***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The authors examined the efficacy of intramuscular flunitrazepam compared with intramuscular haloperidol for the immediate control of agitated or aggressive behavior in acutely psychotic patients . METHOD Twenty-eight actively psychotic in patients , aged 20 - 60 years , who were under treatment with neuroleptic agents were selected for the study . Each was r and omly assigned on a double-blind basis to receive either 5 mg i.m . of haloperidol ( N=13 ) or 1 mg i.m . of flunitrazepam ( N=15 ) during an aggressive event . Verbal and physical aggression was measured over time with the Overt Aggression Scale . Patients were also rated with the Brief Psychiatric Rating Scale and the Clinical Global Impression scale . RESULTS Both flunitrazepam and haloperidol exhibited acute antiaggressive activity . This beneficial effect , as assessed by the Overt Aggression Scale , was obtained within 30 minutes . CONCLUSIONS Intramuscular flunitrazepam may serve as a convenient , rapid , safe , and effective adjunct to neuroleptics in reducing aggressive behavior in emergency psychiatric setting The main aim of this study was to test the effect of the triazolobenzodiazepine , estazolam , on auditory hallucinations .  Fifty-eight patients ( 28 male , 30 female ) with auditory hallucinosis that had responded poorly to neuroleptics alone , were included ; most patients were chronic schizophrenics , and most patients were maintained on previous neuroleptic treatment during the trial . Each patient was treated for three consecutive 3-week periods , and r and omly allocated to receive estazolam ( 1 + 1 + 4 mg ) either in the first and third , or in the second period . Similar-looking placebo tablets were given in the control periods . These were seven drop-outs , three of them due to somnolence on estazolam . In both treatment groups there was a significant ( but not significantly different ) improvement during the first 3-week period , with regard to both global clinical state and auditory hallucinations . During the second and third periods , however , the two groups differed significantly , in that improvement of global state and hallucinosis was seen on estazolam , and deterioration on placebo . It is concluded that estazolam ( as an addition to neuroleptics ) had a significantly better effect than placebo on the global clinical state , on the frequency of , and attitude towards the hallucinations , and also on the single symptoms " Compulsive thoughts " and " Visual hallucinations " ( items in the Comprehensive Psychopathological Rating Scale ) . There were few side effects except drowsiness . Possible pharmacokinetic and pharmacodynamic interactions between benzodiazepines and neuroleptics are discussed briefly This r and omized , parallel-group , open study investigated the efficacy and safety of risperidone oral solution ( RIS-OS ) in combination with clonazepam and intramuscular haloperidol for the treatment of acute agitation in patients with schizophrenia , and the study explored the possibility of decreasing the efficacy of an acute 6-week treatment by switching intramuscular haloperidol injection to RIS-OS .  Two hundred and five agitation-exhibiting schizophrenic in patients at six hospitals were originally included in the study . The 47-day trial consisted of 5 days ( session I ) of receiving either oral treatment ( RIS-OS plus clonazepam ) or intramuscular treatment ( intramuscular haloperidol ) and a 42-day ( session II ) period of either withdrawing from clonazepam or shifting from intramuscular haloperidol to a RIS-OS period . The primary efficacy outcome was measured as the change in the Positive and Negative Syndrome Scale-Excited Component ( PANSS-EC ) in session I and the change in the PANSS in session II . Safety was assessed by the frequency of the adverse events . Mean PANSS-EC improvement was significant after 5 days of treatment in both groups ( P>0.05 ) and was similar between the two treatment groups ( P<0.01 ) . Most patients ’ PANSS-EC scores improved or remained stable during the drawback/shift treatment period . Efficacy was not significantly different between the two treatment groups after the 6-week treatment ( P>0.05 ) . However , combination treatment exhibited greater efficacy , and adverse events , especially extrapyramidal symptoms , were lower with the oral treatment than with the intramuscular treatment in session I. These results show that RIS-OS in combination with clonazepam is an effective treatment , comparable with intramuscular haloperidol , and is well-tolerated