Cochrane · systematic review · CD003079
Benzodiazepines for psychosis‐induced aggression or agitation
Zaman, H, Sampson, SJ, Beck, ALS, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
45
current version
GRADE rated
26
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 19 · 42.2%Very low 11 · 24.4%Low 15 · 33.3%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Show all 2 versionsBenzodiazepines compared to placebo for psychosis‐induced aggression or agitation
Population: people with psychosis‐induced aggression or agitation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tranquillisation or asleep: sedation ‐ medium termNumber of participants sedated Benzodiazepines vs placebo | RR 1.67 [0.42, 6.61] | 1 study · 102 participants | Very low Downgraded: risk of bias, imprecision |
Global state: no improvement ‐ medium termAs defined in each study Benzodiazepines vs placebo | RR 0.62 [0.4, 0.97] | 1 study · 102 participants | Very low Downgraded: risk of bias, imprecision |
Global state: need for additional medication ‐ medium termNumber of participants requiring additional medication Benzodiazepines vs placebo | RR 1 [0.69, 1.44] | 1 study · 102 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects/events: extrapyramidal symptoms ‐ medium termNumber of instances of extrapyramidal symptoms Benzodiazepines vs placebo | RR 0.33 [0.04, 3.1] | 1 study · 102 participants | Very low Downgraded: risk of bias, imprecision |
Satisfaction with treatment: from the perspective of consumer, family and informal carers or professionals/carers at any point during the acute management stage Benzodiazepines vs placebo | no estimate extracted | 0 studies · 0 participants | Ungraded |
Economic outcomes: cost‐effectiveness ‐ clinically important Benzodiazepines vs placebo | no estimate extracted | 0 studies · 0 participants | Ungraded |
Benzodiazepines compared to antipsychotics for psychosis‐induced aggression or agitation
Population: people with psychosis‐induced aggression or agitation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tranquillisation or asleep: sedation ‐ medium term vs haloperidol Number of participants sedated Benzodiazepines vs antipsychotics | RR 1.13 [0.83, 1.54] | 8 studies · 434 participants | Low Downgraded: risk of bias, imprecision |
Global state: no improvement ‐ vs haloperidol ‐ medium term As defined in each study Benzodiazepines vs antipsychotics | RR 0.89 [0.71, 1.11] | 5 studies · 188 participants | Low Downgraded: risk of bias, imprecision |
Global state: no improvement ‐ vs olanzapine ‐ medium term As defined in each study Benzodiazepines vs antipsychotics | RR 1.84 [1.06, 3.18] | 1 study · 150 participants | Very low Downgraded: risk of bias, imprecision |
Global state: need for additional medication ‐ medium termNumber of participants requiring additional medication Benzodiazepines vs antipsychotics | no estimate extracted | 2 studies · 216 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects/events: extrapyramidal symptoms ‐ vs haloperidol ‐ medium term Number of instances of extrapyramidal symptoms Benzodiazepines vs antipsychotics | RR 0.13 [0.04, 0.41] | 6 studies · 233 participants | Low Downgraded: risk of bias, imprecision |
Satisfaction with treatment: from the perspective of consumer, family and informal care givers or professionals/carers at any point during the acute management stage Benzodiazepines vs antipsychotics | no estimate extracted | 0 studies · 0 participants | Ungraded |
Economic outcomes: cost‐effectiveness Benzodiazepines vs antipsychotics | no estimate extracted | 0 studies · 0 participants | Ungraded |
Benzodiazepines compared to antihistamines plus antipsychotics for psychosis‐induced aggression or agitation
Population: people with psychosis‐induced aggression or agitation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tranquillisation or asleep: sedation ‐ medium term ‐ lorazepam vs haloperidol + promethazineNumber of participants sedated Benzodiazepines vs antihistamines plus antipsychotics | RR 0.91 [0.84, 0.98] | 1 study · 200 participants | Low Downgraded: risk of bias, imprecision |
