Journal articles: 'Acute Agitation'

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Wright, P. "Acute agitation: new treatments." European Psychiatry 17 (May 2002): 12. http://dx.doi.org/10.1016/s0924-9338(02)80055-4.

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Childers, Richard, and Gary Vilke. "Ketamine for Acute Agitation." Current Emergency and Hospital Medicine Reports 7, no. 1 (February 6, 2019): 6–13. http://dx.doi.org/10.1007/s40138-019-00177-2.

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Richardson, J. P., and S. Joseph. "Antipsychotics in acute agitation." Psychiatric Bulletin 25, no. 7 (July 2001): 276–77. http://dx.doi.org/10.1192/pb.25.7.276.

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Battaglia, Joseph, Delbert G. Robinson, and Leslie Citrome. "The Treatment of Acute Agitation in Schizophrenia." CNS Spectrums 12, S11 (2007): 1–16. http://dx.doi.org/10.1017/s1092852900026146.

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AbstractAcute agitation is a nonspecific term applied to an array of syndromes and behaviors. It is frequently defined as an increase in psychomotor activity, aggression, disinhibition/impulsivity, and irritable or labile mood. Etiologies of acute agitation include medical disorders, delirium, substance intoxication or withdrawal, psychiatric disorders, and medication side effects. Treatment of acute agitation requires both environmental and pharmacologic intervention. Patients should be calmed with sedating agents early in the course of treatment, allowing for diagnostic tests to take place. Failure to correctly diagnose causes of agitation may lead to delayed treatment for serious conditions, and can even exacerbate agitation.The most common cause of agitation in patients with schizophrenia is psychotic relapse due to medication nonadherence. Pharmacologic treatment options for these patients include lorazepam and antipsychotic agents. Lorazepam causes nonspecific sedation and treats some substance withdrawal, but has little effect on psychosis. First-generation antipsychotics treat psychosis and, at high enough doses, cause sedation, but may induce extrapyramidal side effects (EPS). Some second-generation antipsychotics have been approved for the treatment of agitation in schizophrenia. These agents treat psychosis with a favorable EPS profile, but are comparatively expensive and cause risks such as hypotension. However, avoiding EPS may reduce patients' resistance to antipsychotic treatment.In this expert roundtable supplement, Joseph Battaglia, MD, provides an overview of the definition of acute agitation. Next, Delbert, G. Robinson, MD, outlines evaluation methods for actue agitation. Finally, Leslie Citrome, MD, MPH, reviews interventions for acute and ongoing management of agitation.

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Currier, Glenn W., James C.-Y. Chou, David Feifel, Cynthia A. Bossie, Ibrahim Turkoz, Ramy A. Mahmoud, and Georges M. Gharabawi. "Acute Treatment of Psychotic Agitation." Journal of Clinical Psychiatry 65, no. 3 (March 15, 2004): 386–94. http://dx.doi.org/10.4088/jcp.v65n0315.

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Citrome, Leslie. "Atypical antipsychotics for acute agitation." Postgraduate Medicine 112, no. 6 (December 2002): 85–96. http://dx.doi.org/10.3810/pgm.2002.12.1369.

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Battaglia, John. "Pharmacological Management of Acute Agitation." Drugs 65, no. 9 (2005): 1207–22. http://dx.doi.org/10.2165/00003495-200565090-00003.

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King, Bill, and Glenda Watt. "Dementia in acute units: agitation." Nursing Standard 9, no. 21 (February 15, 1995): 25–27. http://dx.doi.org/10.7748/ns.9.21.25.s36.

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Zimbroff, Dan L. "Pharmacological Control of Acute Agitation." CNS Drugs 22, no. 3 (2008): 199–212. http://dx.doi.org/10.2165/00023210-200822030-00002.

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Benazzi, Franco, Marco Mazzoli, and Emanuela Rossi. "Benzodiazepines and Acute Psychotic Agitation." Canadian Journal of Psychiatry 37, no. 10 (December 1992): 732–33. http://dx.doi.org/10.1177/070674379203701017.

