Risperidone Liquid Concentrate and Oral Lorazepam Versus Intramuscular Haloperidol and Intramuscular Lorazepam for Treatment of Psychotic Agitation
J Clin Psychiatry 2001;62(3):153-157
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Although agitation associated with
psychosis is a common presentation in the psychiatric emergency
service, there is no consensus concerning the best treatment.
Standard treatment often consists of intramuscular (i.m.)
injection of high-potency neuroleptics, sometimes combined with
benzodiazepines. The objective of this study was to determine the
relative efficacy, safety, and tolerability of oral risperidone
versus intramuscular haloperidol, both in combination with
lorazepam, for the emergency treatment of psychotic agitation in
patients who are able to accept oral medications.
Method: A convenience sample of psychotic
patients admitted to a large psychiatric emergency service who
required emergency medication for the control of agitation and/or
violence was offered risperidone (2 mg liquid concentrate) and
oral lorazepam (2 mg) as an alternative to standard care at the
institution, haloperidol (5 mg i.m.) and lorazepam (2 mg i.m.).
Subjects who refused the oral medications were given the
intramuscular treatment as a component of routine care.
Results: Thirty patients were enrolled in each
treatment group. Although men were significantly more likely to
choose oral medication (chi2 = 5.165, p < .023),
other demographic characteristics did not differ significantly
between the 2 treatment groups. Both groups showed similar
improvement in agitation as measured by 5 agitation subscales of
the Positive and Negative Syndrome Scale (PANSS), the Clinical
Global Impressions (CGI) scale, and time to sedation. No patients
receiving risperidone demonstrated any side effects or adverse
events, while 1 patient receiving intramuscular treatment with
haloperidol developed acute dystonia. One subject receiving
risperidone required subsequent treatment with haloperidol for
Conclusion: Oral treatment with
risperidone and lorazepam appears to be a tolerable and
comparable alternative to intramuscular haloperidol and lorazepam
for short-term treatment of agitated psychosis in patients who
accept oral medications.