Tranquillisation or asleep: sedation ‐ medium term ‐ midazolam vs haloperidol + promethazineNumber of participants sedated Benzodiazepines vs antihistamines plus antipsychotics | RR 1.13 [1.04, 1.23] | 1 study · 301 participants | Low Downgraded: risk of bias, imprecision |
Global state: no improvement ‐ medium termAs defined in each study Benzodiazepines vs antihistamines plus antipsychotics | RR 2.17 [1.16, 4.05] | 1 study · 200 participants | Low Downgraded: risk of bias, imprecision |
Global state: need for additional medication ‐ medium termNumber of participants requiring additional medication Benzodiazepines vs antihistamines plus antipsychotics | RR 1.33 [0.31, 5.81] | 1 study · 200 participants | Low Downgraded: risk of bias, imprecision |
Adverse effects/events: extrapyramidal symptoms ‐ medium termNumber of instances of extrapyramidal symptoms Benzodiazepines vs antihistamines plus antipsychotics | no estimate extracted | 0 studies · 0 participants | Ungraded |
Satisfaction with treatment: from the perspective of consumer, family and informal carers or professionals/carers at any point during the acute management stage Benzodiazepines vs antihistamines plus antipsychotics | no estimate extracted | 0 studies · 0 participants | Ungraded |
Economic outcomes: cost‐effectiveness Benzodiazepines vs antihistamines plus antipsychotics | no estimate extracted | 0 studies · 0 participants | Ungraded |
Benzodiazepines + antipsychotics compared to same enzodiazepines for psychosis‐induced aggression or agitation
Population: people with psychosis‐induced aggression or agitation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tranquillisation or asleep: sedation ‐ medium term‐ + haloperidol ‐ medium term Number of participants sedated Benzodiazepines + antipsychotics vs same enzodiazepines | RR 0.84 [0.59, 1.19] | 2 studies · 110 participants | Low Downgraded: risk of bias, imprecision |
Global state: no improvement ‐ + haloperidol ‐ medium term As defined in each study Benzodiazepines + antipsychotics vs same enzodiazepines | RR 0.96 [0.76, 1.2] | 3 studies · 113 participants | Low Downgraded: risk of bias, imprecision |
Global state: no improvement ‐ lorazepam + risperidone vs lorazepam ‐ medium termAs defined in each study Benzodiazepines + antipsychotics vs same enzodiazepines | RR 0.86 [0.45, 1.64] | 1 study · 20 participants | Low Downgraded: risk of bias, imprecision |
Global state: need for additional medication ‐ + haloperidol ‐ medium term Number of participants requiring additional medication Benzodiazepines + antipsychotics vs same enzodiazepines | RR 1.02 [0.79, 1.32] | 3 studies · 103 participants | Low Downgraded: risk of bias, imprecision |
Adverse effects/events: extrapyramidal symptoms ‐ + haloperidol ‐ medium term Number of instances of extrapyramidal symptoms Benzodiazepines + antipsychotics vs same enzodiazepines | RR 1.94 [0.18, 20.3] | 2 studies · 83 participants | Low Downgraded: risk of bias, imprecision |
Satisfaction with treatment: from the perspective of consumer, family and informal carers or professionals/carers at any point during the acute management stage Benzodiazepines + antipsychotics vs same enzodiazepines | no estimate extracted | 0 studies · 0 participants | Ungraded |
Economic outcomes: cost‐effectiveness Benzodiazepines + antipsychotics vs same enzodiazepines | no estimate extracted | 0 studies · 0 participants | Ungraded |
Benzodiazepines + antipsychotics compared to same antipsychotics for psychosis‐induced aggression or agitation
Population: people with psychosis‐induced aggression or agitation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tranquillisation or asleep: sedation ‐ medium term ‐ +/vs haloperidol Number of participants sedated Benzodiazepines + antipsychotics vs same antipsychotics | RR 1.75 [1.14, 2.67] | 3 studies · 172 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Global state: no improvement ‐ +/vs haloperidol ‐ medium term As defined in each study Benzodiazepines + antipsychotics vs same antipsychotics | RR 1.17 [0.93, 1.46] | 4 studies · 185 participants | Low Downgraded: imprecision, inconsistency |