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Currier, Glenn W., Michael H. Allen, E. Bradshaw Bunney, David G. Daniel, Andrew Francis, Andy Jagoda, and Dan Zimbroff. "Standard therapies for acute agitation." Journal of Emergency Medicine 27, no. 4 (November 2004): S9—S12. http://dx.doi.org/10.1016/j.jemermed.2004.09.001.

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Gould, Cathleen M. "Psychopharmacologic Treatment of Acute Agitation." Psychopharm Review 47, no. 7 (July 2012): 49–55. http://dx.doi.org/10.1097/01.psyphr.0000415883.88497.ac.

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&NA;. "Psychopharmacologic Treatment of Acute Agitation." Psychopharm Review 47, no. 7 (July 2012): 56. http://dx.doi.org/10.1097/01.psyphr.0000415884.96120.20.

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Gould, Cathleen M. "Psychopharmacologic Treatment of Acute Agitation." Psychopharm Review 47, no. 9 (September 2012): 65–71. http://dx.doi.org/10.1097/01.psyphr.0000419187.87926.2d.

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&NA;. "Psychopharmacologic Treatment of Acute Agitation." Psychopharm Review 47, no. 9 (September 2012): 72. http://dx.doi.org/10.1097/01.psyphr.0000419188.95550.a2.

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De Luca, Gabriele Carmine, and Eelco F. M. Wijdicks. "Agitation Associated with Acute Bladder Obstruction." New England Journal of Medicine 363, no. 17 (October 21, 2010): 1656. http://dx.doi.org/10.1056/nejmicm0808606.

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Currier, Glenn W., Michael H. Allen, E. Bradshaw Bunney, David G. Daniel, Andrew Francis, Andy Jagoda, and Dan Zimbroff. "Novel therapies for treating acute agitation." Journal of Emergency Medicine 27, no. 4 (November 2004): S13—S18. http://dx.doi.org/10.1016/j.jemermed.2004.09.002.

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Zeller, Scott L., and Michael P. Wilson. "Acute treatment of agitation in schizophrenia." Drug Discovery Today: Therapeutic Strategies 8, no. 1-2 (June 2011): 25–29. http://dx.doi.org/10.1016/j.ddstr.2011.09.005.

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San, Luis, Josef Marksteiner, Peter Zwanzger, María Aragüés Figuero, Francisco Toledo Romero, Grigorios Kyropoulos, Alberto Bessa Peixoto, Roxana Chirita, and Anca Boldeanu. "State of Acute Agitation at Psychiatric Emergencies in Europe: The STAGE Study." Clinical Practice & Epidemiology in Mental Health 12, no. 1 (October 27, 2016): 75–86. http://dx.doi.org/10.2174/1745017901612010075.

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Background: Agitation is an array of syndromes and types of behaviors that are common in patients with psychiatric disorders. In Europe, the estimation of prevalence of agitation has been difficult due to the lack of standard studies or systematic data collection done on this syndrome. Objective: An observational, cross-sectional, multicenter study aimed to assess the prevalence of agitation episodes in psychiatric emergencies in different European countries. Method: For 1 week, all episodes of acute agitation that were attended to at the psychiatric emergency room (ER) or Acute Inpatient Unit (AIU) in the 27 participating centers were registered. The clinical characteristics and management of the agitation episode were also described. A descriptive analysis was performed. Results: A total of 334 agitation episodes out of 7295 psychiatric emergencies were recorded, giving a prevalence rate of 4.6% (95% CI: 4.12-5.08). Of them, 172 [9.4% (95% CI: 8.2-10.9)] were attended at the ER and 162 [2.8% (95% CI: 2.4-3.3)] at AIU. Only data from 165 episodes of agitation (those with a signed informed consent form) was registered and described in this report. The most common psychiatric conditions associated with agitation were schizophrenia, bipolar disorder and personality disorder. The management of agitation included from non-invasive to more coercive measures (mechanical, physical restraint or seclusion) that were unavoidable in more than half of the agitation episodes (59.5%). Conclusion: The results show that agitation is a common symptom in the clinical practice, both in emergency and inpatient psychiatric departments. Further studies are warranted to better recognize (using a standardized definition) and characterize agitation episodes.

