Zuclopenthixol acetate for acute agitation: no clear edge over standard drugs, and longer sedation

The edition in brief

An updated Cochrane review of intramuscular zuclopenthixol acetate for acute behavioural disturbance in schizophrenia and similar illness pooled 11 randomised trials (714 participants). It found low-certainty evidence of no difference from standard drugs in tranquillisation at 15 minutes or in adverse effects. Moderate-certainty evidence showed more sedation with zuclopenthixol acetate at 24 and 48 hours, and fewer people sedated at 15 minutes than with haloperidol plus promethazine. Reduced benzodiazepine use was reported but is very uncertain. A meta-analysis of five trials (248 young people) found no clear difference between CBT and EMDR for PTSD symptoms, with CBT linked to higher depression scores. A retrospective study of 131 people with treatment-resistant depression found that stimulation of specific white matter tracts was associated with response to subcallosal cingulate DBS. A German trial of 484 sick-listed employees found that an 18-month aftercare programme did not significantly improve sustained return to work (OR 1.38, 95% CI 0.89 to 2.12). The pearl covers monitoring after intramuscular rapid tranquillisation.