A controlled Nordic multicentre study of zuclopenthixol acetate in oil solution, haloperidol and zuclopenthixol in the treatment of acute psychosis

Abstract

Zuclopenthixol acetate--a new injectable formulation with a duration of action of 2-3 days--was compared with conventional intramuscular and oral formulations of haloperidol and zuclopenthixol in the initial treatment of acutely disturbed, psychotic patients. The patients were stratified into 3 diagnostic categories: acute psychoses (48 patients), mania (22 patients), and exacerbation of chronic psychoses (73 patients). The patients were rated on the Brief Psychiatric Rating Scale (BPRS), the Bech-Rafaelsen Mania Rating Scale (BRMAS) (only manic patients) and globally on the Clinical Global Impression (CGI). The study was an open, randomized multicentre trial with a 6-day treatment period. The zuclopenthixol acetate patients received 1-4 doses, the haloperidol patients 1-26 and the zuclopenthixol patients 1-22 doses. The assessments on the CGI showed that all 3 treatments caused a clear reduction of the severity of illness scores in all 3 diagnostic categories, with no differences between treatments. The ratings of the acute and chronic psychotic patients on the BPRS also showed significant reductions in scores with no differences between treatments. All 3 treatments caused a rapid remission of symptoms on the BRMAS. Haloperidol induced hypokinesia in significantly more patients than zuclopenthixol acetate after 24 h. Later there were no significant differences between treatments. Zuclopenthixol acetate fulfils many desires for an amended neuroleptic formulation for the initial treatment of acutely disturbed psychotic patients.

Factor structure of Bech's version of the Brief Psychiatric Rating Scale in Brazilian patients

“…This version of the BPRS has been used in several studies involving different countries, languages and cultures (13)(14)(15). However, only one pilot study including 34 patients has been carried out to explore the factor structure of this instrument (12).…”

Pharmacological management of aggression and violence

“…The side effects of ZA were rated mild to moderate and included dystonia, rigidity, orthostatic dizziness and hypokinesia. Baastrup et al (1993) report an open, randomised multicentre trial over a 6-day treatment period. The study revealed that three treatments, ZA, HAL or zuclopenthixol (oral) all caused a clear reduction in the severity of illness in 169 consenting patients with diagnostic categories of acute psychosis, mania and chronic psychosis, with no difference between treatments.…”

Cost comparison of zuclopenthixol acetate and haloperidol

“…The main reason for this was the lower use of special nursing in the zuclopenthixol acetate group, indicating that use of zuclopenthixol acetate may be able to reduce the need for special nursing in some patients. Zuclopenthixol acetate has a longer duration of action than aqueous formulations, with one dose remaining active for up to three days (Baastrup et al 1993). This may mean that patients receiving rapid tranquillisa tion with zuclopenthixol acetate are slower to return to a state of agitation and therefore require less high-intensity nursing.…”