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Howland, Robert H. "Atypical Antipsychotics: Special Formulations for Acute Agitation." Journal of Psychosocial Nursing and Mental Health Services 43, no. 10 (October 1, 2005): 14–17. http://dx.doi.org/10.3928/02793695-20051001-02.

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Sullivan, S. "Aripiprazole takes the edge off acute agitation." Inpharma Weekly &NA;, no. 1518 (December 2005): 15–16. http://dx.doi.org/10.2165/00128413-200515180-00038.

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Hatta, Kotaro, Takeo Takahashi, Hiroyuki Nakamura, Hisato Yamashiro, Nozomu Asukai, and Yosuke Yonezawa. "Hypokalemia and agitation in acute psychotic patients." Psychiatry Research 86, no. 1 (April 1999): 85–88. http://dx.doi.org/10.1016/s0165-1781(99)00018-9.

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Hazaray, Emmeline, Jason Ehret, David J. Posey, Theodore A. Petti, and Christopher J. McDougle. "Intramuscular Ziprasidone for Acute Agitation in Adolescents." Journal of Child and Adolescent Psychopharmacology 14, no. 3 (September 2004): 464–70. http://dx.doi.org/10.1089/cap.2004.14.464.

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Lim, Erle C. H., Hock-Luen Teoh, and Raymond C. S. Seet. "Acute confusion and agitation after epidural anaesthesia." Journal of Clinical Neuroscience 12, no. 7 (September 2005): 790. http://dx.doi.org/10.1016/j.jocn.2005.05.007.

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Lenox, Robert H., Jack G. Modell, and Sheldon Weiner. "Acute treatment of manic agitation with lorazepam." Psychosomatics 27, no. 1 (January 1986): 28–32. http://dx.doi.org/10.1016/s0033-3182(86)72736-9.

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Reither, A., and T. Reiter. "Management of Acute Postoperative Agitation with Auriculotherapy." Journal of Acupuncture and Meridian Studies 11, no. 4 (August 2018): 234. http://dx.doi.org/10.1016/j.jams.2018.08.144.

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Leontieva, Luba, Sally Safadi, Pratik Jain, Sarah Tabi, Cheryl Roe, and Derek Empey. "On importance of new group therapy for decrease of agitation during the critical period of nursing shift changes on an acute psychiatric inpatient floor." Journal of Hospital Administration 9, no. 2 (May 11, 2020): 41. http://dx.doi.org/10.5430/jha.v9n2p41.

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Background: Agitation is a significant challenge to mental healthcare. This project aims to examine the effects of implementing an interactive mental flexibility group to decrease incidences of agitation in the inpatient psychiatric population during nursing shift change.Methods: This observational study, conducted on the acute inpatient psychiatric unit of an academic hospital in Central NY, USA. This 23-bed unit admits psychiatric patients from the E.D. and local hospitals. The art-based interactive group was implemented during the critical period of nursing shift change, which is known for having an increased agitation due to caregiver changes. We tracked group attendance, incidences of agitation, and as-needed medication administration for agitation. We administered a Likert-type scale to rate emotions before and after each session.Results: We observed a dramatic decrease in as needed medications for agitation 1 month prior to group (n = 576) compared to 3 months during group (n = 120). The new group constitutes a significant decrease in agitation incidents. Patients indicated an increase in happiness (mean = 0.46, SD = 0.978), decrease in sadness (mean = 0.44, SD = 1.078), and decrease in anger (mean = 1.15, SD = 1.984).Conclusions: Our project indicates that the patients and staff well receive interactive group sessions in an acute psychiatric unit. The group sessions helped to decrease agitation and medication administration.Future directions: We recommend the utilization of interactive mental flexibility groups on acute psychiatric units to promote emotional regulation, especially during nursing shift change.

