Psychoactive drugs in mania. A controlled comparison of lithium carbonate, chlorpromazine, and haloperidol. Lithium combined with carbamazepine or haloperidol in the treatment of mania. Quality of life during treatment with haloperidol or olanzapine in the year following a first psychotic episode A comparison of haloperidol, lithium carbonate and their combination in the treatment of mania. Allopurinol as an adjunct to lithium and haloperidol for treatment of patients with acute mania: a double-blind, randomized, placebo-controlled trial. A 12-week, double-blind comparison of olanzapine vs haloperidol in the treatment of acute mania. Haloperidol Blood Levels in Acute Mania With Psychosis Acute mania: haloperidol dose and augmentation with lithium or lorazepam. Amisulpride versus haloperidol in treatment of schizophrenic patients--results of a double-blind study. Dosage of haloperidol for mania. Comparative study of the effectiveness of zuclopenthixol acetate and haloperidol in acutely disturbed psychotic patients. Quetiapine or haloperidol as monotherapy for bipolar mania—a 12-week, double-blind, randomised, parallel-group, placebo-controlled trial Dose and blood levels of haloperidol in treatment of mania. HALOPERIDOL, CLOPENTHIXOL, AND CHLORPROMAZINE IN CHRONIC SCHIZOPHRENIA: Chemically Unrelated Antipsychotics As Therapeutic Alternatives Zuclopenthixol decanoate and haloperidol decanoate in chronic schizophrenia: a double‐blind multicentre study Adjunctive antipsychotic treatment is necessary for adolescents with psychotic mania. Minimum effective doses of haloperidol for the treatment of first psychotic episode: a comparative study with risperidone and olanzapine.
Lithium carbonate , haloperidol , and chlorpromazine hydrochloride were compared in a double-blind controlled study with severely ill hospitalized manics .  Lithium carbonate and haloperidol produced a highly significant improvement of manic symptoms without sedation . Although producing considerable sedation , chlorpromazine did little to alter the underlying mania qualitatively . Qualitative differences between lithium carbonate and haloperidol indicate that , while haloperidol has a more dramatically rapid impact on behavior-motor activity , lithium carbonate acted more evenly on the entire manic picture , with total normalization realized during active treatment . The majority of lithium carbonate-treated patients met discharge criteria at study termination , but not the patients receiving either neuroleptic drug . The rating scales are not sensitive enough to monitor manic psychopathology ; this accounts for the lack of statistically significant differences among drug groups at treatment termination , despite the widely disparate discharge rates Hospitalized manic patients were withdrawn from psychoactive medications for 2 weeks after which they were r and omized to double-blind treatment with carbamazepine plus lithium [ CBZ-Li ] or haloperidol plus lithium [ HAL-Li ] with benztropine . Unit dosages of Li 300 mg , CBZ 200 mg and HAL 2 mg were titrated to therapeutic plasma levels and maintained for 8 weeks . No rescue medications were permitted after 3 weeks . St and ard ratings of psychopathology and side effects were accomplished weekly . Sixty patients entered the study but only 33 remained for r and omization after drug washout . By 8 weeks both groups were improved from baseline without statistically reliable differences between them . However HAL-Li patients had more extrapyramidal side effects that were major reasons for dropout , whereas CBZ-Li patients were more often noncompliant and initially required more rescue medications . We conclude that either combination treatment can be beneficial but CBZ-Li has the advantage because of fewer neurologic side effects OBJECTIVES Schizophrenia causes significant impairments of quality of life . As treatment approaches have advanced , more attention has been given to re-integrating patients into their psychosocial environments , rather than simply monitoring psychotic symptoms . The development of the second-generation antipsychotics raised hope that these medications would provide better quality of life improvement than conventional antipsychotics . This improvement is particularly relevant early in the course of schizophrenia . METHODS To address these considerations , improvements in measures of general health and social function ( determined using the SF-36 ) were assessed in 195 patients with first-episode schizophrenia for up to one year following r and omization to either olanzapine or haloperidol  in a double blind clinical trial . We hypothesized that olanzapine would