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Acute interventions for aggression and agitation in psychosis: study protocol for a systematic review and network meta-analysis

INTRODUCTION: Individuals with psychosis may access emergency services due to aggression and agitation. When the de-escalation technique fails to achieve tranquillisation, several pharmacological options are available. However, evidence on which intervention to prefer in terms of efficacy and tolera...

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Autores principales: Ostinelli, Edoardo G, D’Agostino, Armando, Shokraneh, Farhad, Salanti, Georgia, Furukawa, Toshi A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6797276/
https://www.ncbi.nlm.nih.gov/pubmed/31601607
http://dx.doi.org/10.1136/bmjopen-2019-032726
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author Ostinelli, Edoardo G
D’Agostino, Armando
Shokraneh, Farhad
Salanti, Georgia
Furukawa, Toshi A
author_facet Ostinelli, Edoardo G
D’Agostino, Armando
Shokraneh, Farhad
Salanti, Georgia
Furukawa, Toshi A
author_sort Ostinelli, Edoardo G
collection PubMed
description INTRODUCTION: Individuals with psychosis may access emergency services due to aggression and agitation. When the de-escalation technique fails to achieve tranquillisation, several pharmacological options are available. However, evidence on which intervention to prefer in terms of efficacy and tolerability to achieve resolution of the acute episode (ie, rapid tranquillisation) of aggression and agitation is currently fragmentary. METHODS AND ANALYSIS: We will include all randomised controlled trials comparing drugs or drug combinations or placebo for aggression or agitation episodes in adult individuals with psychosis. We will include individuals with psychosis (eg, schizophrenia and related disorders, bipolar disorder with psychotic symptoms, psychotic depression) but not substance or medication-induced psychosis or psychosis due to another medical condition. Our primary outcomes are the change in aggression or agitation scores within few hours since the administration of the intervention (efficacy outcome) and the proportion of participants who dropped out due to adverse effects (tolerability outcome). We will retrieve relevant studies from the register of studies of the Cochrane Schizophrenia Group. Also, we will run additional searches on CENTRAL, Embase and PubMed to retrieve potentially eligible studies focusing on other psychiatric diagnoses than those in the schizophrenia spectrum. We will conduct a random-effects network meta-analysis (NMA) for primary and secondary outcomes. In case of rare events of dichotomous outcomes, a common-effect Mantel-Haenszel NMA will be used instead. We will use the surface under the cumulative ranking curve and the mean ranks to rank all available treatments. Local and global methods of evaluation of inconsistency will be employed. Quality of evidence contributing to network estimates of the main outcomes will also be assessed with Confidence in Network Meta-Analysis. ETHICS AND DISSEMINATION: This study does not require ethical approval. We will disseminate our findings by publishing results in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42019137945.
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spelling pubmed-67972762019-10-31 Acute interventions for aggression and agitation in psychosis: study protocol for a systematic review and network meta-analysis Ostinelli, Edoardo G D’Agostino, Armando Shokraneh, Farhad Salanti, Georgia Furukawa, Toshi A BMJ Open Mental Health INTRODUCTION: Individuals with psychosis may access emergency services due to aggression and agitation. When the de-escalation technique fails to achieve tranquillisation, several pharmacological options are available. However, evidence on which intervention to prefer in terms of efficacy and tolerability to achieve resolution of the acute episode (ie, rapid tranquillisation) of aggression and agitation is currently fragmentary. METHODS AND ANALYSIS: We will include all randomised controlled trials comparing drugs or drug combinations or placebo for aggression or agitation episodes in adult individuals with psychosis. We will include individuals with psychosis (eg, schizophrenia and related disorders, bipolar disorder with psychotic symptoms, psychotic depression) but not substance or medication-induced psychosis or psychosis due to another medical condition. Our primary outcomes are the change in aggression or agitation scores within few hours since the administration of the intervention (efficacy outcome) and the proportion of participants who dropped out due to adverse effects (tolerability outcome). We will retrieve relevant studies from the register of studies of the Cochrane Schizophrenia Group. Also, we will run additional searches on CENTRAL, Embase and PubMed to retrieve potentially eligible studies focusing on other psychiatric diagnoses than those in the schizophrenia spectrum. We will conduct a random-effects network meta-analysis (NMA) for primary and secondary outcomes. In case of rare events of dichotomous outcomes, a common-effect Mantel-Haenszel NMA will be used instead. We will use the surface under the cumulative ranking curve and the mean ranks to rank all available treatments. Local and global methods of evaluation of inconsistency will be employed. Quality of evidence contributing to network estimates of the main outcomes will also be assessed with Confidence in Network Meta-Analysis. ETHICS AND DISSEMINATION: This study does not require ethical approval. We will disseminate our findings by publishing results in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42019137945. BMJ Publishing Group 2019-10-10 /pmc/articles/PMC6797276/ /pubmed/31601607 http://dx.doi.org/10.1136/bmjopen-2019-032726 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Mental Health
Ostinelli, Edoardo G
D’Agostino, Armando
Shokraneh, Farhad
Salanti, Georgia
Furukawa, Toshi A
Acute interventions for aggression and agitation in psychosis: study protocol for a systematic review and network meta-analysis
title Acute interventions for aggression and agitation in psychosis: study protocol for a systematic review and network meta-analysis
title_full Acute interventions for aggression and agitation in psychosis: study protocol for a systematic review and network meta-analysis
title_fullStr Acute interventions for aggression and agitation in psychosis: study protocol for a systematic review and network meta-analysis
title_full_unstemmed Acute interventions for aggression and agitation in psychosis: study protocol for a systematic review and network meta-analysis
title_short Acute interventions for aggression and agitation in psychosis: study protocol for a systematic review and network meta-analysis
title_sort acute interventions for aggression and agitation in psychosis: study protocol for a systematic review and network meta-analysis
topic Mental Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6797276/
https://www.ncbi.nlm.nih.gov/pubmed/31601607
http://dx.doi.org/10.1136/bmjopen-2019-032726
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