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Chen, Baitong, Jacek A. Koziel, Andrzej Białowiec, Myeongseong Lee, Hantian Ma, Peiyang Li, Zhanibek Meiirkhanuly, and Robert C. Brown. "The Impact of Surficial Biochar Treatment on Acute H2S Emissions during Swine Manure Agitation before Pump-Out: Proof-of-the-Concept." Catalysts 10, no. 8 (August 16, 2020): 940. http://dx.doi.org/10.3390/catal10080940.

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Acute releases of hydrogen sulfide (H2S) are of serious concern in agriculture, especially when farmers agitate manure to empty storage pits before land application. Agitation can cause the release of dangerously high H2S concentrations, resulting in human and animal fatalities. To date, there is no proven technology to mitigate these short-term releases of toxic gas from manure. In our previous research, we have shown that biochar, a highly porous carbonaceous material, can float on manure and mitigate gaseous emissions over extended periods (days–weeks). In this research, we aim to test the hypothesis that biochar can mitigate H2S emissions over short periods (minutes–hours) during and shortly after manure agitation. The objective was to conduct proof-of-the-concept experiments simulating the treatment of agitated manure. Two biochars, highly alkaline and porous (HAP, pH 9.2) made from corn stover and red oak (RO, pH 7.5), were tested. Three scenarios (setups): Control (no biochar), 6 mm, and 12 mm thick layers of biochar were surficially-applied to the manure. Each setup experienced 3 min of manure agitation. Real-time concentrations of H2S were measured immediately before, during, and after agitation until the concentration returned to the initial state. The results were compared with those of the Control using the following three metrics: (1) the maximum (peak) flux, (2) total emission from the start of agitation until the concentration stabilized, and (3) the total emission during the 3 min of agitation. The Gompertz’s model for determination of the cumulative H2S emission kinetics was developed. Here, 12 mm HAP biochar treatment reduced the peak (1) by 42.5% (p = 0.125), reduced overall total emission (2) by 17.9% (p = 0.290), and significantly reduced the total emission during 3 min agitation (3) by 70.4%. Further, 6 mm HAP treatment reduced the peak (1) by 60.6%, and significantly reduced overall (2) and 3 min agitation’s (3) total emission by 64.4% and 66.6%, respectively. Moreover, 12 mm RO biochar treatment reduced the peak (1) by 23.6%, and significantly reduced overall (2) and 3 min total (3) emission by 39.3% and 62.4%, respectively. Finally, 6 mm RO treatment significantly reduced the peak (1) by 63%, overall total emission (2) by 84.7%, and total emission during 3 min agitation (3) by 67.4%. Biochar treatments have the potential to reduce the risk of inhalation exposure to H2S. Both 6 and 12 mm biochar treatments reduced the peak H2S concentrations below the General Industrial Peak Limit (OSHA PEL, 50 ppm). The 6 mm biochar treatments reduced the H2S concentrations below the General Industry Ceiling Limit (OSHA PEL, 20 ppm). Research scaling up to larger manure volumes and longer agitation is warranted.

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Brown, Steve. "Treatment of acute psychotic agitation: gaps in the evidence base." Advances in Psychiatric Treatment 17, no. 2 (March 2011): 101–3. http://dx.doi.org/10.1192/apt.bp.110.008318.

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SummaryTreatment of psychotic agitation is an area that is very poorly evidenced, principally because research evidence from patients with moderate agitation may not generalise to the more severely agitated patients. There is a significant gap between current treatment recommendations and what is seen in clinical practice. There are also big differences in clinical practice between different units treating seemingly similar patient groups. This commentary considers possible reasons for these findings and also discusses non-pharmacological interventions, which probably contribute more to the management of psychotic agitation than does the choice of one antipsychotic drug over another.

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Walker, Rachel E., Leigh Anne Nelson, Carrie Kriz, Courtney A. Iuppa, Yifei Liu, Lauren A. Diefenderfer, Ellie S. R. Elliott, and Roger W. Sommi. "Enhancing Outcomes: Acceptability of Medication Formulations for the Treatment of Acute Agitation in a Psychiatric Population." Pharmacy 11, no. 1 (December 23, 2022): 4. http://dx.doi.org/10.3390/pharmacy11010004.

