[Pharmacotherapy of psychiatric acute and emergency situations: General principles]

Influence of intravenous administration of the antipsychotic drug benperidol on the QT interval

A group effect is generally assumed regarding the prolongation of the QT interval through butyrophenone antipsychotics like haloperidol. Consequently intravenous administration of benperidol is seen critically notwithstanding sparse evidence; thus benperidol and haloperidol were compared regarding their cardiac risk of prolonging the QT interval when administered intravenously for acute sedation of psychotic patients. The QT interval was measured by a 12-lead ECG. For the correction of QT values Bazett's formula was used. The resulting QTc intervals of the benperidol and the haloperidol group were compared using Mann-Whitney U-test. Our data provide statistical evidence for benperidol being less prone to cause QTc prolongation than haloperidol (p = 0.049). The results of our study indicate a more favourable risk profile of benperidol compared to haloperidol regarding QTc prolongation when administered intravenously.

[Psychiatric emergencies]

Psychiatric emergencies present a frequent and interdisciplinary challenge. Clinical diagnosis and management are complicated by the acuity, and the patient's compliance is often limited by the illness. Psychiatric emergencies include states of acute agitation, suicidality, delirium, stupor, and drug-induced emergencies. Sometimes interventions such as conversational contact, responding empathically to patients, or "talking down" are sufficient. If pharmacotherapy is necessary, benzodiazepines and antipsychotic drugs are the primary agents of choice.