Journal international sur la santé mentale d'urgence et la résilience humaine

Abstrait

Parenteral Haloperidol-Promethazine versus Haloperidol- Diazepam for Rapid Tranquillization of Acutely Agitated Psychiatric Patients at Mirembe Mental Hospital, Dodoma: A Randomized Control Trial

Syangu Mwankemwa, Azan Nyundo, Wende Mtega, Emmanuel Bonambucha

Objective: To compare the effectiveness between parenteral haloperidol-promethazine versus haloperidol-diazepam in achieving rapid tranquillization of acutely agitated psychiatric patients at emergency settings.

Methods: A single blinded permutated block randomization of two treatments was assigned to 86 acutely agitated psychotic patients at Mirembe mental health hospital. Positive and Negative Syndrome Scale Excited Component (PANSS-EC) was used to evaluate severity of agitation at baseline and at 15, 30, 60 and 120 minutes; Ramsay Sedation Scale (RSS) was used to at follow up to assess degree of sedation. Addition of tranquil medication and side effect profile was assessed at 24 and 72 hours.

Results: Both treatment groups show effectiveness in reducing agitation symptoms. Haloperidol-diazepam group show rapid reduction of agitation at 15-30 min (P=0.0002; P=0.0017); while differences in mean scores were not significant at 60 and 120 minutes. Haloperidol-diazepam group had significant sedation effect to patients 3.92 (SD=1.38) compared to haloperidol plus promethazine group 2.85 (SD=1.26). At 24 hours and 72 hours, haloperidol-diazepam group had more added injection compared to haloperidol-promethazine group. There were more patients who were either drowsy or stuporous and few unresponsive at 15, 30 and 60 minutes in haloperidol-diazepam group compared to haloperidol-promethazine group which had more patients either alert or drowsy and few stupors.

Conclusion: Both combination agents are effective in reducing agitation. However, haloperidol-diazepam had more rapid onset of action with more sedating effect compared to haloperidol-promethazine which had slightly slower onset, prolonged effect and less sedating effect. Guidelines recommend use of medications with rapid action, prolonged effect and less sedating and adverse effects. In this case haloperidol-promethazine appears to be superior compared to haloperidol-diazepam.