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BACKGROUND: There is limited research evaluating patient acceptability of medication formulations in the treatment of acute agitation. This study assessed patient acceptability of medication formulations (tablet, orally-dissolving-tablet [ODT], liquid, intramuscular injection [IM], inhaled device [INH]) for the treatment of acute agitation and examined correlating factors. METHODS: Adults with psychotic illness or bipolar disorder receiving emergency or inpatient services at an inpatient psychiatric facility in Kansas City, Missouri were included. Participants viewed a presentation on medication formulations for acute agitation and were surveyed on acceptability (measured on a five-point Likert scale). The primary outcome variable was the attitudinal measurement of acceptability of each formulation in correlation with the severity of agitation for use in themselves and other patients. RESULTS: One hundred participants completed the survey. Participants rated the following: (1) This medication formulation would be acceptable to treat mild agitation in themselves and others (oral tablet 85% and 48%; ODT 82% and 55%; liquid 74% and 51%; IM 53% and 74%; INH 78% and 72%); and (2) This medication formulation would be acceptable to treat severe agitation in themselves and others (oral tablet 75% and 52%; ODT 74% and 53%; liquid 66% and 53%; IM 61% and 67%; INH 77% and 72%). For treating mild agitation, participants preferred tablets and ODTs to the IM (p < 0.05) and the INH to liquid or IM (p < 0.05), for themselves; and oral formulations were preferred to the IM (p < 0.05) for other patients. For severe agitation in themselves and others, preference for the INH and IM versus oral formulations (p < 0.05) was significant, with no difference between the INH and IM (p > 0.05). CONCLUSIONS: The proportion of responses preferring oral formulations was higher than IM and INH. Dosage formulation acceptability differed depending on the severity of agitation and intended recipient of the medication.

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Miller, Jennifer. "Managing acute agitation and aggression in the world of drug shortages." Mental Health Clinician 11, no. 6 (November 1, 2021): 334–46. http://dx.doi.org/10.9740/mhc.2021.11.334.

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Abstract Acute agitation and aggression create safety risks for both patients and staff, often leading to psychiatric emergencies. Quick and appropriate treatment is necessary to achieve safe and effective outcomes. Unfortunately, there are several factors that hinder timely interventions, such as medication shortages and delay in staff preparedness. Ultimately, the goal of managing acute agitation and aggression in the clinical setting is to de-escalate the situation and prevent harm to patients and staff. This article will explore useful interventions in realizing treatment goals for the management of agitation and aggression in adults while navigating limitations faced in practice.

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Schumaker, Ashley, Richard Gomez, Sofia Rojasova, Cassidy Muir, Katie Bukiri, Clinton Korneffel, Aparna Sharma, Murali Rao, and Edwin Meresh. "Management of Agitation, Delirium, and Catatonia in Intubated COVID-19 Patients: A Case Series & Rationale for Valproate Sodium Use During Extubation." OBM Neurobiology 05, no. 02 (February 25, 2021): 1. http://dx.doi.org/10.21926/obm.neurobiol.2102099.