Global state: need for additional medication Number of participants requiring additional medication Benzodiazepines + antipsychotics vs same antipsychotics | no estimate extracted | 1 study · 67 participants | Low Downgraded: risk of bias, imprecision |
Adverse effects/events: extrapyramidal symptoms ‐ +/vs haloperidol ‐ medium term Number of instances of extrapyramidal symptoms Benzodiazepines + antipsychotics vs same antipsychotics | RR 0.44 [0.16, 1.17] | 2 studies · 127 participants | Low Downgraded: imprecision |
Satisfaction with treatment: from the perspective of consumer, family and informal carers or professionals/carers at any point during the acute management stage Benzodiazepines + antipsychotics vs same antipsychotics | no estimate extracted | 0 studies · 0 participants | Ungraded |
Economic outcomes: cost‐effectiveness Benzodiazepines + antipsychotics vs same antipsychotics | no estimate extracted | 0 studies · 0 participants | Ungraded |
Benzodiazepines plus antipsychotics compared to antipsychotics plus antipsychotics for psychosis‐induced aggression or agitation
Population: people with psychosis‐induced aggression or agitation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tranquillisation or asleep: sedation ‐ medium term Benzodiazepines plus antipsychotics vs antipsychotics plus antipsychotics | no estimate extracted | 0 studies · 0 participants | Ungraded |
Global state: no improvement ‐ medium term Benzodiazepines plus antipsychotics vs antipsychotics plus antipsychotics | no estimate extracted | 0 studies · 0 participants | Ungraded |
Global state: need for additional medication ‐ medium term Benzodiazepines plus antipsychotics vs antipsychotics plus antipsychotics | no estimate extracted | 0 studies · 0 participants | Ungraded |
Adverse effects/events: extrapyramidal symptoms ‐ medium term Benzodiazepines plus antipsychotics vs antipsychotics plus antipsychotics | no estimate extracted | 0 studies · 0 participants | Ungraded |
Satisfaction with treatment: from the perspective of consumer, family and informal carers or professionals/carers at any point during the acute management stage Benzodiazepines plus antipsychotics vs antipsychotics plus antipsychotics | no estimate extracted | 0 studies · 0 participants | Ungraded |
Economic outcomes: cost‐effectiveness Benzodiazepines plus antipsychotics vs antipsychotics plus antipsychotics | no estimate extracted | 0 studies · 0 participants | Ungraded |
Benzodiazepines plus antipsychotics compared to antihistamines plus antipsychotics for psychosis‐induced aggression or agitation
Population: people with psychosis‐induced aggression or agitation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tranquillisation or asleep: sedation ‐ medium termNumber of participants sedated Benzodiazepines plus antipsychotics vs antihistamines plus antipsychotics | RR 12 [1.66, 86.59] | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision |
Global state: no improvement ‐ medium termAs defined in each study Benzodiazepines plus antipsychotics vs antihistamines plus antipsychotics | RR 25 [1.55, 403.99] | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision |
Global state: need for additional medication ‐ medium termNumber of participants requiring additional medication Benzodiazepines plus antipsychotics vs antihistamines plus antipsychotics | no estimate extracted | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects/events: extrapyramidal symptoms ‐ medium termNumber of instances of extrapyramidal symptoms Benzodiazepines plus antipsychotics vs antihistamines plus antipsychotics | RR 0.6 [0.16, 2.29] | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision |
Satisfaction with treatment: from the perspective of consumer, family and informal carers or professionals/carers at any point during the acute management stage Benzodiazepines plus antipsychotics vs antihistamines plus antipsychotics | no estimate extracted | 0 studies · 0 participants | Ungraded |
Economic outcomes: cost‐effectiveness Benzodiazepines plus antipsychotics vs antihistamines plus antipsychotics | no estimate extracted | 0 studies · 0 participants | Ungraded |