after the injection . MEASUREMENTS AND MAIN RESULTS Planned data comparisons included categoric assignment of patients as improved , as defined by decreases in outcome measures 60 minutes after the injection , as well as continuous variables up to 180 minutes after the injection . A significantly greater percentage of subjects receiving combined treatment improved on the specific measures 60 minutes after dosing ( p<0.05 ) . Kaplan-Meier survival analyses showed significant between-group differences in survival curves plotted for the entire study period ( p<0.05 ) . Repeated measures analyses of variance study ing group differences showed that both groups improved over time , but between-group differences were not significant . The powers of these analyses were low due to the small sample . No serious adverse effects occurred in either treatment group . CONCLUSION Our results suggest superior efficacy for HDL-LZ over LZ alone . Categoric tests of improvement at 60 minutes provided the strongest evidence of group differences
When haloperidol and midazolam were compared with olanzapine , there was some evidence the combination was superior in terms of improvement , sedation and behaviour .
There were relatively little good data and most trials are too small to highlight differences in either positive or negative effects .
Adding a benzodiazepine to other drugs does not seem to confer clear advantage and has potential for adding unnecessary adverse effects .
Sole use of older antipsychotics unaccompanied by anticholinergic drugs seems difficult to justify .
BACKGROUND Acute psychotic illness , especially when associated with agitated or violent behaviour , can require urgent pharmacological tranquillisation or sedation .
In several countries , clinicians often use benzodiazepines ( either alone or in combination with antipsychotics ) for this outcome .
OBJECTIVES To estimate the effects of benzodiazepines , alone or in combination with antipsychotics , when compared with placebo or antipsychotics , alone or in combination with antihistamines , to control disturbed behaviour and reduce psychotic symptoms .