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Expert Review of Neurotherapeutics Sep 2014Neuropsychiatric symptoms (NPS) are a major concern in the treatment of Alzheimer's disease. Historically, NPS are difficult to treat effectively due to a high...
Neuropsychiatric symptoms (NPS) are a major concern in the treatment of Alzheimer's disease. Historically, NPS are difficult to treat effectively due to a high side-effect burden associated with commonly used medications, such as atypical antipsychotics. Non-pharmacological treatment approaches have become the first line option. However, when such treatment fails, pharmacological options are often used. Thus, a push toward finding safer alternative pharmacological treatments has occurred. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) have shown promise in clinical trials for alleviating the burden of NPS. Lower overall agitation and caregiver stress has been reported to correlate to treatment with the SSRI citalopram. However, certain side effects of citalopram, such as QTc interval prolongation and increased cognitive decline, carry clinical concern and should be weighed when prescribing their use.
Topics: Alzheimer Disease; Animals; Antidepressive Agents; Humans; Psychomotor Agitation
PubMed: 25148535
DOI: 10.1586/14737175.2014.947964 -
International Psychogeriatrics Jan 2015Agitation is common across neuropsychiatric disorders and contributes to disability, institutionalization, and diminished quality of life for patients and their...
BACKGROUND
Agitation is common across neuropsychiatric disorders and contributes to disability, institutionalization, and diminished quality of life for patients and their caregivers. There is no consensus definition of agitation and no widespread agreement on what elements should be included in the syndrome. The International Psychogeriatric Association formed an Agitation Definition Work Group (ADWG) to develop a provisional consensus definition of agitation in patients with cognitive disorders that can be applied in epidemiologic, non-interventional clinical, pharmacologic, non-pharmacologic interventional, and neurobiological studies. A consensus definition will facilitate communication and cross-study comparison and may have regulatory applications in drug development programs.
METHODS
The ADWG developed a transparent process using a combination of electronic, face-to-face, and survey-based strategies to develop a consensus based on agreement of a majority of participants. Nine-hundred twenty-eight respondents participated in the different phases of the process.
RESULTS
Agitation was defined broadly as: (1) occurring in patients with a cognitive impairment or dementia syndrome; (2) exhibiting behavior consistent with emotional distress; (3) manifesting excessive motor activity, verbal aggression, or physical aggression; and (4) evidencing behaviors that cause excess disability and are not solely attributable to another disorder (psychiatric, medical, or substance-related). A majority of the respondents rated all surveyed elements of the definition as "strongly agree" or "somewhat agree" (68-88% across elements). A majority of the respondents agreed that the definition is appropriate for clinical and research applications.
CONCLUSIONS
A provisional consensus definition of agitation has been developed. This definition can be used to advance interventional and non-interventional research of agitation in patients with cognitive impairment.
Topics: Aged; Behavioral Symptoms; Cognition Disorders; Dementia; Disease Management; Geriatric Assessment; Humans; Psychiatric Status Rating Scales; Psychomotor Agitation; Terminology as Topic
PubMed: 25311499
DOI: 10.1017/S1041610214001963 -
Annals of Internal Medicine Nov 2019Both pharmacologic and nonpharmacologic interventions are used to treat neuropsychiatric symptoms in persons with dementia. (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Both pharmacologic and nonpharmacologic interventions are used to treat neuropsychiatric symptoms in persons with dementia.
PURPOSE
To summarize the comparative efficacy of pharmacologic and nonpharmacologic interventions for treating aggression and agitation in adults with dementia.
DATA SOURCES
MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO between inception and 28 May 2019 without language restrictions; gray literature; and reference lists scanned from selected studies and systematic reviews.
STUDY SELECTION
Randomized controlled trials comparing interventions for treating aggression and agitation in adults with dementia.
DATA EXTRACTION
Pairs of reviewers independently screened studies, abstracted data, and appraised risk of bias.
DATA SYNTHESIS
After screening of 19 684 citations, 163 studies (23 143 patients) were included in network meta-analyses. Analysis of interventions targeting aggression and agitation (148 studies [21 686 patients]) showed that multidisciplinary care (standardized mean difference [SMD], -0.5 [95% credible interval {CrI}, -0.99 to -0.01]), massage and touch therapy (SMD, -0.75 [CrI, -1.12 to -0.38]), and music combined with massage and touch therapy (SMD, -0.91 [CrI, -1.75 to -0.07]) were clinically more efficacious than usual care. Recreation therapy (SMD, -0.29 [CrI, -0.57 to -0.01]) was statistically but not clinically more efficacious than usual care.
