A Cochrane review [Abstract] 1 included 34 studies with a total of 2657 subjects. Nineteen studies included only persons with schizophrenia or schizophrenia-like psychosis. The applied diagnostic criteria varied to a considerable degree because the studies were carried out at different times during a period of 45 years. Fifteen studies additionally included people with other diagnoses. Eighteen trials included exclusively inpatients. The benzodiazepines were administered over a short-term period from one to 10 weeks in 25 trials, over an ultra short-term period - up to 24 hours in 7 trials and over a long-term period (from 18 months to 3 years) in two trials.
•Benzodiazepine monotherapy vs. placebo (8 trials): the proportion of participants with no clinically important response did not significantly differ between those given benzodiazepines or placebo (RR 0.67, CI 0.44 to 1.02; 6 trials, n=382). The results from the various rating scales applied to assess global and mental state were inconsistent.
•Benzodiazepine monotherapy vs. antipsychotic monotherapy (14 trials): Clinically important treatment response assessment revealed no statistically significant difference between the study groups (30 minutes: RR 0.91, CI 0.58 to 1.43; 1 trial, n=44; 60 minutes: RR 0.61, CI 0.20 to 1.86; 1 trial, n=44; 12 hours: RR 0.75, CI 0.44 to 1.30; 1 trial, n = 66; pooled short-term studies: (RR 1.48 CI 0.64 to 3.46; 2 trial, n=112). Desired sedation occurred significantly more often among participants in the benzodiazepine group than in the antipsychotic group at 20 and 40 minutes. No significant between-group differences could be identified for global and mental state or occurrence of adverse effects.
•Benzodiazepine augmentation of antipsychotics vs. antipsychotic monotherapy (20 trials): Referring to clinically important response, statistically significant improvement could be demonstrated only for the first 30 minutes of augmentation treatment (30 minutes: RR 0.38, CI 0.18 to 0.80; 1 trial, n=45, 60 minutes: RR 0.07, CI 0.00 to 1.13; one trial, n=45, 12 hour: RR 0.85, CI 0.51 to 1.41; one trial, n= 67, pooled short-term studies: RR 0.87, CI 0.49 to 1.54; 6 trials, n=511). Analyses of the global and mental state yielded no between-group differences except for desired sedation at 30 as well as 60 minutes (30 minutes: RR 2.25, CI 1.18 to 4.30; 60 minutes: RR 1.39, CI 1.06 to 1.83; one trial, n=45).
Comment: The quality of the evidence is downgraded by study quality (unclear allocation concealment), imprecise results (small studies with wide confidence intervals) and indirectness of evidence (difference in studied patients, short follow-up time).
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