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 .
Calming versus sedative effects of intramuscular olanzapine in agitated patients.
Distinct calming rather than nonspecific sedation is desirable for the treatment of acute agitation . In 3 double-blind studies , acutely agitated patients with schizophrenia ( N = 311 ) , bipolar mania ( N = 201 ) , or dementia ( N = 206 ) were treated with intramuscular ( 1 - 3 injections/24 hrs ) olanzapine ( 2.5 - 10.0 mg ) , haloperidol ( 7.5 mg ) , lorazepam ( 2.0 mg ) , or placebo . The Agitation-Calmness Evaluation Scale ( ACES ; Eli Lilly and Co. ) and treatment-emergent adverse events assessed sedation . Across all studies , 1 patient ( lorazepam-treated , bipolar ) became unarousable . There were no significant between-group differences in ACES scores of deep sleep or unarousable at any time across . Excluding asleep patients , agitation remained significantly more reduced with olanzapine than placebo ( P < .05 ) . The incidences of adverse events indicative of sedation were not significantly different with olanzapine versus comparators . For the treatment of acute agitation associated with schizophrenia , bipolar mania , or dementia , intramuscular olanzapine-treated patients experienced no more sedation than haloperidol- or lorazepam-treated patients and experienced distinct calming rather than nonspecific sedation
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 .