Benzodiazepines for psychosis-induced aggression or agitation

Abstract

Acute psychotic illness, especially when associated with agitated or violent behavior, can require urgent pharmacological tranquillization or sedation. In many countries, benzodiazepines (either alone or in combination with antipsychotics) are often used in this situation (1). Objectives To examine whether benzodiazepines, alone or in combination with other pharmacological agents, are an effective treatment for psychosis-induced aggression or agitation when compared with placebo, other pharmacological agents (alone or in combination) or non-pharmacological approaches. Search Methods We searched the Cochrane Schizophrenia Group's register (January 2012, August 20, 2015 and August 3, 2016), inspected reference lists of included and excluded studies, and contacted authors of relevant studies. Selection Criteria We included all randomized controlled trials (RCTs) comparing benzodiazepines alone or in combination (with antipsychotics), vs placebo or antipsychotics alone or in combination (with other antipsychotics, benzodiazepines or antihistamines) for people who were aggressive or agitated due to psychosis. Data Collection and Analysis We reliably selected studies, quality assessed them, and extracted data. For binary outcomes, we calculated standard estimates of risk ratio (RR) and their 95% CI using a fixed-effect model. For continuous outcomes, we calculated the mean difference (MD) between groups. If there was heterogeneity, this was explored using a random-effects model. We assessed the risk of bias and created a "Summary of findings" table using GRADE (table 1). Main Results Twenty trials including 695 participants are included in this review. The quality of evidence for the main outcomes was low or very low due to the very small sample sizes of included studies and serious risk of bias (randomization, allocation concealment and blinding were not well conducted in the included trials, and 6 out of the 20 trials were supported by pharmaceutical institutes). There was no clear effect for most outcomes.