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International Journal of Environmental... Apr 2021The early and correct assessment of psychomotor agitation (PMA) is essential to ensure prompt intervention by healthcare professionals to improve the patient's... (Review)
Review
The early and correct assessment of psychomotor agitation (PMA) is essential to ensure prompt intervention by healthcare professionals to improve the patient's condition, protect healthcare staff, and facilitate future management. Proper training for recognizing and managing agitation in all care settings is desirable to improve patient outcomes. The best approach is one that is ethical, non-invasive, and respectful of the patient's dignity. When deemed necessary, pharmacological interventions must be administered rapidly and avoid producing an excessive state of sedation, except in cases of severe and imminent danger to the patient or others. The purpose of this brief review is to raise awareness about best practices for the management of PMA in emergency care situations and consider the role of new pharmacological interventions in patients with agitation associated with bipolar disorder or schizophrenia.
Topics: Antipsychotic Agents; Bipolar Disorder; Humans; Loxapine; Psychomotor Agitation; Schizophrenia
PubMed: 33924111
DOI: 10.3390/ijerph18084368 -
The World Journal of Biological... 2016Psychomotor agitation is associated with different psychiatric conditions and represents an important issue in psychiatry. Current recommendations on agitation in... (Review)
Review
BACKGROUND
Psychomotor agitation is associated with different psychiatric conditions and represents an important issue in psychiatry. Current recommendations on agitation in psychiatry are not univocal. Actually, an improper assessment and management may result in unnecessary coercive or sedative treatments. A thorough and balanced review plus an expert consensus can guide assessment and treatment decisions.
METHODS
An expert task force iteratively developed consensus using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new, re-worded or re-rated items.
RESULTS
Out of 2175 papers assessing psychomotor agitation, 124 were included in the review. Each component was assigned a level of evidence. Integrating the evidence and the experience of the task force members, a consensus was reached on 22 statements on this topic.
CONCLUSIONS
Recommendations on the assessment of agitation emphasise the importance of identifying any possible medical cause. For its management, experts agreed in considering verbal de-escalation and environmental modification techniques as first choice, considering physical restraint as a last resort strategy. Regarding pharmacological treatment, the "ideal" medication should calm without over-sedate. Generally, oral or inhaled formulations should be preferred over i.m. routes in mildly agitated patients. Intravenous treatments should be avoided.
Topics: Antipsychotic Agents; Benzodiazepines; Consensus; Disease Management; Emergency Medical Services; Humans; Meta-Analysis as Topic; Olanzapine; Practice Guidelines as Topic; Psychiatric Status Rating Scales; Psychiatry; Psychomotor Agitation; Randomized Controlled Trials as Topic; Risk Factors
PubMed: 26912127
DOI: 10.3109/15622975.2015.1132007 -
Korean Journal of Anesthesiology Dec 2020Emergence agitation (EA), also referred to as emergence delirium, can have clinically significant consequences. The mechanism of EA remains unclear. The proposed risk... (Review)
Review
Emergence agitation (EA), also referred to as emergence delirium, can have clinically significant consequences. The mechanism of EA remains unclear. The proposed risk factors of EA include age, male sex, type of surgery, emergency operation, use of inhalational anesthetics with low blood-gas partition coefficients, long duration of surgery, anticholinergics, premedication with benzodiazepines, voiding urgency, postoperative pain, and the presence of invasive devices. If preoperative or intraoperative objective monitoring could predict the occurrence of agitation during emergence, this would help to reduce its adverse consequences. Several tools are available for assessing EA. However, there are no standardized clinical research practice guidelines and its incidence varies considerably with the assessment tool or definition used. Total intravenous anesthesia, propofol, μ-opioid agonists, N-methyl-D-aspartate receptor antagonists, nefopam, α2-adrenoreceptor agonists, regional analgesia, multimodal analgesia, parent-present induction, and preoperative education for surgery may help in preventing of EA. However, it is difficult to identify patients at high risk and apply preventive measures in various clinical situations. The risk factors and outcomes of preventive strategies vary with the methodologies of studies and patients assessed.This review discusses important outcomes of research on EA and directions for future research.
Topics: Adult; Anesthesia Recovery Period; Anesthetics, Inhalation; Child; Child, Preschool; Emergence Delirium; Humans; Male; Psychomotor Agitation; Sevoflurane
PubMed: 32209961
DOI: 10.4097/kja.20097 -
Journal of Affective Disorders Oct 1999Psychomotor agitation is commonly associated with various psychiatric disorders. This article reviews the definition and measurement of agitation over the past 100 years. (Review)
Review
BACKGROUND
Psychomotor agitation is commonly associated with various psychiatric disorders. This article reviews the definition and measurement of agitation over the past 100 years.
METHODS
Definitions and descriptions of agitation were taken from dictionaries of etymology, medicine and psychiatry, and from psychiatric textbooks. A systematic MEDLINE (1966-1996) search of 'psychomotor', 'agitation', and 'restlessness' was conducted. This was augmented by a search for other relevant references cited in the articles identified by MEDLINE.
RESULTS
The definition of psychomotor agitation has varied in ambiguous and contradictory ways, both over time and in contemporary writings. Tools developed to measure agitation are either too unreliable, or else reflect this conflict of definition and are not comparable.
