Intramuscular ziprasidone in the psychiatric emergency department: expanded sample

Study objectives: Injectable atypical neuroleptics may supplant benzodiazepine or neuroleptic alternatives. Published studies of intramuscular ziprasidone excluded severe psychiatric agitation (AGIT) and agitation from alcohol (ETOH) or other substances (SUBS). This study sought to assess the efficacy of intramuscular ziprasidone in these patients. Methods: We report additional data on Behavioral Activity Rating Scale (BARS) agitation scores (minimum=1, maximum=7) and duration of physical restraints in a naturalistic psychiatric emergency department study with agitated patients. Dosages were 20 mg for intramuscular ziprasidone and varied for conventional intramuscular antipsychotics (78% haloperidol or lorazepam). Results: Baseline scores on the BARS were high for AGIT (n=72), ETOH (n=10), and SUBS (n=28; respective means: 6.5, 6.9, 6.6; P=NS for all). Ziprasidone decreased agitation rapidly (respective means: 5.6, 5.3, and 5.8 at 15 minutes [P<.05 for all versus baseline], and 4.2, 4.1, and 4.1 at 30 minutes [P<.01 for all versus baseline]). At 2 hours, scores were 2.6, 2.1, and 2.3 (P<.01 for all versus baseline). For conventional intramuscular antipsychotics (n=9) baseline scores were 6.6 and then 5.7 at 15 minutes, 4.2 at 30 minutes, and 2.9 at 2 hours. Restraint duration was compared with restraint data from 80 patients receiving conventional intramuscular agents during the month immediately preceding the current study. Restraint duration decreased from 91±4 to 54±3 minutes with ziprasidone (n=77; P<.01), and durations varied with conventional intramuscular antipsychotics, with a mean restraint time of 60±12 minutes (n=7; P=NS). Of 19 ziprasidone patients receiving ECGs, none had prolonged QTc interval; 1 dystonic reaction occurred with ziprasidone. Conclusion: Intramuscular ziprasidone appears effective for severe agitation, including that from alcohol- or substance-induced intoxication. Intramuscular ziprasidone may also lead to reduced time in restraints compared with conventional agents