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Psychiatrike = Psychiatriki Oct 2023Since the COVID-19 pandemic outburst, numerous studies have reported on the holistic approach of the disease, which has negative consequences on physical and mental...
Since the COVID-19 pandemic outburst, numerous studies have reported on the holistic approach of the disease, which has negative consequences on physical and mental health as well as short- and long-term effects on cognition, independently of age. The context of the pandemic brought significant demands on public health systems, leading to restrictive measures against coronavirus expansion (quarantines, physical distancing policies, etc.). Such measures are reported to increase perceived loneliness and helplessness and may exacerbate feelings of emotional distress.1 Elderly diagnosed with neurocognitive disorders, i.e., mild cognitive impairment (MCI) or dementia, may present multifaceted cognitive deficits accompanied by neuropsychiatric symptoms, medical comorbidities, and high mortality rates. Furthermore, elderly with MCI/dementia are more vulnerable to SARS-COV-2 infection and disease complications due to decreased compliance with protective measures and multimorbidity. Simultaneously, limited access to health care services, distancing from their loved ones, abrupt changes in their daily routines or cancellation of daycare programs may make them more susceptible to pandemic secondary effects. According to the World Health Organization about 55 million people live with dementia globally. Dementia diagnosis was reported as an independent risk factor for increased mortality rate among the elderly infected with SARS-COV-2.2 Cross-sectional studies conducted all over Europe reported increased cognitive deterioration rate in patients with MCI and dementia during lockdown compared to the pre-lockdown period, as well as among dementia patients infected with COVID-19 compared to those not infected.3 Exacerbation of pre-existing sleep/appetite dysregulation and aberrant motor behavior, worsened symptoms of apathy, depression, and agitation, a rise in delirium episodes and disease-related falls and onset of behavioral symptoms during quarantine occurred.4 Also, patients living alone expressed excessive worrying and an overall decline in well-being. However, results from a large cohort study conducted in England failed to distinguish COVID-19 effects on dementia patients' psychological state between 2018 and 2020, possibly due to the small number of dementia patients recruited and disease severity.5 Among the Greek elderly, dementia prevalence rates range between 5-10.8% and 32.4% for MCI incidence.6,7 Only a few studies have investigated the impact of COVID-19 quarantine on mental and psychological health of the Greek elderly diagnosed with cognitive disorders. A longitudinal study was conducted between 2018 and 2020 including a rather large number of elderly people with MCI or Alzheimer's disease (AD). The authors compared the objectively assessed deterioration difference pre- and during the quarantine in terms of cognition, behavior and function level. They concluded that no significant quarantine-related changes were detected in cognition between the three time points, although the possibility that behavioral and psychological deterioration indirectly affected cognitive and functional decline among AD patients cannot be excluded.8 In a cross-sectional study conducted during the first quarantine period (i.e., February to May 2020), critical aspects of everyday life (mood, physical health, communication) as well as compliance with confinement policies were examined based on subjective information provided by caregivers of elderly with MCI or dementia. Based on their findings, the authors report that MCI and dementia patients exhibited a significant overall decline, whereas those with dementia were more likely to deteriorate in terms of neuropsychiatric symptoms (apathy, mood changes, psychomotor anxiety), excessive worrying, and limited compliance with measures against COVID-19 expansion.9 In an effort to minimize possible deleterious effects of the pandemic-related quarantine on the elderly with neurocognitive disorders, telemedicine was implemented instead. Neuropsychological online testing, systematic monitoring of clinical outcome (compliance with pharmacotherapy) and motivational interventions such as physical activity programs were accommodated using user-friendly applications and telephone consultations.10 Nevertheless, limited access to and familiarization with technology, severity of cognitive deficits, and demographic factors (i.e., low educational and socioeconomic status), may have limited positive outcomes in the current population. In conclusion, the combined effect of neurocognitive disorders and the pandemic exceeds the healthcare system's demands, posing in some cases insurmountable challenges. To minimize the negative effect of future similar conditions, focus should be given on the following directions: Patient-oriented, holistic protocols for systematic monitoring of clinical course, future cognitive decline, and timely psychiatric/neuropsychological interventions when necessary. Specialized training for caregivers' and nursing staff focusing on the inclusion of self-hygiene measures in patients' daily routine. Patients' familiarization with online tools both for cognitive enhancement programs and for diagnostic/ monitoring purposes.
