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激动和攻击性行为的药理学管理：系统评价和荟萃分析。

The pharmacological management of agitated and aggressive behaviour: A systematic review and meta-analysis.

机构信息

Department of Psychiatry & Neuropsychology, Maastricht University, the Netherlands; Mondriaan Maastricht, the Netherlands.

Department of Psychiatry & Neuropsychology, Maastricht University, the Netherlands; Mondriaan Maastricht, the Netherlands.

出版信息

Eur Psychiatry. 2019 Apr;57:78-100. doi: 10.1016/j.eurpsy.2019.01.014. Epub 2019 Feb 2.

DOI:10.1016/j.eurpsy.2019.01.014
PMID:30721802
Abstract

INTRODUCTION

Non-pharmacological interventions preferably precede pharmacological interventions in acute agitation. Reviews of pharmacological interventions remain descriptive or compare only one compound with several other compounds. The goal of this study is to compute a systematic review and meta-analysis of the effect on restoring calmness after a pharmacological intervention, so a more precise recommendation is possible.

METHOD

A search in Pubmed and Embase was done to isolate RCT's considering pharmacological interventions in acute agitation. The outcome is reaching calmness within maximum of 2 h, assessed by the psychometric scales of PANSS-EC, CGI or ACES. Also the percentages of adverse effects was assessed.

RESULTS

Fifty-three papers were included for a systematic review and meta-analysis. Most frequent studied drug is olanzapine. Changes on PANNS-EC and ACES at 2 h showed the strongest changes for haloperidol plus promethazine, risperidon, olanzapine, droperidol and aripiprazole. However, incomplete data showed that the effect of risperidon is overestimated. Adverse effects are most prominent for haloperidol and haloperidol plus lorazepam.

CONCLUSION

Olanzapine, haloperidol plus promethazine or droperidol are most effective and safe for use as rapid tranquilisation. Midazolam sedates most quickly. But due to increased saturation problems, midazolam is restricted to use within an emergency department of a general hospital.

摘要

简介

在急性激越中，非药物干预最好先于药物干预。药物干预的综述仍然是描述性的，或者只比较一种化合物与几种其他化合物。本研究的目的是计算药物干预后恢复平静的效果的系统评价和荟萃分析，以便能够提出更精确的建议。

方法

在 Pubmed 和 Embase 中进行检索，以分离考虑急性激越中药物干预的 RCT。主要结局是在 2 小时内达到平静，通过 PANSS-EC、CGI 或 ACES 的心理计量学量表来评估。还评估了不良反应的百分比。

结果

有 53 篇论文被纳入系统评价和荟萃分析。最常研究的药物是奥氮平。在 2 小时时，PANNS-EC 和 ACES 的变化显示，氟哌啶醇加异丙嗪、利培酮、奥氮平、氟哌啶醇和阿立哌唑的变化最强。然而，不完整的数据表明，利培酮的效果被高估了。氟哌啶醇和氟哌啶醇加劳拉西泮的不良反应最为明显。

结论

奥氮平、氟哌啶醇加异丙嗪或氟哌啶醇是最有效和安全的快速镇静药物。咪达唑仑镇静作用最快。但由于饱和度增加的问题，咪达唑仑仅限于在综合医院的急诊部门使用。

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