Cipriani A, Rendell J M, Geddes J R
University of Verona, Department of Medicine and Public Health, Section of Psychiatry, Policlinico "G.B.Rossi", Pzz.le L.A. Scuro, 10, 37134 Verona, Italy. andrea.cipriani@ univr.it
Cochrane Database Syst Rev. 2006 Jul 19(3):CD004362. doi: 10.1002/14651858.CD004362.pub2.
The main objectives in treating mania are to control dangerous behaviour, reduce suicide, produce appropriate acute sedation and shorten the episode of mood disturbance. Among different drugs, haloperidol has for many years been used in treating psychotic patients, but it has a troublesome side effect profile.
To assess the effects of haloperidol for the treatment of mania in comparison with placebo or other active drugs, either as monotherapy or add-on treatment.
We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (11 October 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005), MEDLINE (1966-2003), EMBASE (1980-2003), CINAHL (1982-2003), PsycINFO (1872-2003) and reference lists. We also contacted experts, triallists and pharmaceutical companies in the field.
Randomised trials comparing haloperidol with placebo or other active treatment in the treatment of acute manic or mixed episodes in patients with bipolar disorder or schizoaffective disorder.
Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We collected adverse effects information from the trials.
Fifteen trials involving 2022 people were included. Compared to placebo, haloperidol was more effective at reducing manic symptoms, both as monotherapy (Weighted Mean Difference (WMD) -5.85, 95% Confidence Interval (CI) -7.69 to -4.00) and as adjunctive treatment to lithium or valproate (WMD -5.20, 95% CI -9.26 to -1.14). There was a statistically significant difference, with haloperidol being less effective than aripiprazole (Relative Risk (RR) 1.45, 95% CI 1.22 to 1.73). No significant differences between haloperidol and risperidone, olanzapine, carbamazepine or valproate were found. Compared with placebo, a statistically significant difference in favour of haloperidol in failure to complete treatment (RR 0.74, 95% Cl 0.57 to 0.96) was reported. Haloperidol was associated with less weight gain than olanzapine (RR: 0.28, 95% CI 0.12 to 0.67), but with a higher incidence of tremor (RR: 3.01, 95% CI 1.55 to 5.84) and other movement disorders.
AUTHORS' CONCLUSIONS: There is some evidence that haloperidol is an effective treatment for acute mania. From the limited data available, there was no difference in overall efficacy of treatment between haloperidol and olanzapine or risperidone. Some evidence suggests that haloperidol could be less effective than aripiprazole. Referring to tolerability, when considering the poor evidence comparing drugs, clinicians and patients should consider different side effect profiles as an important issue to inform their choice.
治疗躁狂症的主要目标是控制危险行为、降低自杀风险、实现适当的急性镇静并缩短情绪紊乱发作期。在不同药物中，氟哌啶醇多年来一直用于治疗精神病患者，但其副作用令人困扰。
评估氟哌啶醇与安慰剂或其他活性药物相比，作为单一疗法或辅助治疗用于治疗躁狂症的效果。
我们检索了Cochrane协作抑郁、焦虑与神经症对照试验注册库（2005年10月11日）、Cochrane对照试验中央注册库（《Cochrane图书馆》2005年第3期）、MEDLINE（1966年至2003年）、EMBASE（1980年至2003年）、CINAHL（1982年至2003年）、PsycINFO（1872年至2003年）以及参考文献列表。我们还联系了该领域的专家、试验者和制药公司。
比较氟哌啶醇与安慰剂或其他活性治疗用于治疗双相情感障碍或分裂情感性障碍患者急性躁狂或混合发作的随机试验。
两位作者独立评估试验质量并提取数据。我们联系研究作者获取更多信息。我们从试验中收集不良反应信息。
纳入了15项涉及2022人的试验。与安慰剂相比，氟哌啶醇作为单一疗法（加权均数差（WMD）-5.85，95%置信区间（CI）-7.69至-4.00）以及作为锂盐或丙戊酸盐的辅助治疗（WMD -5.20，95% CI -9.26至-1.14）时，在减轻躁狂症状方面更有效。存在统计学显著差异，氟哌啶醇的疗效低于阿立哌唑（相对风险（RR）1.45，95% CI 1.22至1.73）。未发现氟哌啶醇与利培酮、奥氮平、卡马西平或丙戊酸盐之间存在显著差异。与安慰剂相比，报告显示在治疗未完成方面氟哌啶醇有统计学显著优势（RR 0.74，95% Cl 0.57至0.96）。氟哌啶醇导致的体重增加少于奥氮平（RR：0.28，95% CI 0.12至0.67），但震颤发生率更高（RR：3.01，95% CI 1.55至5.84）以及其他运动障碍。
有一些证据表明氟哌啶醇是治疗急性躁狂的有效药物。从现有有限数据来看，氟哌啶醇与奥氮平或利培酮在总体治疗疗效上无差异。一些证据表明氟哌啶醇的疗效可能低于阿立哌唑。在耐受性方面，鉴于比较药物的证据不足，临床医生和患者应将不同的副作用情况作为重要因素来指导用药选择。