PubMed: 37449850
DOI: 10.22365/jpsych.2023.018 -
The Primary Care Companion For CNS... Jan 2024The prompt effective treatment of acute agitation among patients with schizophrenia or bipolar disorder can alleviate distressing symptoms for the patient and decrease... (Review)
Review
The prompt effective treatment of acute agitation among patients with schizophrenia or bipolar disorder can alleviate distressing symptoms for the patient and decrease the risk of escalation to aggression and the potential for serious harm to the patient, health care providers, and others. A commonly used approach for the management of acute agitation has been the intramuscular administration of antipsychotic medications and/or benzodiazepines. However, US Food and Drug Administration-approved treatments with alternative routes of delivery now include inhaled loxapine powder and, more recently, dexmedetomidine sublingual film. Two formulations of intranasal olanzapine for acute agitation are in development. Intranasal formulations offer the potential for favorable pharmacokinetics and onset of action combined with ease of delivery obviating the need for injections and are thus consistent with patient-centered factors such as preference and self-administration. In this review, alternative methods of medication delivery are discussed, with an emphasis on the potential for intranasal administration to treat acute agitation in adult patients with schizophrenia or bipolar disorder. .
Topics: Adult; Humans; Schizophrenia; Antipsychotic Agents; Bipolar Disorder; Psychomotor Agitation; Loxapine
PubMed: 38301034
DOI: 10.4088/PCC.23nr03596 -
The Journal of International Medical... Jun 2024The aim of this short narrative review was to evaluate the existing literature regarding the clinical use of ketamine among individuals with dementia, especially those... (Review)
Review
The aim of this short narrative review was to evaluate the existing literature regarding the clinical use of ketamine among individuals with dementia, especially those with behavioral disturbances. PubMed, Cochrane, and Ovid (Embase, APA PsycINFO, and MEDLINE) databases were searched for abstracts using the search terms "ketamine" AND "dementia." Only articles describing the use of ketamine in individuals with dementia were included. Articles that did not include individuals with dementia, did not use ketamine, were published in a non-English language, primarily described animal studies, or were reviews were excluded. Three case reports met the inclusion criteria. One described the use of subcutaneous ketamine for depression, one described the use of intramuscular ketamine for acute agitation, and one described the use of S-ketamine as anesthesia during electroconvulsive therapy for depression and catatonia. No significant adverse effects were reported in any of the cases. Although the use of ketamine in the treatment of depression and agitation associated with dementia has potential, the current evidence remains limited. High-quality prospective studies are needed to confirm the observations of these case reports before ketamine can be used to treat behavioral disturbances in individuals with dementia.
Topics: Ketamine; Humans; Dementia; Depression; Psychomotor Agitation; Electroconvulsive Therapy
PubMed: 38907362
DOI: 10.1177/03000605241258473 -
African Journal of Emergency Medicine :... Sep 2023Psychomotor agitation and aggressive behaviour (AAB) have the potential to occur in any healthcare setting, including those in which Emergency Medical Services (EMS)... (Review)
Review
BACKGROUND
Psychomotor agitation and aggressive behaviour (AAB) have the potential to occur in any healthcare setting, including those in which Emergency Medical Services (EMS) operate. This scoping review aimed to examine the available literature on physical restraint of patients within the prehospital setting and to identify guidelines and their effectiveness, safety to patients and health care practitioners and strategies relating to physical restraint when used by EMS.
METHODS
We performed our scoping review using the methodological framework described by Arksey and O'Malley augmented by that of Sucharew and Macaluso. Several steps guided the review process: identification of the research question, eligibility criteria, information sources (CINAHL, Medline, Cochrane and Scopus), search, selection and data collection, ethical approval, collation, summarizing and reporting on the results.
RESULTS
The population of interest, in this scoping review was prehospital physically restrained patients, however, there was a reduced research focus on this population in comparison to the larger emergency department.
CONCLUSION
The limitation of informed consent from incapacitated patients may relate to the lack of prospective real-world research from previous and future studies. Future research should focus on patient management, adverse events, practitioner risk, policy, and education within the prehospital setting.
PubMed: 37334175
DOI: 10.1016/j.afjem.2023.03.006 -
Molecular Psychiatry Feb 2024Up to 70% of patients with major depressive disorder present with psychomotor disturbance (PmD), but at the present time understanding of its pathophysiology is limited....