for acute agitation in patients with schizophrenia Abstract Acute catatonic syndromes occurring in the context of various medical and neuropsychiatric conditions , including schizophrenia , have been shown to respond well to benzodiazepines ( BZD ) . However , there have been no studies specifically design ed to address the BZD treatment response of persistent catatonic states . Eighteen patients with clinical ly stable chronic schizophrenia , who also displayed enduring catatonic features , underwent a 12-week long , r and om assignment , double-blind , placebo-controlled cross-over trial with lorazepam ( 6 mg/day ) . A comprehensive assessment , including the subjects ’ clinical and motor ( catatonic as well as drug-induced movement disorders ) condition , was performed at baseline and four weekly intervals thereafter . Pre-existing medication was kept constant throughout the study . Lorazepam had no effect on the subjects’catatonic signs and symptoms , suggesting that acute and chronic catatonic syndromes associated with schizophrenic illness might have a different neurobiological basis Fifty-five schizophrenic out patients with negative symptoms were treated for up to six weeks by the addition of alprazolam ( mean dose , 4.2 mg/d ) , diazepam ( mean dose , 40.4 mg/d ) , or placebo to their ongoing neuroleptic treatment . A repeated- measures analysis of variance with baseline measurements entered as covariates indicated the presence of a significant time X drug interaction effect for the weekly Brief Psychiatric Rating Scale ( BPRS ) withdrawal/retardation subfactor scores . During the initial weeks of the study , the alprazolam-treated group had lower scores , while the diazepam-treated group had higher scores than the placebo-treated group . However , an end point analysis performed on the final BPRS withdrawal/retardation subfactor scores showed no significant differences among the three groups , nor were beneficial effects observed on any of the BPRS subfactor scores that assess positive symptoms . Plasma alprazolam levels were maintained throughout the study and ranged from 20 to 100 ng/mL. These results suggest that alprazolam had no sustained significant effect on negative schizophrenic symptoms OBJECTIVE While neuroleptics remain the mainstay of drug intervention in the emergency management of psychosis , a variety of agents have received study as alternatives or adjuncts to these drugs in an attempt to improve the safety and efficacy of acute treatment . The purpose s of this study were to investigate the efficacy and safety of alprazolam as a neuroleptic adjunct for schizophrenic patients in psychotic relapse and to clarify the effects of combination treatment on specific aspects of the psychotic process . METHOD Twenty-eight acutely psychotic patients with schizophrenia who were admitted to an emergency psychiatric service were r and omly assigned to treatment with either haloperidol and alprazolam or haloperidol with placebo under double-blind conditions . Drug administration lasted 72 hours . RESULTS Both groups improved significantly . The combination-treated group required significantly less medication and had 56 % fewer dystonic reactions . The addition of alprazolam was most effective for symptoms of excitement and uncooperativeness , particularly in the initial hours of treatment . CONCLUSIONS The combination of alprazolam and haloperidol seems to be the most effective for agitated patients , particularly in the first 48 hours of treatment . It may also result in fewer dystonic reactions Use of concomitant medications with antipsychotic agents in the treatment of schizophrenia is common but lacks a clear scientific rationale . We evaluated concomitant medication usage during the first 6 months of the prospect i ve , observational , European Schizophrenia Outpatient Health Outcomes ( SOHO ) study , examining its frequency , variation according to type of antipsychotic drug used , and impact on treatment tolerability . We also determined factors that were associated with concomitant medication use . The use of concomitant medications differed greatly among the countries participating in the SOHO study . The presence of depressive symptoms and being female were associated with the use of concomitant antidepressants . Certain antipsychotics were associated with less use of concomitant medications : significantly fewer olanzapine- , quetiapine- and clozapine-treated patients used concomitant anticholinergics or anxiolytics/hypnotics .  