demonstrate better improvement on these measures than haloperidol . In order to test this hypothesis , we used a repeated measure model with SF-36 scores as the outcome , and treatment group , time , time2 , time-by-treatment group interaction , and time2-by-treatment group interaction as fixed effects . RESULTS Both treatments demonstrated similar changes on the SF-36 . Independent of treatment , patients demonstrated significant improvements in most of the SF-36 subscales , which approached normative scores by the end of one year of treatment . Forty-six of 100 olanzapine-treated patients and 37 of 95 haloperidol-treated patients completed the one year of this study ( p<.4 ) . CONCLUSIONS These results suggest an important initial treatment goal for patients with new onset schizophrenic disorders , namely that they can expect to recover significant quality of life and social function at least initially in treatment Previous investigations of the treatment of mania have result ed in uncertainty about the efficacy of lithium versus a neuroleptic . In addition there have been reports of toxicity with a haloperidol -- lithium combination . In order to determine the comparative efficacy of lithium vs haloperidol vs a combination of haloperidol -- lithium , we studied 21 severely ill manic patients who all met rigorous criteria for bipolar illness and who required in hospital treatment . Subjects were r and omly assigned to 3 groups : ( A ) Lithium plus placebo ( B ) Placebo plus haloperidol and ( C ) Lithium plus haloperidol . The study was conducted in double blind fashion for 3 weeks with the dosages of the medications varied according to clinical response or untoward effects . Subjects on haloperidol and placebo or the haloperidol -- lithium combination were significantly improved after 7 days in comparison to the lithium-treated group . Groups B and C did not differ from each other , either in degree of improvement or in side effects . Inspite of the relatively small sample size the results suggest ( 1 ) that haloperidol is superior to lithium for treating severely ill acute mania and ( 2 ) that while a haloperidol -- lithium combination does not result in a significant increase in side effects , it is not superior to haloperidol alone OBJECTIVE Allopurinol , a hypouricemic agent , has been shown to present therapeutic effects in mania associated with hyperuricemia . This study assessed the efficacy and safety of risperidone as an adjunctive agent to lithium and haloperidol for the treatment of acute mania in hospitalized bipolar patients . METHODS Eighty-two patients aged between 18 and 49 were eligible to participate , as they met the DSM-IV criteria for a current manic episode , on the basis of a clinical interview by two academician psychiatrists . In addition , a score of at least 20 points on the Young Mania Rating Scale was required representing at least a moderate-to-severe mania . Forty-one patients were r and omly allocated to lithium ( 1 - 1.2 mEq/L ) + haloperidol ( 10 mg/day ) + allopurinol ( 300 mg/day ) ( group A ) or lithium ( 1 - 1.2 mEq/L ) + haloperidol ( 10 mg/day ) + placebo ( group B ) for an 8-week , double-blind , placebo-controlled study . Patients were assessed by a third-year resident of psychiatry at baseline and at 7 , 14 , 28 , 42 , and 56 days after the medication started . The mean decrease in the Young Mania Rating Scale score from baseline was used as the main outcome measure of response of mania to treatment . The extrapyramidal symptoms were assessed using the Extrapyramidal Symptoms Rating Scale ( ESRS ) . Side effects were systematic ally recorded throughout the study and were assessed using a checklist . RESULTS Young Mania Rating Scale scores improved with allopurinol . The difference between the two protocol s was significant as indicated by the effect of the group , the between-subjects factor ( F = 5.22 , df = 1 , p = 0.008 ) . The mean ESRS scores for the placebo group were higher than the allopurinol group . However , the differences were not significant over the trial . The difference between the two groups in the frequency of side effects was not significant except for agitation that was more often in the placebo group . CONCLUSIONS The efficacy of allopurinol to obtain a greater improvement in patients with mania seems to support the purinergic dysfunction in mania BACKGROUND This r and omized controlled trial compares the efficacy and safety of olanzapine vs haloperidol , as well as the quality of life of patients taking these drugs , in patients with bipolar mania . METHODS The design consisted of 2 successive , 6-week , double-blind periods and compared