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International Journal of Geriatric... Jun 2014A wide range of behavioural and psychological symptoms (BPSD) are common in dementia, and it has been suggested that groups of correlated symptoms should be studied... (Review)
Review
OBJECTIVE
A wide range of behavioural and psychological symptoms (BPSD) are common in dementia, and it has been suggested that groups of correlated symptoms should be studied together. Here, we describe the groups of BPSD that have been identified in the literature and how they have been used to study associations, burden, treatment and underlying biology.
METHODS
The literature database PubMed was searched for articles that identified clusters or factors of BPSD or used previously defined symptom groups.
RESULTS
Sixty-two studies were included. Generally, the following symptom groups were suggested: affective symptoms, including depression and anxiety; psychosis, including delusions and hallucinations; hyperactivity, including irritability and aggression; and euphoria. Symptoms that did not show consistent results include apathy, eating disturbances, night-time behaviour disturbances, disinhibition and aberrant motor behaviour. Symptom groups differed in their associations, treatment and biology.
CONCLUSIONS
Studies investigating symptom groups show relatively consistent results. Studying symptom groups allows similar symptoms to be studied together, which might strengthen results and may point to differences in their aetiology and treatment. However, a large amount of the individual variability of the symptoms could not be explained by the factors, and authors should carefully address their research question and hypotheses to decide if symptoms should be studied in groups or individually. Clinicians need to consider each symptom in its own right and also to be aware of the interrelations between them when assessing patients and developing strategies for treatment.
Topics: Affective Symptoms; Behavioral Symptoms; Cluster Analysis; Cost of Illness; Dementia; Humans; Mental Disorders; Neuropsychological Tests; Psychomotor Agitation
PubMed: 24677112
DOI: 10.1002/gps.4037 -
Schizophrenia Bulletin Aug 2018
Review
Topics: Aggression; Benzodiazepines; Humans; Psychomotor Agitation; Psychotic Disorders; Tranquilizing Agents
PubMed: 29788190
DOI: 10.1093/schbul/sby056 -
BMJ (Clinical Research Ed.) Jan 2016To study serious harms associated with selective serotonin and serotonin-norepinephrine reuptake inhibitors.Design Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To study serious harms associated with selective serotonin and serotonin-norepinephrine reuptake inhibitors.Design Systematic review and meta-analysis.
MAIN OUTCOME MEASURES
Mortality and suicidality. Secondary outcomes were aggressive behaviour and akathisia.
DATA SOURCES
Clinical study reports for duloxetine, fluoxetine, paroxetine, sertraline, and venlafaxine obtained from the European and UK drug regulators, and summary trial reports for duloxetine and fluoxetine from Eli Lilly's website.
ELIGIBILITY CRITERIA FOR STUDY SELECTION
Double blind placebo controlled trials that contained any patient narratives or individual patient listings of harms.
DATA EXTRACTION AND ANALYSIS
Two researchers extracted data independently; the outcomes were meta-analysed by Peto's exact method (fixed effect model).
RESULTS
We included 70 trials (64,381 pages of clinical study reports) with 18,526 patients. These trials had limitations in the study design and discrepancies in reporting, which may have led to serious under-reporting of harms. For example, some outcomes appeared only in individual patient listings in appendices, which we had for only 32 trials, and we did not have case report forms for any of the trials. Differences in mortality (all deaths were in adults, odds ratio 1.28, 95% confidence interval 0.40 to 4.06), suicidality (1.21, 0.84 to 1.74), and akathisia (2.04, 0.93 to 4.48) were not significant, whereas patients taking antidepressants displayed more aggressive behaviour (1.93, 1.26 to 2.95). For adults, the odds ratios were 0.81 (0.51 to 1.28) for suicidality, 1.09 (0.55 to 2.14) for aggression, and 2.00 (0.79 to 5.04) for akathisia. The corresponding values for children and adolescents were 2.39 (1.31 to 4.33), 2.79 (1.62 to 4.81), and 2.15 (0.48 to 9.65). In the summary trial reports on Eli Lilly's website, almost all deaths were noted, but all suicidal ideation events were missing, and the information on the remaining outcomes was incomplete.
CONCLUSIONS
Because of the shortcomings identified and having only partial access to appendices with no access to case report forms, the harms could not be estimated accurately. In adults there was no significant increase in all four outcomes, but in children and adolescents the risk of suicidality and aggression doubled. To elucidate the harms reliably, access to anonymised individual patient data is needed.
Topics: Antidepressive Agents; Depressive Disorder; Double-Blind Method; Humans; Psychomotor Agitation; Selective Serotonin Reuptake Inhibitors; Suicidal Ideation; Suicide; Suicide Prevention
PubMed: 26819231
DOI: 10.1136/bmj.i65 -
The American Journal of Geriatric... Dec 2021
Topics: Alzheimer Disease; Anxiety; Cannabinoids; Humans; Psychomotor Agitation
PubMed: 33839012
DOI: 10.1016/j.jagp.2021.03.004 -
Revista Brasileira de Psiquiatria (Sao... 2019
Topics: Humans; Practice Guidelines as Topic; Psychomotor Agitation
PubMed: 31365715
DOI: 10.1590/1516-4446-2019-4105 -
Psychiatria Polska 2016Behavioral disturbances and psychosis associated with dementia are becoming an increasingly common cause of morbidity in patients with dementia. Approximately 70% of... (Review)
Review
Behavioral disturbances and psychosis associated with dementia are becoming an increasingly common cause of morbidity in patients with dementia. Approximately 70% of individuals with dementia will experience agitation, and 75% will experience symptoms of psychosis such as delusions or hallucinations. The goal of this article is to review the pharmacologic treatment options for behavioral disturbances and psychosis associated with dementia. A literature review was conducted on PubMed/Medline using key words of "dementia" and "interventions." The results were filtered for meta-analysis, clinical trials, and systematic reviews. The results were then reviewed. At this time, the most evidence exists for the use of a second generation antipsychotics (SGAs), but consideration should be given to their collective boxed warning of morbidity/mortality. The evidence for second line treatments are limited. There is limited evidence to support the use of first generation antipsychotics (FGAs), antidepressants, anticonvulsants, cognitive enhancers, and analgesics. Additional randomized control trials are needed to guide clinical decision making regarding the behavioral disturbances and psychosis associated with dementia.
