• Kai MacDonald, Michael P Wilson, Arpi Minassian, Gary M Vilke, Rachel Perez, Patrice Cobb, Kimberly Tallian, Olga Becker, and David Feifel.
• Department of Psychiatry, University of California, San Diego, San Diego, CA 92093, USA. ksmacdonald@ucsd.edu
• Gen Hosp Psychiatry. 2010 Jul 1;32(4):443-5.

ObjectiveThe treatment of agitation in drug- and alcohol-using emergency patients is understudied.MethodWe performed a retrospective chart review of 105 agitated emergency department patients who received either intramuscular (IM) haloperidol or IM olanzapine, comparing prescribing patterns, level of agitation, response to treatment and side effects in patients positive for drugs or alcohol [D/A(+)] and patients negative for drugs or alcohol [(D/A(-)].ResultsThe haloperidol-benzodiazepine combination was the most frequently prescribed treatment in both groups, although alcohol(+) status biased clinicians toward using haloperidol alone. Overall, D/A(+) and D/A(-) patients responded to the initial intervention at similar rates, although D/A(+) patients were rated as more agitated and had more posttreatment sedation than D/A(-) patients. In D/A(+) patients, haloperidol+benzodiazepine and IM olanzapine performed better than haloperidol alone. There were no serious adverse events with any treatment.ConclusionFindings support the generalization of efficacy data from more rarified agitated samples to populations with high rates of substance use and highlight the need for prospective, inclusive, randomized trials comparing the commonly used haloperidol-benzodiazepine combination with newer injectable antipsychotics.Copyright 2010 Elsevier Inc. All rights reserved.

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