Up to 70% of patients with major depressive disorder present with psychomotor disturbance (PmD), but at the present time understanding of its pathophysiology is limited. In this study, we capitalized on a large sample of patients to examine the neural correlates of PmD in depression. This study included 820 healthy participants and 699 patients with remitted (n = 402) or current (n = 297) depression. Patients were further categorized as having psychomotor retardation, agitation, or no PmD. We compared resting-state functional connectivity (ROI-to-ROI) between nodes of the cerebral motor network between the groups, including primary motor cortex, supplementary motor area, sensory cortex, superior parietal lobe, caudate, putamen, pallidum, thalamus, and cerebellum. Additionally, we examined network topology of the motor network using graph theory. Among the currently depressed 55% had PmD (15% agitation, 29% retardation, and 11% concurrent agitation and retardation), while 16% of the remitted patients had PmD (8% retardation and 8% agitation). When compared with controls, currently depressed patients with PmD showed higher thalamo-cortical and pallido-cortical connectivity, but no network topology alterations. Currently depressed patients with retardation only had higher thalamo-cortical connectivity, while those with agitation had predominant higher pallido-cortical connectivity. Currently depressed patients without PmD showed higher thalamo-cortical, pallido-cortical, and cortico-cortical connectivity, as well as altered network topology compared to healthy controls. Remitted patients with PmD showed no differences in single connections but altered network topology, while remitted patients without PmD did not differ from healthy controls in any measure. We found evidence for compensatory increased cortico-cortical resting-state functional connectivity that may prevent psychomotor disturbance in current depression, but may perturb network topology. Agitation and retardation show specific connectivity signatures. Motor network topology is slightly altered in remitted patients arguing for persistent changes in depression. These alterations in functional connectivity may be addressed with non-invasive brain stimulation.
Topics: Humans; Female; Male; Adult; Depressive Disorder, Major; Magnetic Resonance Imaging; Middle Aged; Psychomotor Disorders; Psychomotor Agitation; Brain; Depression; Neural Pathways; Motor Cortex; Brain Mapping; Nerve Net
PubMed: 38036604
DOI: 10.1038/s41380-023-02327-1 -
JAMA Network Open Jun 2024
Topics: Humans; Delirium; Emergency Service, Hospital; Male; Female; Aged; Psychomotor Agitation; Middle Aged; Inpatients; Length of Stay; Aged, 80 and over; Hospitalization; Time Factors
PubMed: 38861262
DOI: 10.1001/jamanetworkopen.2024.16343 -
BMC Pediatrics Nov 2023Some studies reported that pediatric patients undergoing otorhinolaryngology (ENT) and ophthalmic surgeries have higher incidences of emergence agitation (EA). Children...
BACKGROUND
Some studies reported that pediatric patients undergoing otorhinolaryngology (ENT) and ophthalmic surgeries have higher incidences of emergence agitation (EA). Children with EA tend to carry the risk of self-harm, have longer periods of recovery and delayed hospital discharge. Consequently, EA needs to be monitored and risk factors ought to be emphasized to implement preventative measures. The objective of this study was to describe EA and to identify risk factors after pediatric ophthalmic or ENT surgery.
METHODS
Between September 2021 and December 2021, a cross-sectional study was conducted in 100 children aged of 0-12 years who underwent ophthalmic or ENT surgery. The Watcha scale was used to observe and record EA, which was defined at levels of 3 or 4 at any time in the post-anesthesia care unit (PACU). The pain intensity was graded with the Face, Legs, Activity, Cry, Consolability (FLACC) Scale after surgery. Patient and surgery-related characteristics, the behavioral criteria of EA, the pharmacologic and non-pharmacologic interventions and recovery outcomes were objectively recorded. A binary logistic regression model was constructed to identify the associated factors of EA.
RESULTS
From the 100 analyzed children, 58 were males and 42 were females, and 44 patients received ophthalmic surgery and 56 ENT surgery. The median age was 6 (IQR 4-7) years. The overall incidence of EA among pediatrics was 30% (34.5% for ENT and 24.4% for ophthalmic surgery). High preoperative modified Yale Preoperative Anxiety scale (m-YPAS) grade (OR = 1.19, 95%CI 1.06-1.33, P = 0.003) and high postoperative FLACC score (OR = 3.36, 95%CI 1.88-6.02, P < 0.001) were risk factors for EA.
