{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T17:21:54Z","timestamp":1788110514536,"version":"build-2803163510"},"reference-count":24,"publisher":"BMJ","issue":"7417","license":[{"start":{"date-parts":[[2003,9,25]],"date-time":"2003-09-25T00:00:00Z","timestamp":1064448000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2003,7,10]]},"published-print":{"date-parts":[[2003,9,27]]},"abstract":"<jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>\n                      <jats:bold>Objective<\/jats:bold>\n                      To compare two widely used drug treatments for people with aggression or agitation due to mental illness.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>Design<\/jats:bold>\n                      Pragmatic, randomised clinical trial.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>Setting<\/jats:bold>\n                      Three psychiatric emergency rooms in Rio de Janeiro, Brazil.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>Subjects<\/jats:bold>\n                      301 aggressive or agitated people.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>Interventions<\/jats:bold>\n                      Open treatment with intramuscular midazolam or intramuscular haloperidol plus promethazine.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>Main outcome measures<\/jats:bold>\n                      Patients tranquil or sedated at 20 minutes. Secondary outcomes: patients tranquil or asleep by 40, 60, and 120 minutes; restrained or given extra drugs within 2 hours; severe adverse events; another episode of agitation or aggression; needing extra visits from doctor during first 24 hours; overall antipsychotic load in first 24 hours; and not discharged by two weeks.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>Results<\/jats:bold>\n                      151 patients were randomised to midazolam, and 150 to haloperidol-promethazine mix. Follow up for the primary outcome was available for 298 (99%): 134\/151 (89%) of patients given midazolam were tranquil or asleep after 20 minutes compared with 101\/150 (67%) of those given haloperidol plus promethazine (relative risk 1.32 (95% confidence interval 1.16 to 1.49)). By 40 minutes, midazolam still had a statistically and clinically significant 13% relative advantage (1.13 (1.01 to 1.26)). After 1 hour, about 90% of both groups were tranquil or asleep. One important adverse event occurred in each group: a patient given midazolam had transient respiratory depression, and one given haloperidol-promethazine had a grande mal seizure.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>Conclusions<\/jats:bold>\n                      Both treatments were effective. Midazolam was more rapidly sedating than haloperidol-promethazine, reducing the time people are exposed to aggression. Adverse effects and resources to deal with them should be considered in the choice of the treatment.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj.327.7417.708","type":"journal-article","created":{"date-parts":[[2003,9,25]],"date-time":"2003-09-25T19:07:12Z","timestamp":1064516832000},"page":"708-713","source":"Crossref","is-referenced-by-count":150,"title":["Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine"],"prefix":"10.1136","volume":"327","member":"239","published-online":{"date-parts":[[2003,9,25]]},"reference":[{"key":"2025122508531628000_327.7417.708.1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.180.6.485"},{"key":"2025122508531628000_327.7417.708.2","unstructured":"Kaplan HI Sadock BJ Grebb JA . Kaplan and Sadock's synopsis of psychiatry. 7th ed. 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