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The complete spectrum of neuropsychiatric effects of SARS-CoV-2 acute respiratory distress syndrome has yet to be fully appreciated, particularly in intubated patients. Manifestations including delirium and catatonia need to be considered in intubated COVID-19 patients. Medications known to exhibit neuroprotective effects, like valproate, can assist in agitation related to sedative withdrawal during extubation. This case series reports on the management of agitation, delirium, and catatonia in COVID-19 patients during and after extubation efforts. We present three cases in which Psychiatry was consulted for agitation in intubated COVID-19 patients. These patients were managed for severe agitation during weaning from extubation as well as for subsequent psychiatric challenges, including catatonia. Patient 1: 26-year-old female with bipolar I with psychotic features who was admitted for acute hypoxic respiratory failure from COVID-19 pneumonia. After an emergency C-section at 31 weeks’ gestation, she was intubated for 9 days and started on valproate 250 mg BID for agitation. She was extubated successfully and discharged home. Patient 2: 42-year-old female with bipolar I and PTSD who was intubated following COVID-19-related acute hypoxic respiratory failure. She received valproate 250mg BID and was extubated successfully. She became catatonic when home quetiapine was resumed and recovered following quetiapine discontinuation and lorazepam. She was discharged on valproic acid and alprazolam. Patient 3: 23-year-old female with bipolar I with psychotic features who was admitted for COVID-19 acute hypoxic respiratory failure and intubated. She received valproate 250 mg BID and was extubated successfully. She became catatonic when risperidone was re-initiated, but recovered following risperidone discontinuation and addition of lorazepam, gabapentin, and duloxetine. Quetiapine was added before discharge. Valproate was effective for managing delirium and agitation during extubation, as evidenced by normalizing Richmond Agitation and Sedation Scale scores. Additionally, valproate aided in managing catatonia post-extubation. This case series reports on the management of agitation in COVID-19 patients during extubation efforts with valproate sodium, due to its ability to manage delirium and catatonia. Valproate is known to exhibit neuroprotective effects, which possibly explains successful management of agitation during the extubation process.

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Kotecha, Anish. "AKT question relating to acute episode of agitation." InnovAiT: Education and inspiration for general practice 14, no. 5 (April 20, 2021): 294. http://dx.doi.org/10.1177/1755738021996994b.

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Pergjika, Alba. "4.1 STANDARDIZED ACUTE AGITATION MANAGEMENT ACROSS HOSPITAL SETTINGS." Journal of the American Academy of Child & Adolescent Psychiatry 60, no. 10 (October 2021): S6. http://dx.doi.org/10.1016/j.jaac.2021.07.039.

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Niforatos, Joshua D., Jonathon W. Wanta, Anna P. Shapiro, Justin A. Yax, and Adele C. Viguera. "How should I treat acute agitation in pregnancy?" Cleveland Clinic Journal of Medicine 86, no. 4 (April 2019): 243–47. http://dx.doi.org/10.3949/ccjm.86a.18041.

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Tulloch, Karen J., and Peter J. Zed. "Intramuscular Olanzapine in the Management of Acute Agitation." Annals of Pharmacotherapy 38, no. 12 (October 26, 2004): 2128–35. http://dx.doi.org/10.1345/aph.1e258.

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Baker, Stephanie N. "Management of Acute Agitation in the Emergency Department." Advanced Emergency Nursing Journal 34, no. 4 (2012): 306–18. http://dx.doi.org/10.1097/tme.0b013e31826f12d6.

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&NA;. "Management of Acute Agitation in the Emergency Department." Advanced Emergency Nursing Journal 34, no. 4 (2012): 319–20. http://dx.doi.org/10.1097/tme.0b013e318273f8fa.

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Ellison, James M. "Emergency Treatment of Acute Psychosis, Agitation, and Anxiety." Psychiatric Services 36, no. 4 (April 1985): 351–52. http://dx.doi.org/10.1176/ps.36.4.351.

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Zafonte, Ross D. "Treatment of Agitation in the Acute Care Setting." Journal of Head Trauma Rehabilitation 12, no. 2 (April 1997): 78–81. http://dx.doi.org/10.1097/00001199-199704000-00008.

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Canas, F. "What does agitation mean in the acute setting?" European Psychiatry 22 (March 2007): S89. http://dx.doi.org/10.1016/j.eurpsy.2007.01.1166.

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Currier, Glenn W., Michael H. Allen, E. Bradshaw Bunney, David G. Daniel, Andrew Francis, Andy Jagoda, and Dan Zimbroff. "Safety of medications used to treat acute agitation." Journal of Emergency Medicine 27, no. 4 (November 2004): S19—S24. http://dx.doi.org/10.1016/j.jemermed.2004.09.003.

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Ovejero, S., M. Iza, S. Vallejo, C. Vera, A. Sedano, R. Álvarez, L. Mata, and S. Sánchez-Alonso. "Use of inhaled loxapine in acute psychiatric agitation." European Psychiatry 33, S1 (March 2016): s228. http://dx.doi.org/10.1016/j.eurpsy.2016.01.564.

