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Agitated patients constitute 10% of all emergency psychiatric treatment. Management guidelines, the preferred treatment of clinicians differ in opinion and practice. In Lebanon, the use of the triple therapy haloperidol plus promethazine plus chlorpromazine (HPC) is frequently used but no studies involving this combination exists.
A pragmatic randomised open trial (September 2018–July 2019) in the Lebanese Psychiatric Hospital of the Cross in Beirut Lebanon involving 100 people requiring urgent intramuscular sedation due to aggressive behaviour were given intramuscular chlorpromazine 100 mg plus haloperidol 5 mg plus promethazine 25 mg (HPC) or intramuscular haloperidol 5 mg plus promethazine 25 mg
Primary outcome data were available for 94 (94%) people. People allocated to the haloperidol plus promethazine (HP) group showed no clear difference at 20 min compared with patients allocated to the HPC group [relative risk (RR) 0.84, 95% confidence interval (CI) 0.47–1.50].
Neither intervention consistently impacted the outcome of ‘calm’, or ‘asleep’ and had no discernible effect on the use of restraints, use of additional drugs or recurrence. If clinicians are faced with uncertainty on which of the two intervention combinations to use, the simpler HP is much more widely tested and the addition of chlorpromazine adds no clear benefit with a risk of additional adverse effects.
A growing body of evidence suggests trophic generalism (feeding on resources from more than one trophic level and/or on different resources of the same trophic level) is a widespread feature among ground beetles (Coleoptera: Carabidae). However, it remains unclear whether trophic generalism applies to single individuals, at the intrapopulation or interpopulation level. Here we present stable isotope data (δ15N, δ13C) of seven common European carabid species on an archipelago of 18 lake islands in northeastern Poland. We found strong differences in isotopic ratios between individuals of the same population as well as between different populations, indicating that carabids are opportunistic feeders and that the degree of opportunism differs between habitats and between islands. Trophic niche breadth as assessed by isotopic ratios was influenced by local habitat diversity. We suggest that opportunistic usage of different local resources results in striking differences between local populations and a very broad trophic niche observed at regional level.
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