flexible dosing of olanzapine ( 5 - 20 mg/d , n = 234 ) with haloperidol ( 3 - 15 mg/d , n = 219 ) . RESULTS Rates of remission ( Young-Mania Rating Scale score of < or = 12 and 21-item Hamilton Rating Scale for Depression score of < or = 8 at week 6 ) were similar for  olanzapine- and haloperidol-treated patients ( 52.1 % vs 46.1 % , respectively ; P = .15 ) . For the subgroup of patients whose index episode did not include psychotic features , rates of remission were significantly greater for the olanzapine group compared with the haloperidol group ( 56.7 % vs 41.6 % , P = .04 ) . Relapse into an affective episode ( mania and /or depression ) occurred in 13.1 % and 14.8 % of olanzapine- and haloperidol-treated patients , respectively ( P = .56 ) . Switch to depression occurred significantly more rapidly with haloperidol than with olanzapine when using survival analysis techniques ( P = .04 ) , and significantly more haloperidol-treated patients experienced worsening of extrapyramidal symptoms , as indicated by several measures . Weight gain was significantly greater in the olanzapine group compared with the haloperidol group ( 2.82 vs 0.02 kg , P<.001 ) . The olanzapine group had significant improvement in quality of life on several dimensions compared with the haloperidol group . CONCLUSIONS These data suggest that olanzapine does not differ from haloperidol in achieving overall remission of bipolar mania . However , haloperidol carries a higher rate of extrapyramidal symptoms , whereas olanzapine is associated with weight gain In this study , the authors examined the relationship between steady-state haloperidol  blood levels and clinical response in patients with acute psychotic mania . Fifty-four in patients with acute mania were r and omly assigned to receive either haloperidol 25 mg/day or haloperidol 5 mg/day . Each subject also received a concomitant medication : lorazepam 4 mg/day , lithium , or placebo . The relationship between steady-state  haloperidol blood levels and clinical improvement was studied using analysis of covariance . There was wide interindividual variation in the  haloperidol blood level – dose ratio . Haloperidol blood levels ( log-transformed ) were found to significantly correlate with clinical response in acute mania . Low-dose haloperidol with concomitant lithium may produce an optimal response in acute mania .  Haloperidol blood levels may be clinical ly useful in identifying patients who are nonresponsive because of low drug levels and , hence , in enhancing optimal haloperidol dosing for acute mania with psychosis Antipsychotic dosing for acute mania has not been well studied . Combined treatment with lithium and an antipsychotic is the most common treatment , but additional antimanic efficacy of a lithium-antipsychotic combination beyond that of an antipsychotic alone has not been well demonstrated . Furthermore , the possibility that lithium could affect antipsychotic dose requirement is believed to have never been studied . In this study , 63 acutely psychotic bipolar manic in patients were r and omly assigned to receive double-blind treatment with 1 of 2 haloperidol doses , 25 mg/day or 5 mg/day , for 21 days . In addition to haloperidol , subjects were r and omly assigned to receive concomitant treatment with placebo , st and ard lithium , or lorazepam 4 mg/day . The high haloperidol dose produced greater improvement and more side effects than did the low dose . Lithium added to the low dose produced a markedly greater clinical response than did the low dose alone . Lorazepam did not improve the outcome for the patients receiving low-dose haloperidol . The clinical response produced by high-dose haloperidol was not enhanced by adding either lithium or lorazepam . All treatment effects emerged by the fourth day of treatment and persisted . Used alone , a haloperidol dose of 5 mg/day is too low for most manic patients , but concomitant lithium produces a dose-dependent enhancement of haloperidol response .  