Lorazepam psychotic patients

An open, comparative study of 14 acutely psychotic patients treated with lorazepam alone n = 8, mean dose, 20.9 mg/day) or lorazepam plus haloperidol (mean dose, 15 mg/day mean dose, 5.2 mg/day, respectively) demonstrated a significant decrease in psychotic symptoms over 48 hours (118). Although the improvement in both groups was equal, the doses of haloperidol were low, and there was no comparative placebo group. 

In clearly nonresponding, nonaffective, psychotic patients, BZDs may be of benefit, but presently, there is no way to predict which patients will be helped. Although there is no evidence that any particular BZD is more effective than another, we would recommend the use of higher potency agents such as lorazepam or clonazepam. 

Guz L, Moraea R, Sartoretto JN. The therapeutic effects of lorazepam in psychotic patients treated with haloperidol a double-blind study. Curr TherRes 1972 14 767-774. 

Lorazepam. Lorazepam has been increasingly studied for control of psychotic aggressivity ( 157,158, 159,160, 161,162, 163,164, 165,166 and 167). One reason is that, of all the BZDs available in parenteral form, lorazepam has a pharmacokinetic profile (quick, reliable absorption) that makes it particularly suitable for this type of use. Open, retrospective, and controlled studies indicate that oral or parenteral lorazepam added to an antipsychotic controls disruptive behavior safely and effectively for most patients. The combination may also permit an overall reduction of the antipsychotic dose, although this assumption requires further study ( 162, 164, 166). 

TCAs, together with neuroleptics should be avoided as they may aggravate psychotic symptoms and potentiate any anticholinergic side effects. In the case of the very aggressive patient, parenteral administration of lorazepam or diazepam will usually be sufficient to enable the patient to be managed. 

In another study, Malsch and Kieser (2001) investigated the anxiolytic effects of WS 1490 compared to placebo in patients previously treated with a benzodiazepine. They evaluated the potential of the kava preparation as a replacement for the benzodiazepine, as well as the ability of the kava preparation to reduce benzodiazepine withdrawal symptoms. This was a five-week randomized, double blind placebo-controlled study in outpatients with non-psychotic anxiety (e.g., generalized anxiety disorder, social phobia, and simple phobia). Forty patients were included, and all had been on benzodiazepines (i.e., lorazepam, bromazepam, oxazepam, or alprazolam) for a mean duration of 20 months prior to entering the study. Of the 40 patients, 25 were males, and the mean age of the total sample was 40 years (range 21—75 years). 

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