Droperidol for psychosis-induced aggression or agitation

Abstract

Background People experiencing acute psychotic illnesses, especially those associated with agitated or violent behaviour, may require urgent pharmacological tranquillisation or sedation. Droperidol, a butyrophenone antipsychotic, has been used for this purpose in several countries. Objectives To estimate the effects of droperidol, including its cost-effectiveness, when compared to placebo, other 'standard' or 'non-standard' treatments, or other forms of management of psychotic illness, in controlling acutely disturbed behaviour and reducing psychotic symptoms in people with schizophrenia-like illnesses. Search methods We updated previous searches by searching the Cochrane Schizophrenia Group Register (18 December 2015). We searched references of all identified studies for further trial citations and contacted authors of trials. We supplemented these electronic searches by handsearching reference lists and contacting both the pharmaceutical industry and relevant authors. Selection criteria We included all randomised controlled trials (RCTs) with useable data that compared droperidol to any other treatment for people acutely ill with suspected acute psychotic illnesses, including schizophrenia, schizoaffective disorder, mixed affective disorders, the manic phase of bipolar disorder or a brief psychotic episode. Data collection and analysis For included studies, we assessed quality, risk of bias and extracted data. We excluded data when more than 50% of participants were lost to follow-up. For binary outcomes, we calculated standard estimates of risk ratio (RR) and the corresponding 95% confidence intervals (CI). We created a 'Summary of findings' table using GRADE. Main results We identified four relevant trials from the update search (previous version of this review included only two trials). When droperidol was compared with placebo, for the outcome of tranquillisation or asleep by 30 minutes we found evidence of a clear difference (1 RCT, N = 227, RR 1.18, 95% CI 1.05 to 1.31, high-quality evidence). There was a clear demonstration of reduced risk of needing additional medication after 60 minutes for the droperidol group (1 RCT, N = 227, RR 0.55, 95% CI 0.36 to 0.85, high-quality evidence). There was no evidence that droperidol caused more cardiovascular arrhythmia (1 RCT, N = 227, RR 0.34, 95% CI 0.01 to 8.31, moderate-1 Droperidol for psychosis-induced aggression or agitation (Review)

The Physical Health Care Fidelity Scale: Psychometric Properties

“…Physical health care for people with psychosis should encompass oral health assessment, help with oral hygiene and early dental referral (Kisely et al 2015a , b ). Evidence for the effectiveness of oral health education, and practical support to visits dentists and brush teeth is limited (Khokhar et al 2016 ).…”

Treatment Options for Acute Agitation in Psychiatric Patients: Theoretical and Empirical Evidence

“…Numerous clinical trials have been conducted, utilizing both the oldest available drugs (haloperidol and benzodiazepines) as well as the more recent ones (atypical antipsychotics) [34,41-43]. Comprehensive systematic reviews are available for benzodiazepines [23] (including trials of different drugs of this class), haloperidol [10], droperidol (a haloperidol analog with a shorter duration of action used mostly in anesthesia) [44], the combination of haloperidol and promethazine [4] and the atypical antipsychotics olanzapine [45], risperidone [46] and aripiprazole [47]. Clinical trials involving other drugs, including ziprasidone have been published, but systematic reviews of these trials are not currently available.…”

Evidence-based review and appraisal of the use of droperidol in the emergency department

“…Tranquilizers and sedatives are usually administered immediately for the safety of patients and medical staffs, and droperidol is one of the choices. A systemic review of six RCTs which investigated the efficacy and safety of droperidol was reported by the Cochrane library [ 11 ]. One high-quality evidence-based RCT in that systemic review demonstrated that patients treated with droperidol (5 mg IV) fell asleep more rapidly at 30 min than when treated by placebo with statistical significance [ 12 ].…”