Lorazepam 4 mg/day was insufficient to produce an advantage when added to low-dose haloperidol In a double-blind study , 41 schizophrenic patients ( ICD , 9th rev . ) were divided into two groups . With a flexible dose , twenty patients were treated with haloperidol , twenty-one with amisulpride . With respect to relevant criteria such as age , sex , length and degree of illness , the two groups were comparable . The study was conducted over 42 days . As early as within the first 14 days , both groups showed significant improvement with respect to their psychotic symptoms . When the two groups were compared on the basis of the BPRS subscore for the anxiety-depression syndrome , and the AMDP system subscores for the somatic-depressive syndrome and the hypochondriac syndrome , the amisulpride group showed significantly better results than the haloperidol group . The ratings on the EPS scales of Webster and Simpson revealed significantly fewer extrapyramidal side-effects in the amisulpride group . Psychotic symptoms were improved after both types of treatment . Amisulpride treatment showed better results with regard to depressive symptoms , and less tendency to generate extrapyramidal side-effects BACKGROUND We compared three doses of a neuroleptic as a treatment for mania . METHOD Forty-seven newly admitted in- patients with mania were r and omised to receive 10 , 30 , or 80 mg a day of oral haloperidol , under double-blind conditions for up to six weeks . All subjects received prophylactic benztropine . RESULTS Repeated- measures analysis of variance and survival analysis showed no difference in outcome by the different doses . Excluding drop-outs ( 38 % ) , most of whom left the study during the first two weeks , 72 % of the subjects responded . Side-effects were minimal ; there were no differences among the three doses . Non-responders received more adjunctive lorazepam than responders . CONCLUSIONS The limited data suggest that more than 10 mg a day of haloperidol offers no advantage in mania OBJECTIVES To study the effectiveness , frequency of administration and side effects of zuclopenthixol acetate ( ZPTA ) and haloperidol ( HAL ) in the treatment of acute psychotic disturbance with aggression . METHOD Purposive sampling method was employed in a group of psychotic patients with aggression admitted to Songkla Neuropsychiatric Hospital , they were r and omly divided into 2 groups :  ZPTA  group and HAL group . All of the patients were evaluated daily for 7 consecutive days using the Brief Psychiatric Rating Scale ( BPRS ) and the Clinical Global Impression Scale ( CGI ) . Statistical analysis was performed by using the Student t-test and Linear regression . RESULTS There were 70 patients with diagnosis of schizophrenia , mania and acute psychosis . Thirty-eight patients were r and omly assigned to the ZPTA group and were given 50 - 100 mg of the drug , while 32 patients received HAL 5 - 10 mg . The result showed a significant reduction in BPRS or CGI scores in both groups . Patients treated with ZPTA required less frequent administration than did those on HAL ( p < 0.05 ) . There was no statistically significant difference in the reduction in scores between the two groups . Nor was there a statistical difference in reduction of aggression based on BPRS rating . Each group of patients showed a few side effects of mild degree . CONCLUSION Both ZPTA and HAL were effective in the treatment of acute psychosis with aggression , but frequency of administration was lower in the ZPTA METHODS Patients ( n=302 ) with bipolar I disorder ( manic episode ) were r and omised to 12 weeks ' double-blind treatment with quetiapine ( flexibly dosed up to 800 mg/day ) , placebo , or haloperidol ( up to 8 mg/day ) . The primary efficacy outcome variable was change from baseline to Day 21 in Young Mania Rating Scale ( YMRS ) score . RESULTS YMRS score improved with quetiapine at Day 21 ( -12.29 versus -8.32 for placebo ; P<0.01 ) . The difference in favor of quetiapine increased by Day 84 ( -17.52 versus -9.48 ; P<0.001 ) . Haloperidol also showed an advantage over placebo at Days 21 and 84 ( P<0.001 ) . There was no significant difference in efficacy measures between quetiapine and haloperidol groups at any assessment except Day 21 . The only common adverse event with quetiapine was somnolence ( 12.7 % ) . Extrapyramidal symptoms ( EPS ) , including akathisia , occurred at 59.6 % with haloperidol , 12.7 % with quetiapine , 15.8 % with placebo . Most quetiapine responders ( 84 % ) received a dose of 400 - 800 mg/day . CONCLUSIONS Quetiapine was effective and well tolerated . The efficacy and tolerability profile of haloperidol ( including its propensity for EPS ) supported study validity Three doses of haloperidol , 10 mg/day , 30 mg/day , and 80 mg/day , were compared in 47 newly admitted manic patients . There was no difference in outcome within 6 weeks among the three doses . Four blood levels of plasma and red blood cell ( RBC )  haloperidol and reduced haloperidol showed no linear or curvilinear relationships to clinical response In a double-blind placebo controlled clinical trial in chronic schizophrenic patients , haloperidol and clopenthixol were found to be effective antipsychotic agents , favorably altering behavior as observed by the psychiatrist , the nurse , and ward attendants . In this respect they appeared to compare adequately to the st and ard drug , chlorpromazine . In this experiment , neither the st and ard drug nor the investigational drugs affected psychological test performance . The expected side effects such as extrapyramidal signs and sedation did occur and in some instances required dose reduction for alleviation . One case of possible hepatoxicity in the CX group occurred at the end of the study and was considered of serious import requiring cessation of medication . It was concluded that these chemically unrelated antipsychotics could be used in practice as therapeutic alternatives , the particular choice depending on side effects and possibly symptomatology Zuclopenthixol decanoate ( ZPT‐D ) and haloperidol decanoate ( HAL‐D ) were compared in the maintenance treatment of chronic schizophrenic patients . All patients were treated with either ZPT‐D or HAL‐D for at least 3 months and were then r and omly allocated to treatment with either ZPT‐D ( 100–600 mg every 4 weeks ) or HAL‐D ( 38–200 mg every 4 weeks ) for 9 months . Sixty‐four patients entered the study . Three patients were only assessed at baseline . Four patients in the HAL‐D group were withdrawn because of deterioration . One patient in the ZPT‐D group committed suicide . Fifty‐six patients completed the trial . The assessment programme comprised Clinical Global Impressions by psychiatrists and nurses , the Brief Psychiatric Rating Scale ( BPRS ) , Montgomery‐Åsberg Depression Rating Scale ( MADRS ) , UKU Side Effect Scale and Simpson‐Angus Scale . Ratings were made at baseline and after 12 , 24 and 36 weeks of treatment . The severity of illness scores remained almost constant . The only between‐group difference was recorded at month 6 in favour of ZPT‐D.  The BPRS total scores were reduced significantly in both groups with no between‐group differences . The depression scores on the MADRS were very low . Both treatments caused few and mild side effects according to the UKU Side Effect Scale and the Simpson‐Angus scale , and there were no significant differences between the groups . Both ZPT‐D and HAL‐D seem to be effective in the maintenance treatment of chronic schizophrenic patients and cause few side effects . The injections of ZPT‐D and HAL‐D can be given at 4‐week intervals Adolescents with acute psychotic mania were treated with lithium and adjunctive haloperidol as part of a lithium efficacy study . If the psychosis completely resolved , haloperidol was discontinued after 1 week of therapeutic lithium levels . Our first five subjects experienced a rapid exacerbation of symptoms , which responded to restarting haloperidol . A longer duration of adjunctive antipsychotic treatment is necessary in adolescents with bipolar psychosis Minimum doses of haloperidol might show similar efficacy and side-effects compared to atypical antipsychotics . The objectives of this study were to compare the efficacy of minimum doses of haloperidol with st and ard doses of risperidone and olanzapine on a 6-month open trial in first psychotic episode patients and to examine the effect of compliance on their outcome . Forty-two patients were recruited and started on flexible doses of these drugs . Olanzapine was given with no cost to the patients . Efficacy and side-effects were monitored every 3 months using st and ardized assessment s. Thirty patients completed the study . All treatment groups showed improvement in positive , negative and depressive symptoms . There were no differences in side-effects among them . The haloperidol group required higher doses of anticholinergics . The rate of treatment discontinuation was higher in the risperidone group due to the direct cost . Minimum doses of haloperidol might prove to be a good choice of treatment for patients with a first episode of psychosis
There is some evidence that haloperidol is an effective treatment for  acute mania .
From the limited data available , there was no difference in overall efficacy of treatment between haloperidol and olanzapine or risperidone .
Some evidence suggests that haloperidol could be less effective than aripiprazole .
BACKGROUND The main objectives in treating mania are to control dangerous behaviour , reduce suicide , produce appropriate acute sedation and shorten the episode of mood disturbance .
Among different drugs , haloperidol has for many years been used in treating psychotic patients , but it has a troublesome side effect profile .
OBJECTIVES To assess the effects of haloperidol for the treatment of mania in comparison with placebo or other active drugs , either as monotherapy or add-on treatment .