COMMENTARY

An Out-of-Reach Option for Psychosis-Induced Agitation

Peter M. Yellowlees, MBBS, MD

Disclosures

March 15, 2017

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This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees. Droperidol, a butyrophenone, is used in many countries to treat agitated or violent patients with acute psychoses but is seldom used in the United States for this purpose following a 2001 black box warning. Now a team of investigators[1] from the University of Sheffield, England, have undertaken a systematic review of six published randomized controlled trials with useable data that compared droperidol with any other treatment for people acutely ill with suspected acute psychotic illnesses. They noted that up until now, the use of droperidol has been justified on the basis of experience rather than evidence from well-conducted and reported randomized trials. However, in this update, the researchers found high-quality evidence to support the use of droperidol for acute psychosis and as a treatment option for people acutely ill and disturbed because of serious mental illnesses.

These results are of interest primarily to physicians working outside of the United States who will be able to continue to use droperidol for treating acutely psychotic patients with the backing of stronger evidence than previously available. This review showed no evidence of increased cardiovascular problems despite the FDA black box warning regarding rare potential cardiac problems. Physicians in the United States will continue to have a much more restricted range of psychiatric medications to use than physicians in most other western countries, with this being one example. For those of us who have worked in other countries, this is a shame, as we know that our patients could benefit from having a greater range of drugs available to them. Thank you for listening to this Medscape Psychiatry Minute. Do enjoy your practice.

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