TITLE:
A Comparison Study of the Efficacy of Rapid Titration Quetiapine and Haloperidol in Agitated Adults in an Emergency Setting
AUTHORS:
Akikur Mohammad, Eugene Laska, Marius Campaneau, Fauzia Syed, Rebecca Ninah, Joseph Wanderling, George Simpson
KEYWORDS:
Quetiapine (Oral), Haloperidol (Parenteral), Agitation, Excitement, Psychoses
JOURNAL NAME:
Open Journal of Psychiatry,
Vol.4 No.3,
July
2,
2014
ABSTRACT: Objective: Intramuscular
(IM) Benzodiazepines and/or Haloperidol alone or with benzodiazepines are
frequently used to treat agitation. Based on emerging literature regarding
Quetiapine used for the control of anxiety we examined Quetiapine as a possible
alternative in selected cases. Methods: This study was a single-blind
randomized study comparing Quetiapine PO (300 mg) with a combination of
Haloperidol (5 mg), Benztropine mesylate (2 mg) and lorazepam (2 mg) administered
IM to treat agitated patients seeking care in a busy psychiatric emergency
setting. Male or female patients (18 - 60), deemed by the attending (admitting)
psychiatrist to be indicative of agitated and/or aggressive behavior and had a
Positive and Negative Syndrome Score-Excited Component (PANSS-EC), as evaluated
by the Research Psychiatrist, and total score equal to or greater than 15.
Patients deemed competent were randomized into one of the following treatment
groups: Quetiapine 300 or Haloperidol 5 mg, benztropine mesylate, or lorazepam
given by the IM route. Two scales, PANSS-EC and CGI-C were used to assess patients
in the trial. The primary outcome measure PANSS-EC at 2 hours after
administration of the medication. Results: Sixty-eight patients were included
in the study. There were no significant treatment group differences in baseline
condition. There was no significant difference between the two conditions.
There was, however, a significant within-group decrease from baseline
condition. Conclusion: Finding no significant differences suggests that in
general the two treatments were equivalent. To sum up, Quetiapine 300 mg as a
single dose appeared safe and effective in agitated patients treated in an ER.
The results were similar to a comparison group receiving an intra-muscular
combination of Haloperidol, Lorazepam and Benztropine. This study has
significant limitations. The study was single blind and the use of a placebo
would have strengthened the design but would be considered unethical. The
sample size was relatively small and the group of patients who come to the ER
may not be representative of the population of patients who visit across the
country. And finally it was a select subgroup who made up the study population
and who were probably less severely ill than other subjects who came to our ER.