Diazepam in high doses is effective in schizophrenia

Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine

“…A trial of zuclopenthixol acetate versus other typical antipsychotics for treating aggressive patients with severe psychiatric illness gave only equivocal results (relative risk of “not tranquil or asleep by 1 hour” of 0.6 (95% confidence interval 0.3 to 1.3)) 10. Similar results were reported for comparisons of benzodiazepines with placebo (relative risk 0.2 (0.03 to 1.2))11 and of a benzodiazepine-haloperidol mix with haloperidol alone (0.67 (0.3 to 1.4)) 12. There was some suggestion of an effect, however, when haloperidol was compared with placebo (0.2 (0.04 to 0.9))13 and benzodiazepines were compared with typical antipsychotics (0.64 (0.4 to 0.98)) 12…”

“…Trials evaluating the management of aggressive or violent people are rare and usually small 11 – 14 23 24. TREC is large in comparison, with a completeness of data collection not seen even in short duration randomised trials for psychoses.…”

What kind of research can we realistically expect from the practitioner?

“…For example, this model attributes to high levels of anxiety a strategic role in the development of paranoid schizophrenic symptoms. The first line of evidence came from studies in which high doses of diazepam rapidly ameliorated positive and negative schizophrenic symptoms within a few hours to a few days (Nestoros, 1980a;Nestoros, Suranyi-Cadotte, Spees, Schwartz, & Nair, 1982). This rapid improvement of schizophrenic symptoms was also observed with cholecystokinin (Nair, Bloom, & Nestoros, 1982).…”

Current practices in managing acutely disturbed patients at three hospitals in Rio de Janeiro-Brazil: a prevalence study

“…Only one statistically significant difference was found (RR unimproved by 2 hours 0.19 95% CI 0.04 to 0.9). A very small (n = 12) randomised trial compared benzodiazepines with placebo for acutely disturbed people [11], and, unsurprisingly, found no clear differences. Seven trials (total n = 206), compared benzodiazepines versus typical antipsychotics[9].…”