Department of Psychiatry & Behavioral Sciences, SUNY at Stony Brook, Stony Brook, NY 11794, USA.
Child Adolesc Psychiatry Ment Health. 2009 Mar 12;3(1):9. doi: 10.1186/1753-2000-3-9.
The objective of this study was to compare intramuscular (IM) ziprasidone to conventional IM medications (haloperidol combined with lorazepam) for the treatment of severe agitation in adolescents (age 12-17).
We retrospectively identified consecutive severe agitation episodes (defined as requiring physical restraint) in adolescents treated with either IM ziprasidone or conventional IM agents in a psychiatric emergency room. For ziprasidone, the dosage was 20 mg for 23 episodes and 10 mg for 5 episodes. For 24 episodes treated with combined haloperidol and lorazepam, the dosages were 4.8 +/- 0.3 SEM mg and 1.9 +/- 0.4 mg respectively. Outcomes were the duration of restraint and need for adjunctive "rescue" medications within 60 minutes. These outcomes were decided prior to reviewing any records.
No difference was found in restraint duration (ziprasidone, N = 28, 55 +/- 5 minutes; haloperidol with lorazepam N = 24, 65 +/- 7 minutes, P = NS). Use of "rescue" medications did not differ between the two groups. No changes in blood pressure were found, but pulse decreased 8.3 +/- 2.4 for haloperidol with lorazepam and 8.9 +/- 4.24 for ziprasidone (P = NS). No instances of excessive sedation or extra-pyramidal symptoms were documented.
In this study, IM ziprasidone appeared effective, well tolerated, and similar in clinical profile to combined conventional IM medications for treating severe agitation in adolescents. Given the reportedly favorable acute side effect profile of parenteral atypical agents, they may provide an alternative to conventional antipsychotics for treating acute agitation in both adult and adolescent populations. Future randomized, controlled studies are needed.
本研究旨在比较肌肉内（IM）齐拉西酮与传统 IM 药物（氟哌啶醇联合劳拉西泮）治疗青少年（12-17 岁）严重激越的疗效。
我们回顾性地确定了在精神科急诊室中接受 IM 齐拉西酮或传统 IM 药物治疗的连续严重激越发作（定义为需要身体约束）的青少年病例。对于齐拉西酮，剂量为 20mg 的有 23 例，10mg 的有 5 例。对于接受氟哌啶醇联合劳拉西泮治疗的 24 例，剂量分别为 4.8±0.3SEMmg 和 1.9±0.4mg。60 分钟内的约束持续时间和需要辅助“抢救”药物的情况是结局。在查看任何记录之前，就已经确定了这些结局。
约束持续时间无差异（齐拉西酮，N=28，55±5 分钟；氟哌啶醇联合劳拉西泮，N=24，65±7 分钟，P=NS）。两组之间抢救药物的使用无差异。未发现血压变化，但氟哌啶醇联合劳拉西泮组的脉搏下降 8.3±2.4，齐拉西酮组下降 8.9±4.24（P=NS）。未记录到过度镇静或锥体外系症状。
在这项研究中，IM 齐拉西酮似乎有效、耐受性良好，且在临床特征上与联合使用传统 IM 药物治疗青少年严重激越相似。鉴于静脉注射非典型药物的急性副作用谱据称较好，它们可能为成人和青少年人群急性激越的治疗提供了一种替代传统抗精神病药物的选择。未来需要进行随机、对照研究。
