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Comparison 1 CLOTIAPINE versus STANDARD MEDICATION ‐ OTHER ANTIPSYCHOTICS, Outcome 1 General clinical impression: No significant improvement.
Figuras y tablas -
Analysis 1.1

Comparison 1 CLOTIAPINE versus STANDARD MEDICATION ‐ OTHER ANTIPSYCHOTICS, Outcome 1 General clinical impression: No significant improvement.

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Comparison 1 CLOTIAPINE versus STANDARD MEDICATION ‐ OTHER ANTIPSYCHOTICS, Outcome 2 Hospital and service outcome: Not well enough to be discharged.
Figuras y tablas -
Analysis 1.2

Comparison 1 CLOTIAPINE versus STANDARD MEDICATION ‐ OTHER ANTIPSYCHOTICS, Outcome 2 Hospital and service outcome: Not well enough to be discharged.

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Comparison 1 CLOTIAPINE versus STANDARD MEDICATION ‐ OTHER ANTIPSYCHOTICS, Outcome 3 Leaving the study early.
Figuras y tablas -
Analysis 1.3

Comparison 1 CLOTIAPINE versus STANDARD MEDICATION ‐ OTHER ANTIPSYCHOTICS, Outcome 3 Leaving the study early.

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Comparison 1 CLOTIAPINE versus STANDARD MEDICATION ‐ OTHER ANTIPSYCHOTICS, Outcome 4 Adverse effects: 1. Movement disorders ‐ use of antiparkinsonian medication.
Figuras y tablas -
Analysis 1.4

Comparison 1 CLOTIAPINE versus STANDARD MEDICATION ‐ OTHER ANTIPSYCHOTICS, Outcome 4 Adverse effects: 1. Movement disorders ‐ use of antiparkinsonian medication.

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Comparison 1 CLOTIAPINE versus STANDARD MEDICATION ‐ OTHER ANTIPSYCHOTICS, Outcome 5 Adverse effects: 2. Incidence of specific side‐effects.
Figuras y tablas -
Analysis 1.5

Comparison 1 CLOTIAPINE versus STANDARD MEDICATION ‐ OTHER ANTIPSYCHOTICS, Outcome 5 Adverse effects: 2. Incidence of specific side‐effects.

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Comparison 2 CLOTIAPINE versus STANDARD MEDICATION ‐ BENZODIAZEPINES, Outcome 1 Mental state: No significant improvement ‐ three days after beginning of treatment.
Figuras y tablas -
Analysis 2.1

Comparison 2 CLOTIAPINE versus STANDARD MEDICATION ‐ BENZODIAZEPINES, Outcome 1 Mental state: No significant improvement ‐ three days after beginning of treatment.

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Comparison 2 CLOTIAPINE versus STANDARD MEDICATION ‐ BENZODIAZEPINES, Outcome 2 Leaving the study early.
Figuras y tablas -
Analysis 2.2

Comparison 2 CLOTIAPINE versus STANDARD MEDICATION ‐ BENZODIAZEPINES, Outcome 2 Leaving the study early.

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Study

Clotiapine N

Clotiapine mean (SD)

Lorazepam N

Lorazepam Mean (SD)

on admission

Subramaney 1998

30

6.43 (4.07)

30

5.87 (3.27)

by 24 hours

Subramaney 1998

30

1.33 (2.78)

30

1.83 (3.14)

by 72 hours

Subramaney 1998

30

1.30 (2.85)

30

1.17 (2.15)

by 1 week

Subramaney 1998

29

1.41(4.14)

29

1.03 (2.26)

Figuras y tablas -
Analysis 2.3

Comparison 2 CLOTIAPINE versus STANDARD MEDICATION ‐ BENZODIAZEPINES, Outcome 3 Behaviour: Aggression (Overt Aggression Scale, skewed data, high=poor).

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Study

Clotiapine N

Clotiapine mean (SD)

Lorazepam N

Lorazepam mean (SD)

by 24 hours

Subramaney 1998

30

2.67 (2.43)

30

1.2 (1.81)

by 72 hours

Subramaney 1998

30

2.83 (2.15)

30

1.67 (2.47)

by 1 week

Subramaney 1998

30

2.07 (1.86)

30

1.37 (2.22)

Figuras y tablas -
Analysis 2.4

Comparison 2 CLOTIAPINE versus STANDARD MEDICATION ‐ BENZODIAZEPINES, Outcome 4 Adverse effects: Movement disorders (Simpson‐Angus Scale, skewed data, high=poor).