LIMITATIONS
Forty-six percent of studies were at high risk of bias because of missing outcome data. Harms and costs of therapies were not evaluated.
CONCLUSION
Nonpharmacologic interventions seemed to be more efficacious than pharmacologic interventions for reducing aggression and agitation in adults with dementia.
PRIMARY FUNDING SOURCE
Alberta Health Services Critical Care Strategic Clinical Network. (PROSPERO: CRD42017050130).
Topics: Aggression; Dementia; Humans; Network Meta-Analysis; Psychomotor Agitation
PubMed: 31610547
DOI: 10.7326/M19-0993 -
Jornal de Pediatria 2008Postoperative agitation in children is a well-documented clinical phenomenon with incidence ranging from 10% to 67%. There is no definitive explanation for this... (Review)
Review
OBJECTIVE
Postoperative agitation in children is a well-documented clinical phenomenon with incidence ranging from 10% to 67%. There is no definitive explanation for this agitation. Possible causes include rapid awakening in unfamiliar settings, pain (wounds, sore throat, bladder distension, etc.), stress during induction, hypoxemia, airway obstruction, noisy environment, anesthesia duration, child's personality, premedication and type of anesthesia. The purpose of this paper is to discuss the possible causes of postoperative agitation in children, providing a foundation for better methods of identifying and preventing this problem.
SOURCES
MEDLINE and PubMed were searched using the following words: emergence, agitation, incidence, etiology, diagnosis, treatment, children, pediatric, anesthesia.
SUMMARY OF THE FINDINGS
This study includes a review of potential agitation trigger factors and a proposal for a standardized diagnostic score system, in addition to measures to improve prevention and treatment.
CONCLUSION
No single factor can identified as the cause of postoperative agitation, which should therefore be considered a syndrome made up of biological, pharmacological, psychological and social components, and which anesthesiologists and pediatric intensive care specialists should be prepared to identify, prevent and intervene appropriately as necessary.
Topics: Anesthesia Recovery Period; Anesthesia, General; Child; Child, Preschool; Humans; Infant; Psychomotor Agitation; Risk Factors
PubMed: 18372935
DOI: 10.2223/JPED.1763 -
Journal of Affective Disorders Jul 2008Psychomotor disturbances have been described repeatedly over many centuries. More recently, Sobin and Sackeim [Sobin, C., Sackeim, H.A., 1997. Psychomotor symptoms of... (Review)
Review
BACKGROUND
Psychomotor disturbances have been described repeatedly over many centuries. More recently, Sobin and Sackeim [Sobin, C., Sackeim, H.A., 1997. Psychomotor symptoms of depression. Am. J. Psychiatry. 154, 4-17.] discussed the relevance of psychomotor symptoms in depression in an extensive review. Since their report, new pathophysiological, diagnostic and therapeutic findings have been published. In the current review of the recent literature, we aim to argue the importance of psychomotor symptoms in depression and propose directions for future research.
METHOD
A review of all the relevant reports on this topic, published between 1996 and 2006, was conducted.
RESULTS
Several assessment methods demonstrate the diagnostic and pathophysiological significance of psychomotor symptoms. Antidepressants show differential effects on psychomotor performance and findings concerning the symptoms' predictive capacity for clinical response are contradictory. Numerous imaging studies as well as studies on the neurotransmitter systems and the HPA-axis contribute to the elucidation of the neurobiological processes underlying impaired psychomotor functioning in depression.
CONCLUSIONS
Psychomotor disturbances are of great diagnostic significance for the depressive subtype of melancholia. To enhance the conceptualisation of the construct 'psychomotor' a standardised battery for their assessment is recommended. As to the symptoms' predictive therapeutic power, to date research into functional outcome and studies applying objective experimental assessment methods are lacking. Moreover, the reported pathophysiological importance of dopamine for 'retarded depression' still warrants translation to the daily practice.