Topics: Antipsychotic Agents; Behavior Therapy; Combined Modality Therapy; Dementia; Drug Therapy, Combination; Female; Humans; Male; Psychomotor Agitation; Psychotic Disorders
PubMed: 27288676
DOI: 10.12740/PP/60904 -
Deutsches Arzteblatt International Jun 2019Psychomotor agitation and aggressiveness in the context of mental illnessare medical emergencies. In a survey of six German psychiatric hospitals, 1.7 to 5 aggressive... (Review)
Review
BACKGROUND
Psychomotor agitation and aggressiveness in the context of mental illnessare medical emergencies. In a survey of six German psychiatric hospitals, 1.7 to 5 aggressive attacks per patient-year were reported. If talking to the patient has no calming effect, intervention with drugs is required. In this article, we review the evidence on tranquilizing drugs and discuss clinically relevant ethical and practical questions, e.g., with respect to involuntary medication.
METHODS
This review is based on pertinent articles retrieved by a selective search in MEDLINE, supplemented by a reference search.
RESULTS
The evidence for the treatment of psychomotor agitation with antipsychotic drugs and benzodiazepines is relatively good. Randomized, controlled trials and a number of Cochrane reviews are available. These publications, however, contain data only on patients who were able to give informed consent. Their findings are often not applicable to real-life emergencies, e.g., when the patient is intoxicated with alcohol or suffers from a pre-existing disease. Haloperidol has a relatively weak effect on aggression when given alone and can also cause side effects such as early dyskinesia and epileptic seizures. It should, therefore, no longer be used as monotherapy. On the other hand, haloperidol combined with benzodiazepines or promethazine and monotherapy with lorazepam, olanzapine, ziprasidone, or aripiprazole intramuscular are effective options for the treatment of aggressive psychomotor agitation.
CONCLUSION
All of these drugs, if accepted by the patient, can also have an additional, beneficial placebo effect, with the patient calming down more rapidly than could be explained on pharmacological grounds alone. It is, therefore, important in emergencies (as at other times) for the patient to be involved in treatment decisions to the greatest possible extent.
Topics: Aggression; Antipsychotic Agents; Benzodiazepines; Haloperidol; Humans; Psychomotor Agitation; Psychotic Disorders
PubMed: 31431244
DOI: 10.3238/arztebl.2019.0445 -
Anaesthesia Feb 2014
Topics: Adenoidectomy; Anesthesia, Inhalation; Anesthetics, Inhalation; Anticonvulsants; Female; Humans; Magnesium Sulfate; Male; Methyl Ethers; Postoperative Complications; Psychomotor Agitation; Tonsillectomy
PubMed: 24443865
DOI: 10.1111/anae.12573 -
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 -
Academic Emergency Medicine : Official... May 2018We aimed to clarify the definition, epidemiology, and pathophysiology of excited delirium syndrome (ExDS) and to summarize evidence-based treatment recommendations.
OBJECTIVE
We aimed to clarify the definition, epidemiology, and pathophysiology of excited delirium syndrome (ExDS) and to summarize evidence-based treatment recommendations.
METHODS
We conducted a systematic literature search of MEDLINE, Ovid, Web of Knowledge, and Cochrane Library for articles published to March 18, 2017. We also searched the gray literature (Google Scholar) and official police or medical expert reports to complete specific epidemiologic data. Search results and full-text articles were independently assessed by two investigators and agreements between reviewers assessed with K statistics. We classified articles by study type, setting, and evidence level.
RESULTS
After reviewing the title and abstract of 3,604 references, we fully reviewed 284 potentially relevant references, from which 66 were selected for final review. Six contributed to the definition of ExDS, 24 to its epidemiology, 38 to its pathophysiology, and 27 to its management. The incidence of ExDS varies widely with medical or medicolegal context. Mortality is estimated to be as much as 8.3% to 16.5%. Patients are predominantly male. Male sex, young age, African-American race, and being overweight are independent risk factors. Pathophysiology hypotheses mostly implicate dopaminergic pathways. Most cases occur with psychostimulant use or among psychiatric patients or both. Proposed treatments are symptomatic, often with rapid sedation with benzodiazepines or antipsychotic agents. Ketamine is suggested as an alternative.
CONCLUSION
The overall quality of studies was poor. A universally recognized definition is lacking, remaining mostly syndromic and based on clinical subjective criteria. High mortality rate may be due to definition inconsistency and reporting bias. Our results suggest that ExDS is a real clinical entity that still kills people and that has probably specific mechanisms and risk factors. No comparative study has been performed to conclude whether one treatment approach is preferable to another in the case of ExDS.
Topics: Antipsychotic Agents; Delirium; Female; Humans; Ketamine; Male; Psychomotor Agitation; Retrospective Studies; Risk Factors; Substance-Related Disorders; Syndrome; Young Adult
PubMed: 28990246
DOI: 10.1111/acem.13330