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Table 1. Survey of Medical Directors of 20 Emergency rooms in the USA

Favoured drug regime

Number

haloperidol + lorazepam +/‐ benztropine

11

droperidol

4

benzodiazepine (unspecified) alone

3

droperidol + lorazepam + diphenhydramine

1

haloperidol + benztropine

1
Figuras y tablas -
Table 1. Survey of Medical Directors of 20 Emergency rooms in the USA
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Table 2. Drugs for rapid tranquillisation in London survey

Drug of choice

Mean dose (range)

diazepam*

27 (10‐80)

haloperidol

22 (10‐60)

chlorpromazine

162 (50‐400)

droperidol

14 (10‐20)

paraldehyde

U/K

amytal

U/K

lorazepam

U/K

nitrazepam**

U/K

* most frequent ** least frequent
Figuras y tablas -
Table 2. Drugs for rapid tranquillisation in London survey
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Table 3. Preferred medication for rapid tranquillisation in Rio de Janeiro

Drug of choice

Mean dose (range)

Frequency of use

haloperidol + promethazine

5 (2.5‐10) + 50 (25‐100)

61%

haloperidol + promethazine + diazepam

5 (2.5‐10) + 50 (25‐100) + 10

15%

diazepam

10

9%

haloperidol + promethazine + chlorpromazine

5 + 50 + 25

7%

chlorpromazine + diazepam + promethazine

25 + 10 + 50

1%

chlorpromazine + promethazine

25 + 50

1%

chlorpromazine

25

1%

diazepam + promethazine

10 + 50

1%

haloperidol + diazepam

5 + 10

1%

promethazine

50

1%
Figuras y tablas -
Table 3. Preferred medication for rapid tranquillisation in Rio de Janeiro
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Comparison 1. CLOTIAPINE versus STANDARD MEDICATION ‐ OTHER ANTIPSYCHOTICS

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 General clinical impression: No significant improvement Show forest plot

3

83

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.25, 2.66]

2 Hospital and service outcome: Not well enough to be discharged Show forest plot

1

49

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.93, 1.16]

3 Leaving the study early Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 any reason

3

121

Risk Ratio (M‐H, Random, 95% CI)

2.26 [0.40, 12.88]

3.2 adverse effects

3

121

Risk Ratio (M‐H, Random, 95% CI)

5.63 [0.28, 111.43]

4 Adverse effects: 1. Movement disorders ‐ use of antiparkinsonian medication Show forest plot

2

91

Risk Ratio (M‐H, Random, 95% CI)

0.38 [0.03, 4.10]

5 Adverse effects: 2. Incidence of specific side‐effects Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

5.1 dry mouth

1

42

Risk Ratio (M‐H, Random, 95% CI)

0.4 [0.09, 1.84]

5.2 headache

1

30

Risk Ratio (M‐H, Random, 95% CI)

1.83 [0.92, 3.66]

5.3 insomnia

1

30

Risk Ratio (M‐H, Random, 95% CI)

1.18 [0.82, 1.70]

5.4 pain at site of injection

1

42

Risk Ratio (M‐H, Random, 95% CI)

5.0 [0.25, 98.27]

5.5 palpitations

1

42

Risk Ratio (M‐H, Random, 95% CI)

0.5 [0.10, 2.44]

5.6 rash

1

49

Risk Ratio (M‐H, Random, 95% CI)

5.63 [0.28, 111.43]

5.7 seizure

1

42

Risk Ratio (M‐H, Random, 95% CI)

3.0 [0.13, 69.70]

5.8 sweating ‐ facial

1

30

Risk Ratio (M‐H, Random, 95% CI)

1.38 [0.78, 2.41]
Figuras y tablas -
Comparison 1. CLOTIAPINE versus STANDARD MEDICATION ‐ OTHER ANTIPSYCHOTICS
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Comparison 2. CLOTIAPINE versus STANDARD MEDICATION ‐ BENZODIAZEPINES

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mental state: No significant improvement ‐ three days after beginning of treatment Show forest plot

1

60

Mean Difference (IV, Fixed, 95% CI)

‐3.36 [‐8.09, 1.37]

2 Leaving the study early Show forest plot

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.07, 15.26]

3 Behaviour: Aggression (Overt Aggression Scale, skewed data, high=poor) Show forest plot

Other data

No numeric data

3.1 on admission

Other data

No numeric data

3.2 by 24 hours

Other data

No numeric data

3.3 by 72 hours

Other data

No numeric data

3.4 by 1 week

Other data

No numeric data

4 Adverse effects: Movement disorders (Simpson‐Angus Scale, skewed data, high=poor) Show forest plot

Other data

No numeric data

4.1 by 24 hours

Other data

No numeric data

4.2 by 72 hours

Other data

No numeric data

4.3 by 1 week

Other data

No numeric data
Figuras y tablas -
Comparison 2. CLOTIAPINE versus STANDARD MEDICATION ‐ BENZODIAZEPINES
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