CONCLUSIONS
A preferred definition of agitation is proposed which takes into account both theoretical and empirical data. This has implications for further research into psychomotor agitation in classification of and treatment response in affective disorders, old age psychiatry and the evaluation of putative anti-agitation drugs.
Topics: Aged; Diagnosis, Differential; Geriatric Psychiatry; Humans; Psychomotor Agitation; Terminology as Topic
PubMed: 10628877
DOI: 10.1016/s0165-0327(99)00010-5 -
The American Journal of Psychiatry May 2016
Topics: Antipsychotic Agents; Consensus Development Conferences as Topic; Dementia; Humans; Psychomotor Agitation; Psychotic Disorders; United States
PubMed: 27133416
DOI: 10.1176/appi.ajp.2015.173501 -
Psychiatry Research Dec 2018The aims of this study were to establish the prevalence of moderate and severe psychomotor agitation in patients hospitalized for an active phase of schizophrenia, the... (Observational Study)
Observational Study
The aims of this study were to establish the prevalence of moderate and severe psychomotor agitation in patients hospitalized for an active phase of schizophrenia, the associations between psychomotor agitation and patients' demographic and clinical variables, the intra-individual stability of the agitated/non-agitated dichotomy in independent psychotic breakdowns. The study was performed on a database relative to 630 inpatients hospitalized with a diagnosis of schizophrenia. Psychomotor agitation was measured with the Positive and Negative Syndrome Scale - Excited Component (PANSS-EC). Prevalence of moderate and severe psychomotor agitation was 40.5% and 23.7%, respectively. Non-agitated patients were older, with longer illness history and duration of untreated psychosis, were more frequently on antipsychotic medication, had lower incidence of recent use of substances, and functioned better before the index hospitalization than moderately and/or severely agitated patients. Non-agitated patients had lower scores for total PANSS and Emsley's positive and anxiety dimensions. Compared with the severely agitated group, non-agitated and moderately agitated patients scored more in Emsley's depression dimension. Poor functioning before index hospital admission, higher scores for negative subscale and Emsley's positive dimension and use of substances exerted an effect on risk of psychomotor agitation.
Topics: Acute Disease; Adult; Antipsychotic Agents; Anxiety; Female; Hospitalization; Humans; Male; Middle Aged; Psychomotor Agitation; Retrospective Studies; Schizophrenia; Schizophrenic Psychology; Severity of Illness Index
PubMed: 30293014
DOI: 10.1016/j.psychres.2018.09.058 -
Seminars in Respiratory and Critical... Apr 2013
Topics: Critical Illness; Delirium; Humans; Pain; Pain Management; Psychomotor Agitation
PubMed: 23716306
DOI: 10.1055/s-0033-1342974 -
Journal of the American Medical... Nov 2011
Topics: Dementia; Humans; Nursing Homes; Psychomotor Agitation
PubMed: 21975343
DOI: 10.1016/j.jamda.2011.08.008 -
The Western Journal of Emergency... Mar 2019Agitation in children and adolescents in the emergency department (ED) can be dangerous and distressing for patients, family and staff. We present consensus guidelines...
Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department: Consensus Statement of the American Association for Emergency Psychiatry.
INTRODUCTION
Agitation in children and adolescents in the emergency department (ED) can be dangerous and distressing for patients, family and staff. We present consensus guidelines for management of agitation among pediatric patients in the ED, including non-pharmacologic methods and the use of immediate and as-needed medications.
METHODS
Using the Delphi method of consensus, a workgroup comprised of 17 experts in emergency child and adolescent psychiatry and psychopharmacology from the the American Association for Emergency Psychiatry and the American Academy of Child and Adolescent Psychiatry Emergency Child Psychiatry Committee sought to create consensus guidelines for the management of acute agitation in children and adolescents in the ED.
RESULTS
Consensus found that there should be a multimodal approach to managing agitation in the ED, and that etiology of agitation should drive choice of treatment. We describe general and specific recommendations for medication use.
CONCLUSION
These guidelines describing child and adolescent psychiatry expert consensus for the management of agitation in the ED may be of use to pediatricians and emergency physicians who are without immediate access to psychiatry consultation.
Topics: Adolescent; Child; Consensus; Disease Management; Emergency Medical Services; Humans; Practice Guidelines as Topic; Psychiatry; Psychomotor Agitation; United States
PubMed: 30881565
DOI: 10.5811/westjem.2019.1.41344 -
AACN Clinical Issues Aug 1997Agitation is a frequent clinical problem that adds significant morbidity to the hospital course. Agitation is usually part of an ambiguous constellation of cognitive and... (Review)
Review
Agitation is a frequent clinical problem that adds significant morbidity to the hospital course. Agitation is usually part of an ambiguous constellation of cognitive and psychiatric symptoms, with a fluctuating clinical course. Observation of vastly different symptoms occurring at different times leads to misdiagnosis or underrecognition of serious underlying disorders. The most common causes of agitation include delirium, dementia, and acute psychosis. Risk factors attributable to hospitalization include pain, anxiety, and stressors endemic to intensive care. Agitated states may have multiple causes, and each potential contributor must be pursued and treated independently. Definitive diagnosis is dependent on a comprehensive history, patient observation, physical examination, and selective diagnostic studies.
Topics: Adult; Algorithms; Critical Care; Decision Trees; Diagnosis, Differential; Humans; Nursing Assessment; Psychomotor Agitation; Risk Factors
PubMed: 9313372
DOI: 10.1097/00044067-199708000-00005