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Tijdschrift voor Psychiatrie 53 (2011) 10, 727 - 737

Review article

Rapid tranquillisation; review of the literature and recommendations

M. Bak, J. van Os, M. Marcelis

summary
background In The Netherlands, no guidelines exist for rapid tranquillisation in the contextof acute agitation, excitementor aggression secondarytoapsychiatric disorder.
aim To generate an overview of medication regimes suitable for rapid tranquillisation.
method Aliterature search was conducted focussing on the effect of medical interventions in acute excitement, agitation or aggression. Primary outcome measurements were tranquillity, being calm, sedation, or asleep within two hours. Secondary outcome measures were frequency of re-administration and adverse side effects.
results Haloperidol appears as effective as lorazepam; haloperidol in combination with lorazepam does not have added value to lorazepam or haloperidol alone. Dehydrobenzperidol, risperidone, olanzapine and aripiprazole are comparable in effectiveness to lorazepam or haloperidol. Haloperidolin combination with promethazineis associated withamore rapid onset of effect than lorazepam, haloperidol or olanzapine. Midazolam is faster than the combination of haloperidol and promethazine, but requires more frequent re-administration of medication and increases the risk for respiratory depression. The literature on quetiapine was insufficient. The level of evidence, however, is modest. conclusion Haloperidol in combination with promethazine, and olanzapine, are effectivein psychotic agitation, although haloperidolplus promethazinehasamorerapid onsetof effect faster; lorazepam is effective in non-psychotic agitation, aggression or excitement as well as in acute agitation of unknown origin.

keywords aggression, agitation, sedation, tranquillisation