Risperidone Liquid Concentrate and Oral Lorazepam Versus Intramuscular Haloperidol and Intramuscular Lorazepam for Treatment of Psychotic Agitation

Background: Although agitation associated withpsychosis is a common presentation in the psychiatric emergencyservice, there is no consensus concerning the best treatment.Standard treatment often consists of intramuscular (i.m.)injection of high-potency neuroleptics, sometimes combined withbenzodiazepines. The objective of this study was to determine therelative efficacy, safety, and tolerability of oral risperidoneversus intramuscular haloperidol, both in combination withlorazepam, for the emergency treatment of psychotic agitation inpatients who are able to accept oral medications.

Method: A convenience sample of psychoticpatients admitted to a large psychiatric emergency service whorequired emergency medication for the control of agitation and/orviolence was offered risperidone (2 mg liquid concentrate) andoral lorazepam (2 mg) as an alternative to standard care at theinstitution, haloperidol (5 mg i.m.) and lorazepam (2 mg i.m.).Subjects who refused the oral medications were given theintramuscular treatment as a component of routine care.

Results: Thirty patients were enrolled in eachtreatment group. Although men were significantly more likely tochoose oral medication (chi² = 5.165, p < .023),other demographic characteristics did not differ significantlybetween the 2 treatment groups. Both groups showed similarimprovement in agitation as measured by 5 agitation subscales ofthe Positive and Negative Syndrome Scale (PANSS), the ClinicalGlobal Impressions (CGI) scale, and time to sedation. No patientsreceiving risperidone demonstrated any side effects or adverseevents, while 1 patient receiving intramuscular treatment withhaloperidol developed acute dystonia. One subject receivingrisperidone required subsequent treatment with haloperidol forongoing agitation.

Conclusion: Oral treatment withrisperidone and lorazepam appears to be a tolerable andcomparable alternative to intramuscular haloperidol and lorazepamfor short-term treatment of agitated psychosis in patients whoaccept oral medications.