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. 2017 Dec 8;2017(12):CD003079. doi: 10.1002/14651858.CD003079.pub4

Comparison 2. Benzodiazepines versus antipsychotics.

Outcome or subgroup title No. of studies No. of participants Statistical method Effect size
2.1 Tranquillisation or asleep: 1. sedation 9   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
2.1.1 vs droperidol ‐ short term 1 153 Risk Ratio (M‐H, Fixed, 95% CI) 2.71 [1.55, 4.73]
2.1.2 vs haloperidol ‐ short term 1 44 Risk Ratio (M‐H, Fixed, 95% CI) 1.17 [0.53, 2.59]
2.1.3 vs haloperidol ‐ medium term 8 434 Risk Ratio (M‐H, Fixed, 95% CI) 1.13 [0.83, 1.54]
2.1.4 vs olanzapine ‐ medium term 1 150 Risk Ratio (M‐H, Fixed, 95% CI) 0.75 [0.28, 1.98]
2.2 Behaviour: 2. mean change/endpoint score (Agitated Behaviour Scale, high = worse) 2   Mean Difference (IV, Fixed, 95% CI) Subtotals only
2.2.1 vs haloperidol ‐ medium term 1 66 Mean Difference (IV, Fixed, 95% CI) 1.80 [‐2.39, 5.99]
2.2.2 vs olanzapine ‐ medium term 1 149 Mean Difference (IV, Fixed, 95% CI) 2.91 [0.80, 5.02]
2.3 Behaviour: 4. mean change score (Overt Aggression Scale, high = worse) 1   Mean Difference (IV, Fixed, 95% CI) Totals not selected
2.3.1 vs haloperidol ‐ medium term 1   Mean Difference (IV, Fixed, 95% CI) Totals not selected
2.4 Global state: 1. no improvement (> 40% reduction Positive and Negative Syndrome Scale‐Excited Component (PANSS‐EC)) 6   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
2.4.1 vs olanzapine ‐ short term 1 150 Risk Ratio (M‐H, Fixed, 95% CI) 1.26 [0.95, 1.66]
2.4.2 vs olanzapine ‐ medium term 1 150 Risk Ratio (M‐H, Fixed, 95% CI) 1.84 [1.06, 3.18]
2.4.3 vs haloperidol ‐ medium term 5 188 Risk Ratio (M‐H, Fixed, 95% CI) 0.89 [0.71, 1.11]
2.5 Global state: 2. need for additional medication 3   Risk Ratio (M‐H, Fixed, 95% CI) Totals not selected
2.5.1 vs droperidol ‐ short term 1   Risk Ratio (M‐H, Fixed, 95% CI) Totals not selected
2.5.2 vs haloperidol ‐ medium term 1   Risk Ratio (M‐H, Fixed, 95% CI) Totals not selected
2.5.3 vs olanzapine ‐ medium term 1   Risk Ratio (M‐H, Fixed, 95% CI) Totals not selected
2.6 Global state: 3. mean change/endpoint score (Clinical Global Impression Severity Scale, high = worse) 3   Mean Difference (IV, Fixed, 95% CI) Totals not selected
2.6.1 vs haloperidol ‐ short term 1   Mean Difference (IV, Fixed, 95% CI) Totals not selected
2.6.2 vs haloperidol ‐ medium term 1   Mean Difference (IV, Fixed, 95% CI) Totals not selected
2.6.3 vs haloperidol ‐ medium term 1   Mean Difference (IV, Fixed, 95% CI) Totals not selected
2.6.4 vs olanzapine ‐ medium term 1   Mean Difference (IV, Fixed, 95% CI) Totals not selected
2.7 Global state: 4. mean endpoint score (Inpatient Multidimensional Psychiatric Scale, high = worse) 1 16 Mean Difference (IV, Fixed, 95% CI) 2.60 [‐3.04, 8.24]
2.7.1 vs haloperidol ‐ medium term 1 16 Mean Difference (IV, Fixed, 95% CI) 2.60 [‐3.04, 8.24]
2.8 Mental state: 1. no improvement (decrease rate of Brief Psychiatric Rating Scale (BPRS) score < 30%) 1 30 Risk Ratio (M‐H, Fixed, 95% CI) 0.93 [0.73, 1.18]
2.8.1 vs haloperidol ‐ medium term 1 30 Risk Ratio (M‐H, Fixed, 95% CI) 0.93 [0.73, 1.18]
2.9 Mental state: 2. mean change/endpoint score (BPRS, high = worse) 3   Mean Difference (IV, Fixed, 95% CI) Subtotals only
2.9.1 vs haloperidol ‐ short term 1 37 Mean Difference (IV, Fixed, 95% CI) ‐3.26 [‐10.65, 4.13]
2.9.2 vs haloperidol ‐ medium term 3 123 Mean Difference (IV, Fixed, 95% CI) 1.67 [‐1.84, 5.18]
2.10 Mental state: 3. mean endpoint score (BPRS psychosis subscale, high = worse) 1   Mean Difference (IV, Fixed, 95% CI) Subtotals only
2.10.1 vs haloperidol ‐ medium term 1 66 Mean Difference (IV, Fixed, 95% CI) 0.70 [‐7.20, 8.60]
2.11 Mental state: 3a. mean endpoint score (BPRS positive subscale, high = worse) 1   Mean Difference (IV, Fixed, 95% CI) Subtotals only
