Haloperidol for psychosis-induced aggression or agitation (rapid tranquillisation)

Area of Science:

• Psychiatry and Pharmacology
• Clinical Trial Analysis
• Evidence-Based Medicine

Background:

• Haloperidol is a recommended antipsychotic for managing aggression and agitation in psychosis.
• It is widely accessible and often the only option in resource-limited areas.

Purpose of the Study:

• To evaluate the efficacy of haloperidol monotherapy for psychosis-induced aggression or agitation.
• To assess its effectiveness in preventing harm to self and others.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) from the Cochrane Schizophrenia Group's register.
• Included trials compared haloperidol alone against other treatments for psychosis-related aggression/agitation.
• Outcomes assessed included sedation, need for re-sedation, specific behaviors, and adverse effects.

Main Results:

• Haloperidol alone led to more people being asleep at two hours compared to placebo, but with increased risk of dystonia.
• Compared to aripiprazole, haloperidol required fewer injections but had a higher incidence of dystonia.
• Adding promethazine showed benefits, while adding lorazepam did not demonstrate significant advantages and carried risks.

Conclusions:

• Sole use of haloperidol may be life-saving in emergencies where no alternatives exist.
• In settings with other drug options, its sole use for extreme emergencies may be ethically questionable.
• Adding sedating promethazine is supported by moderate-quality evidence; adding benzodiazepines lacks strong evidence and poses risks.