Patients using concomitant medications had an increased incidence of sexually related side effects and extrapyramidal side effects ( EPS ) at 6 months follow-up compared with patients not using concomitant medications . The results should be interpreted conservatively due to the observational design of SOHO BACKGROUND Acute psychotic illness , especially when associated with agitated or violent behaviour , can require urgent pharmacological tranquillisation or sedation . In several countries , clinicians often use benzodiazepines ( either alone or in combination with antipsychotics ) for this outcome . OBJECTIVES To estimate the effects of benzodiazepines , alone or in combination with antipsychotics , when compared with placebo or antipsychotics , alone or in combination with antihistamines , to control disturbed behaviour and reduce psychotic symptoms . SEARCH METHODS We search ed the Cochrane Schizophrenia Group 's register ( January 2012 ) , inspected reference lists of included and excluded studies and contacted authors of relevant studies . SELECTION CRITERIA We included all r and omised clinical trials ( RCTs ) comparing benzodiazepines alone or in combination with any antipsychotics , versus antipsychotics alone or in combination with any other antipsychotics , benzodiazepines or antihistamines , for people with acute psychotic illnesses . DATA COLLECTION AND ANALYSIS We reliably selected studies , quality assessed them and extracted data . For binary outcomes , we calculated st and ard estimates of relative risk ( RR ) and their 95 % confidence intervals ( CI ) using a fixed-effect model . For continuous outcomes , we calculated the mean difference ( MD ) between groups . If heterogeneity was identified , this was explored using a r and om-effects model . MAIN RESULTS We included 21 trials with a total of n = 1968 participants . There was no significant difference for most outcomes in the one trial that compared benzodiazepines with placebo , although there was a higher risk of no improvement in people receiving placebo in the medium term ( one to 48 hours ) ( n = 102 , 1 RCT , RR 0.62 , 95 % CI 0.40 to 0.97 , very low quality evidence ) . There was no difference in the number of participants who had not improved in the medium term when benzodiazepines were compared with antipsychotics ( n = 308 , 5 RCTs , RR 1.10 , 95 % CI 0.85 to 1.42 , low quality evidence ) ; however , people receiving benzodiazepines were less likely to experience extrapyramidal effects ( EPS ) in the medium term ( n = 536 , 8 RCTs , RR 0.15 , 95 % CI 0.06 to 0.39 , moderate quality of evidence ) . Data comparing combined benzodiazepines and antipsychotics versus benzodiazepines alone did not yield any significant results . When comparing combined benzodiazepines/antipsychotics ( all studies compared haloperidol ) with the same antipsychotics alone ( haloperidol ) , there was no difference between groups in improvement in the medium term ( n = 155 , 3 RCTs , RR 1.27 , 95 % CI 0.94 to 1.70 , very low quality evidence ) but sedation was more likely in people who received the combination therapy ( n = 172 , 3 RCTs , RR 1.75 , 95 % CI 1.14 to 2.67 , very low quality evidence ) . However , more participants receiving combined benzodiazepines and haloperidol had not improved by medium term when compared to participants receiving olanzapine ( n = 60,1 RCT , RR 25.00 , 95 % CI 1.55 to 403.99 , very low quality evidence ) or ziprasidone ( n = 60 , 1 RCT , RR 4.00 , 95 % CI 1.25 to 12.75very low quality evidence ) . When haloperidol and midazolam were compared with olanzapine , there was some evidence the combination was superior in terms of improvement , sedation and behaviour . AUTHORS ' CONCLUSIONS The evidence from trials for the use of benzodiazepines alone is not good . There were relatively little good data and most trials are too small to highlight differences in either positive or negative effects . Adding a benzodiazepine to other drugs does not seem to confer clear advantage and has potential for adding unnecessary adverse effects . Sole use of older antipsychotics unaccompanied by anticholinergic drugs seems difficult to justify . Much more high quality research is needed in this area In 61 acute schizophrenic patients the effects of haloperidol ( HPL ) and lorazepam combined vs. HPL alone and the interaction between these drugs were evaluated . Patients were assigned to groups r and omly . The study design was open . Study duration was 28 days . Psychop 
    Output:
    
Conclusion Benzodiazepine superiority over placebo was found for global , psychiatric and behavioural outcomes , but inferiority to antipsychotics on longer-term global outcomes .