CONCLUSIONS
This study identified that preoperative anxiety and postoperative pain are associated with EA in children after ophthalmic or ENT surgery. Preoperative anxiety assessment and management, and administration of adjunct analgesic treatments should be considered in the routine care.
Topics: Male; Female; Child; Humans; Child, Preschool; Emergence Delirium; Cross-Sectional Studies; Sevoflurane; Methyl Ethers; Prevalence; Psychomotor Agitation; Risk Factors
PubMed: 37996779
DOI: 10.1186/s12887-023-04434-y -
Cureus Jan 2024Introduction Schizophrenia symptom severity is linked to neuroinflammation. Certain blood cell indexes such as neutrophil-lymphocyte ratio (NLR) and neutrophil-albumin...
Introduction Schizophrenia symptom severity is linked to neuroinflammation. Certain blood cell indexes such as neutrophil-lymphocyte ratio (NLR) and neutrophil-albumin ratio (NAR) have been used as biomarkers in various diseases, including schizophrenia. In acute clinical practice, it is challenging to decide whether to provide intravenous antipsychotic treatment in some cases due to the lack of objective biomarkers of psychiatric symptoms. The NLR of individuals with schizophrenia is thought to be associated with disease severity, and changes in NLR may reflect a patient's response to antipsychotic treatment. We investigated the application of NLR as a biomarker for identifying acute severity and determining acute treatment response in patients with schizophrenia. Methods We retrospectively examined 251 inpatients diagnosed with schizophrenia and classified them according to treatment (intravenous haloperidol vs. oral antipsychotic medication during the acute phase) and investigated their NLR and NAR while receiving inpatient care. Results A total of 48 inpatients were given intravenous haloperidol to manage their acute symptoms; 208 were given oral antipsychotics. The intravenous haloperidol group experienced more severe symptoms, such as agitation and disorganized thinking, during the acute phase. Further, those who received intravenous haloperidol had significantly higher Clinical Global Impression-Severity (CGI-S) scores than the oral antipsychotic group. NLR and NAR were also significantly higher in the haloperidol intravenous group. Conclusion Elevated NLR and NAR could be easily measured in patients with psychomotor agitation who should be treated at any facility. Further, they are useful biomarkers for determining disease severity and the effects of treatment on psychomotor excitement in patients who require intravenous haloperidol.
PubMed: 38222994
DOI: 10.7759/cureus.52181 -
CNS Drugs Apr 2024Drug-induced movement disorders (DIMDs) are associated with use of dopamine receptor blocking agents (DRBAs), including antipsychotics. The most common forms are... (Review)
Review
Drug-induced movement disorders (DIMDs) are associated with use of dopamine receptor blocking agents (DRBAs), including antipsychotics. The most common forms are drug-induced parkinsonism (DIP), dystonia, akathisia, and tardive dyskinesia (TD). Although rare, neuroleptic malignant syndrome (NMS) is a potentially life-threatening consequence of DRBA exposure. Recommendations for anticholinergic use in patients with DIMDs were developed on the basis of a roundtable discussion with healthcare professionals with extensive expertise in DIMD management, along with a comprehensive literature review. The roundtable agreed that "extrapyramidal symptoms" is a non-specific term that encompasses a range of abnormal movements. As such, it contributes to a misconception that all DIMDs can be treated in the same way, potentially leading to the misuse and overprescribing of anticholinergics. DIMDs are neurobiologically and clinically distinct, with different treatment paradigms and varying levels of evidence for anticholinergic use. Whereas evidence indicates anticholinergics can be effective for DIP and dystonia, they are not recommended for TD, akathisia, or NMS; nor are they supported for preventing DIMDs except in individuals at high risk for acute dystonia. Anticholinergics may induce serious peripheral adverse effects (e.g., urinary retention) and central effects (e.g., impaired cognition), all of which can be highly concerning especially in older adults. Appropriate use of anticholinergics therefore requires careful consideration of the evidence for efficacy (e.g., supportive for DIP but not TD) and the risks for serious adverse events. If used, anticholinergic medications should be prescribed at the lowest effective dose and for limited periods of time. When discontinued, they should be tapered gradually.
Topics: Humans; Aged; Dystonia; Cholinergic Antagonists; Psychomotor Agitation; Movement Disorders; Tardive Dyskinesia; Antipsychotic Agents; Neuroleptic Malignant Syndrome; Dystonic Disorders
PubMed: 38502289
DOI: 10.1007/s40263-024-01078-z