How effective is aripiprazole for calming people who are aggressive or agitated due to psychosis?

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How effective is aripiprazole for calming people who are aggressive or agitated due to psychosis?

Ostinelli EG, Jajawi S, Spyridi S, Sayal K, Jayaram MB

People with psychosis may experience hearing voices (hallucinations) or abnormal thoughts (delusions) which can make them frightened, distressed and agitated (restless, excitable or irritable). Experiencing such emotions can sometimes result in behaviour that is aggressive or violent. This poses a challenge and dilemma for mental health professionals who have to diagnose and, often quickly, give the best available treatment to prevent those who are aggressive, harming themselves or others.

Aripiprazole is a medication that can be used to treat psychosis and also calm people who are aggressive or agitated due to psychosis. It can be taken by mouth or by injection (intramuscular). However, aripiprazole can also cause unpleasant side effects such as headaches, upset stomach, and excessive sleepiness or drowsiness.

This review looks for evidence from randomised controlled trials that assesses the effectiveness of intramuscular aripiprazole for people who are agitated and aggressive as a result of having psychosis.

The Information Specialist of the Cochrane Schizophrenia group ran an electronic search in 2014 and in 2017 for studies randomising adults with aggression due to psychosis to receive either injections of aripiprazole or injections of a placebo (dummy treatment) or injections of another antipsychotic. The search found 63 relevant records, referring to 21 trials. Review authors screened these records for inclusion or exclusion.

Main results
Only three studies could be included. Evidence is limited due to the small number of trials and poor quality of data reported. Fewer people receiving aripiprazole required more injections to become calm than those receiving placebo or haloperidol. Overall, aripiprazole caused a similar number of adverse effects to placebo or haloperidol. Compared to olanzapine, aripiprazole was less effective at calming people but caused less sleepiness or drowsiness

Some evidence is available, but is of poor quality, and it is difficult to make conclusions about aripiprazole’s effectiveness from such data. Health professionals and people with mental health problems are therefore left without clear guidance concerning use of aripiprazole as a rapid tranquilliser. More research is needed to help people consider which medication is better at calming people down, has fewer adverse effects, and works quickly and rapidly.

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