Intravenous Haloperidol versus Midazolam in Management of Conversion Disorder; a Randomized Clinical Trial
EMERGENCY ,
Vol. 6 No. 1 (2018),
19 November 2017
,
Page e43
https://doi.org/10.22037/emergency.v6i1.20888
Abstract
Introduction: Conversion disorder is a condition in which the patient shows psychological stress in physical ways. This study aimed to compare the effects of haloperidol versus midazolam in patients with conversion disorder.
Methods: This double-blind randomized clinical trial was conducted on patients with conversion disorder who had presented to the emergency department, throughout 2015. Patients were randomly divided into two groups and were either treated with 2.5 mg of intravenous (IV) haloperidol or 2.5 mg of IV midazolam. Recovery rate, time to recovery, and side effects of both drugs 1 hour, 24 hours, and 1 week after treatment were compared using SPSS19.
Results: 140 patients were divided into two groups of 70. There were no significant differences between the groups regarding the baseline characteristics. 12 (17.1%) patients who were treated with IV haloperidol experienced drug side effects within 1 hour and 12 (17.1%) within 24 hours, while only 3 (4.3%) patients in IV midazolam experienced side-effects within 1 hour after drug administration (p = 0.026). The symptoms of the disease subsided in 45 (success rate: 64.3%) patients in midazolam and in 64 (success rate: 91.5%) participants in haloperidol group (P<0.001). Mean recovery time was 31.24 ± 7.03 minutes in IV midazolam and 30.53 ± 7.11 minutes in IV haloperidol group (p = 0.592). Absolute risk reduction (ARR) of treating patients with haloperidol compared to midazolam is about 27%.
Conclusion: The response of patients to treatment with haloperidol is clearly better than midazolam. Although more transient and minor side-effects were observed in the group treated with haloperidol compared to midazolam group, serious side-effects were rare for both treatments.
- Conversion disorder
- hysteria
- Haloperidol
- Midazolam
- side effects
- intravenous
References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Association. 2013.
Spiegel D, Lewis-Fernandez R, Lanius R, Vermetten E, Simeon D, Friedman M. Dissociative disorders in DSM-5. Annu Rev Clin Psychol. 2013;9:299-326.
HI K, BJ S. Synopsis of Psychiatry. New York: Williams & Wilkins. 1998;8th ed:634-39.
Stone J, LaFrance WC, Jr., Brown R, Spiegel D, Levenson JL, Sharpe M. Conversion disorder: current problems and potential solutions for DSM-5. J Psychosom Res. 2011;71(6):369-76.
Bidaki R, Zarepur E, Akrami M, Mohammad M. Functional Neurological Symptom Disorder: Mismanagement, Misdiagnosis, Chronic Cough Following Sexual Abuse: A Rare Case Report. Iran J Child Neurol. 2016;10(2):90-2.
Brown RJ, Cardena E, Nijenhuis E, Sar V, van der Hart O. Should conversion disorder be reclassified as a dissociative disorder in DSM V? Psychosomatics. 2007;48(5):369-78.
Stone J, Zeman A, Simonotto E, Meyer M, Azuma R, Flett S, et al. FMRI in patients with motor conversion symptoms and controls with simulated weakness. Psychosom Med. 2007;69(9):961-9.
Bidaki R, Zarepur E. Intermittent Hemiplegia in a Boy with Primary Moyamoya Disease: A Case Report from Iran. Iran J Child Neurol. 2017;11(2):65-8.
Esmailian M, Ahmadi O, Taheri M, Zamani M. Comparison of haloperidol and midazolam in restless management of patients referred to the Emergency Department: A double-blinded, randomized clinical trial. J Res Med Sci. 2015;20(9):844-9.
Nobay F, Simon BC, Levitt MA, Dresden GM. A prospective, double-blind, randomized trial of midazolam versus haloperidol versus lorazepam in the chemical restraint of violent and severely agitated patients. Acad Emerg Med. 2004;11(7):744-9.
TREC Collaborative Group. Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine. BMJ. 2003;327(7417):708-13.
Baldacara L, Sanches M, Cordeiro DC, Jackoswski AP. Rapid tranquilization for agitated patients in emergency psychiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone. Rev Bras Psiquiatr. 2011;33(1):30-9.
Cascella M. Anesthesia awareness. Can midazolam attenuate or prevent memory consolidation on intraoperative awakening during general anesthesia without increasing the risk of postoperative delirium? Korean J Anesthesiol. 2015;68(2):200-2.
Clinton JE, Sterner S, Stelmachers Z, Ruiz E. Haloperidol for sedation of disruptive emergency patients. Ann Emerg Med. 1987;16(3):319-22.
Griffin CE, 3rd, Kaye AM, Bueno FR, Kaye AD. Benzodiazepine pharmacology and central nervous system-mediated effects. Ochsner J. 2013;13(2):214-23.
Powney MJ, Adams CE, Jones H. Haloperidol for psychosis-induced aggression or agitation (rapid tranquillisation). Cochrane Database Syst Rev. 2012;11:CD009377.
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