2.11.1 vs haloperidol ‐ medium term 1 30 Mean Difference (IV, Fixed, 95% CI) 0.80 [‐1.83, 3.43]
2.12 Mental state: 4a. mean endpoint score (BPRS‐excited component, high = worse) 1   Mean Difference (IV, Fixed, 95% CI) Subtotals only
2.12.1 vs haloperidol ‐ medium term 1 30 Mean Difference (IV, Fixed, 95% CI) 1.27 [‐0.49, 3.03]
2.13 Mental state: 2a. mean change score (Positive and Negative Syndrome Scale, high = worse) 1   Mean Difference (IV, Fixed, 95% CI) Subtotals only
2.13.1 vs olanzapine ‐ medium term 1 146 Mean Difference (IV, Fixed, 95% CI) 5.64 [2.20, 9.08]
2.14 Mental state: 4. mean change score (PANSS‐EC, high = worse) 1   Mean Difference (IV, Fixed, 95% CI) Subtotals only
2.14.1 vs olanzapine ‐ medium term 1 149 Mean Difference (IV, Fixed, 95% CI) 2.85 [1.14, 4.56]
2.15 Adverse effects/events: 1. extrapyramidal symptoms (EPS) 8 536 Risk Ratio (M‐H, Fixed, 95% CI) 0.15 [0.06, 0.39]
2.15.1 vs haloperidol ‐ medium term 6 233 Risk Ratio (M‐H, Fixed, 95% CI) 0.13 [0.04, 0.41]
2.15.2 vs olanzapine ‐ medium term 1 150 Risk Ratio (M‐H, Fixed, 95% CI) 0.24 [0.03, 1.89]
2.15.3 vs droperidol ‐ medium term 1 153 Risk Ratio (M‐H, Fixed, 95% CI) 0.15 [0.01, 2.90]
2.16 Adverse effects/events: 2. use of medication for EPS 2 216 Risk Ratio (M‐H, Fixed, 95% CI) 0.40 [0.15, 1.05]
2.16.1 vs haloperidol ‐ medium term 1 66 Risk Ratio (M‐H, Fixed, 95% CI) 0.50 [0.17, 1.47]
2.16.2 vs olanzapine ‐ medium term 1 150 Risk Ratio (M‐H, Fixed, 95% CI) 0.24 [0.03, 1.89]
2.17 Adverse effects/events: 3. specific 5   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
2.17.1 vs haloperidol ‐ akathisia ‐ medium term 1 30 Risk Ratio (M‐H, Fixed, 95% CI) 0.33 [0.01, 7.58]
2.17.2 vs droperidol ‐ airway management ‐ medium term 1 153 Risk Ratio (M‐H, Fixed, 95% CI) 7.47 [0.39, 142.14]
2.17.3 vs haloperidol ‐ ataxia ‐ medium term 1 66 Risk Ratio (M‐H, Fixed, 95% CI) 2.26 [0.22, 23.71]
2.17.4 vs droperidol ‐ low blood pressure ‐ medium term 1 153 Risk Ratio (M‐H, Fixed, 95% CI) 1.42 [0.33, 6.15]
2.17.5 vs haloperidol ‐ dizziness ‐ medium term 1 66 Risk Ratio (M‐H, Fixed, 95% CI) 1.13 [0.25, 5.19]
2.17.6 vs olanzapine ‐ dizziness ‐ medium term 1 150 Risk Ratio (M‐H, Fixed, 95% CI) 1.51 [0.60, 3.82]
2.17.7 vs haloperidol ‐ drowsiness ‐ medium term 1 30 Risk Ratio (M‐H, Fixed, 95% CI) 1.00 [0.07, 14.55]
2.17.8 vs haloperidol ‐ dry mouth ‐ medium term 1 66 Risk Ratio (M‐H, Fixed, 95% CI) 1.88 [0.49, 7.24]
2.17.9 vs droperidol ‐ low heart rate ‐ medium term 1 153 Risk Ratio (M‐H, Fixed, 95% CI) 0.36 [0.01, 8.59]
2.17.10 vs haloperidol ‐ high heart rate ‐ medium term 1 46 Risk Ratio (M‐H, Fixed, 95% CI) 0.22 [0.01, 4.29]
2.17.11 vs droperidol ‐ hypoxia ‐ medium term 1 153 Risk Ratio (M‐H, Fixed, 95% CI) 1.42 [0.33, 6.15]
2.17.12 vs olanzapine ‐ nausea ‐ medium term 1 150 Risk Ratio (M‐H, Fixed, 95% CI) 7.76 [0.89, 67.67]
2.17.13 vs droperidol ‐ seizure ‐ medium term 1 0 Risk Ratio (M‐H, Fixed, 95% CI) Not estimable
2.17.14 vs haloperidol ‐ speech disorder ‐ medium term 1 66 Risk Ratio (M‐H, Fixed, 95% CI) 0.56 [0.11, 2.87]
2.17.15 vs haloperidol ‐ tremor ‐ medium term 1 46 Risk Ratio (M‐H, Fixed, 95% CI) 0.10 [0.01, 1.69]
2.17.16 vs droperidol ‐ vomiting ‐ medium term 1 0 Risk Ratio (M‐H, Fixed, 95% CI) Not estimable
2.17.17 vs olanzapine ‐ vomiting ‐ medium term 1 150 Risk Ratio (M‐H, Fixed, 95% CI) 13.46 [0.71, 255.70]
2.18 Leaving the study early: 1. any reason 3 339 Risk Ratio (M‐H, Fixed, 95% CI) 1.48 [0.70, 3.13]
2.18.1 vs droperidol ‐ medium term 1 173 Risk Ratio (M‐H, Fixed, 95% CI) 1.51 [0.60, 3.79]
2.18.2 vs haloperidol ‐ medium term 1 16 Risk Ratio (M‐H, Fixed, 95% CI) 0.20 [0.01, 3.61]
2.18.3 vs olanzapine ‐ medium term 1 150 Risk Ratio (M‐H, Fixed, 95% CI) 5.82 [0.62, 54.58]