Authors' objectives:

To systematically identify and appraise international evidence for the effectiveness and safety of drug treatment for urgent sedation of individuals in psychiatric emergencies. Urgent sedation is taken to mean the use of drug treatments to achieve rapid, short-term behavioural control of extreme agitation, aggression and potentially violent behaviour that places the patient or those around them at risk of physical harm.

Authors' recommendations: The following conclusions are based on the current evidence available from this reports critical appraisal of literature published on the effectiveness and safety of drug treatments for urgent sedation of individuals in psychiatric emergencies. There are few well-conducted, comparative trials in this field, and only a small range of drugs and settings are represented in the studies appraised in this review. This limits the ability to make specific conclusions to cover the many situations in which urgent sedation may be warranted. From the appraisal of 12 research papers reporting on randomised controlled trials in psychiatric and emergency room settings, pharmacological approaches to urgent sedation appear to be both effective and reasonably safe. There were no studies eligible for appraisal set in the wider community, and no studies were appraised which considered valproic acid derivatives or atypical antipsychotics. There is currently limited availability of drugs for urgent sedation in New Zealand, particularly those available intra-muscularly. Comparisons between particular drug regimens suggest no conclusive benefit in terms of effectiveness of one antipsychotic over another, antipsychotics over benzodiazepines, or combination drugs (of antipsychotics, benzodiazepines and hypnosedatives) over single drug regimens. Side effects were extremely rare in the hours shortly following initial drug administration and urgent sedation appears to be reasonably safe. Given small sample sizes and the shortness of follow-up there was limited scope for conclusive research into the longer-term safety of the drugs considered for urgent sedation in real-world settings. These conclusions are broadly consistent with a systematic review of the management of imminent violence by adult users of mental health services conducted by Wing and colleagues (1998), based on research published between 1980 and 1997. High quality, randomised controlled trials are required investigating the utility of available drugs for urgent sedation (including atypical antipsychotics), employing larger samples, situated in community settings, and systematically manipulating dosage and frequency of drug administration.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://nzhta.chmeds.ac.nz/publications.htm

Year Published: 2001

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: New Zealand

Organisation Name: New Zealand Health Technology Assessment

Contact Address: Department of Public Health and General Practice, Christchurch School of Medicine and Health Sciences, University of Otago, P.O. Box 4345, Christchurch, New Zealand. Tel: +64 3 364 1145; Fax: +64 3 364 1152;

Contact Name: nzhta@chmeds.ac.nz

Contact Email: nzhta@chmeds.ac.nz

Copyright: New Zealand Health Technology Assessment