Study designs of evaluations included in the review
No inclusion criteria for the study design were specified in the review. However, the authors appear to have intended to include only trials, although whether they were to be randomised or not was unclear. Study design was not listed as one of the characteristics of the included studies.
Specific interventions included in the review
Studies in which the patients were assigned to treatment with a conventional antipsychotic (classic high potency neuroleptic available in the USA), a benzodiazepine, or a combination of both, with one of the other two options as a comparator, were eligible for the review. With the exception of one study of droperidol, the included studies used haloperidol as the conventional antipsychotic; the benzodiazepines were lorazepam, alprozolam, flunitrazepam, clonazepam and midazolam.
Studies in which patients were assigned to either a novel antipsychotic, a conventional antipsychotic, a benzodiazepine or a placebo were also eligible. The novel antipsychotics in the included studies were risperidone, ziprasidone or olanzapine; the conventional antipsychotic was haloperidol; the benzodiazepine was lorazepam.
Participants included in the review
Studies of adult psychiatric patients with acute agitation were eligible for the review. Further details of those included in the review were not given.
Outcomes assessed in the review
For studies involving conventional antipsychotics, the outcomes had to be assessed within 4 hours of drug administration. For studies of atypical antipsychotics, the outcomes had to be assessed within 72 hours of drug administration. Specific criteria for the outcomes were not stated. A range of assessment scales were employed in the included trials: Brief Psychiatric Rating Scale, with various subscales; visual analogue scale for agitation; Overt Aggression Scale; sedation scale score; and Positive and Negative Syndrome Scale (PANSS). Note, the PANSS was only used in trials involving the atypical antipsychotics.
Adverse events, in particular extrapyramidal symptoms (EPS), were reported.
How were decisions on the relevance of primary studies made?
The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.