Topics: Depressive Disorder, Major; Drug Therapy; Humans; Psychomotor Agitation; Psychomotor Disorders; Severity of Illness Index
PubMed: 18082896
DOI: 10.1016/j.jad.2007.10.019 -
The Australian and New Zealand Journal... Jun 2015
Topics: Bipolar Disorder; Depression; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Fatigue; Humans; Psychomotor Agitation
PubMed: 25931574
DOI: 10.1177/0004867415585858 -
Translational Psychiatry Oct 2017Unsurprisingly, the subject of dementia has been a rising matter of public health concerns as people now live longer. World Alzheimer Report 2015, estimate that about... (Review)
Review
Unsurprisingly, the subject of dementia has been a rising matter of public health concerns as people now live longer. World Alzheimer Report 2015, estimate that about 46.8 million people worldwide have dementia. These numbers are projected to almost double every 20 years, reaching 74.7 million in 2030 and 131.5 million in 2050. The modality for treating agitation and other behavioral symptoms in dementia patients has been a challenge. Many years on, there has been no FDA-approved pharmacotherapy in treating dementia-related agitation. This review discusses the current knowledge of non-pharmacological interventions, and analyzes the risks and benefits of pharmacotherapy in the management of dementia-related agitation, as well as providing an anecdotal of the author's clinical experience. This article aims to provide opportunity for increase awareness for clinicians, particularly those with no specialty training in geriatrics medicine but see dementia patients with agitation and other behavioral symptoms from time to time. Likewise, it hopefully will benefit the readers of medical journals to update their existing knowledge on matters relating to the management of dementia-related agitation.
Topics: Antipsychotic Agents; Dementia; Humans; Psychomotor Agitation; Risk Assessment
PubMed: 29087372
DOI: 10.1038/tp.2017.199 -
The British Journal of Psychiatry : the... Dec 2014Agitation in dementia is common, persistent and distressing and can lead to care breakdown. Medication is often ineffective and harmful. (Review)
Review
BACKGROUND
Agitation in dementia is common, persistent and distressing and can lead to care breakdown. Medication is often ineffective and harmful.
AIMS
To systematically review randomised controlled trial evidence regarding non-pharmacological interventions. Method We reviewed 33 studies fitting predetermined criteria, assessed their validity and calculated standardised effect sizes (SES).
RESULTS
Person-centred care, communication skills training and adapted dementia care mapping decreased symptomatic and severe agitation in care homes immediately (SES range 0.3-1.8) and for up to 6 months afterwards (SES range 0.2-2.2). Activities and music therapy by protocol (SES range 0.5-0.6) decreased overall agitation and sensory intervention decreased clinically significant agitation immediately. Aromatherapy and light therapy did not demonstrate efficacy.
CONCLUSIONS
There are evidence-based strategies for care homes. Future interventions should focus on consistent and long-term implementation through staff training. Further research is needed for people living in their own homes.
Topics: Behavioral Symptoms; Clinical Competence; Dementia; Evidence-Based Practice; Humans; Music Therapy; Patient-Centered Care; Psychomotor Agitation; Randomized Controlled Trials as Topic; Socioenvironmental Therapy
PubMed: 25452601
DOI: 10.1192/bjp.bp.113.141119 -
Critical Care (London, England) 2007Agitation is a psychomotor disturbance characterized by a marked increase in motor and psychological activity in a patient. It occurs very frequently in the intensive... (Review)
Review
Agitation is a psychomotor disturbance characterized by a marked increase in motor and psychological activity in a patient. It occurs very frequently in the intensive care setting. It may be isolated, or accompanied by other mental disorders, such as severe anxiety and delirium. Frequently, agitation is a sign of brain dysfunction and, as such, may have adverse consequences, for at least two reasons. First, agitation can interfere with the patient's care and second, there is evidence demonstrating that the prognosis of agitated (and delirious) patients is worse than that of non-agitated (non-delirious) patients. These conditions are often under-diagnosed in the intensive care unit (ICU). Consequently, a systematic evaluation of this problem in ICU patients should be conducted. Excellent tools are presently available for this purpose. Treatment, including prevention, must be undertaken without delay, and the ICU physician should follow logical, strict and systematic rules when applying therapy.
Topics: Critical Care; Critical Illness; Delirium; Humans; Psychomotor Agitation
PubMed: 17521456
DOI: 10.1186/cc5787 -
Journal of Clinical Psychopharmacology 2020
Observational Study
Topics: Adult; Antipsychotic Agents; Humans; Loxapine; Male; Middle Aged; Motor Activity; Psychomotor Agitation; Remission Induction; Treatment Outcome
PubMed: 33065716
DOI: 10.1097/JCP.0000000000001290