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ObjectivesThe aim of this work is to study the efficacy of loxapine inhalation powder on agitated patients in a psychiatric inpatient unit.MethodsNineteen patients sample, with an average age of 39.4 years old, diagnosed with schizophrenia, bipolar disorder or schizoaffective disorder. Patients inhaled loxapine 10 mg, using the staccato system, when they suffered a psychomotor agitation. The clinical efficacy was measured as a change from baseline in the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) and in the Young Mania Rating Scale (YMRS) one hour after the administration of loxapine.ResultsA mean of 9.8 points reduction (22.6 at baseline and 12.7 one hour after the administration) was found on the PANSS-EC (t-test, P < .001) and 68.4% of the patients were considered responders as they obtained a reduction of at least 40% of the basal score. On 10 of the total of the agitated patients showed an improvement of the psychomotor excitement, and this allowed the clinicians to remove the physical restraint; on 6 of the agitated patients the physical restraint could be avoided during the whole treatment; and 3 of the patients experienced a reduction of the excitement. The reduction on PANNS-EC on the latest group was not statistically significant (t-test, P = .121).ConclusionsInhaled loxapine was a non-invasive, rapid and effective alternative treatment for acute agitation in a psychiatric inpatient unit. It resulted more effective on mild and moderate cases; not been significantly effective on the severe cases of agitation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Maas, Mark S., Karen E. Moeller, and Brittany L. Melton. "Determination of combination therapy prescribing patterns for the treatment of acute agitation in psychiatric patients: A regression model of patient diagnoses and demographics." Mental Health Clinician 9, no. 5 (September 1, 2019): 298–303. http://dx.doi.org/10.9740/mhc.2019.09.298.

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Abstract Introduction Guidelines for the treatment of acute agitation typically recommend monotherapy with an antipsychotic or a benzodiazepine, but combination therapy is frequently used in practice. We created a regression model to identify which factors lead to the prescribing of combination therapy for acute agitation on a psychiatry unit. Methods We collected retrospective data from hospitalized patients in the psychiatry unit. An a priori alpha of 0.05 was used for binary logistic regression models to determine if and how the number of prescribed medications for acute agitation was influenced by: age, sex, race, cardiovascular comorbidities, and psychiatric diagnoses. Results We identified 1998 encounters from 1200 patients. Patients are significantly more likely to be prescribed combination therapy if they are young, male, and of non-white race or have a diagnosis of central nervous system stimulant use, hallucinogen use, depression, bipolar, cluster B personality, or psychosis. Patients are significantly more likely to be prescribed monotherapy if they have cardiovascular comorbidity or have neurocognitive disorder. Discussion Several demographic or diagnostic factors predict combination therapy prescribing. Acute agitation guidelines should be reviewed to include more clear instructions on combination therapy use.

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Fagiolini, A. "Appropriate treatments for agitation associated with schizophrenia: Control of acute agitation and maintenance of efficacy." European Psychiatry 22 (March 2007): S89—S90. http://dx.doi.org/10.1016/j.eurpsy.2007.01.1168.

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Gonçalves, Ferraz, Ana Almeida, Sara Teixeira, Sara Pereira, and Natércia Edra. "A Protocol for the Acute Control of Agitation in Palliative Care." American Journal of Hospice and Palliative Medicine® 29, no. 7 (February 23, 2012): 522–24. http://dx.doi.org/10.1177/1049909111434472.

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Agitation is one of the most frequent causes for palliative sedation. It often requires urgent control to avoid negative consequences and even endangerment of all involved, including the patients themselves. A protocol for the control of episodes of agitation was developed, based on a previous experience. The protocol includes a combination of haloperidol and midazolam. The protocol was used 86 times in 27 patients. Each patient was sedated from 1 to 12 times, median 2 times. The median time from the beginning of sedation to the control of agitation was 15 minutes with a range from 1 minute (2 cases) to 3 hours and 5 minutes (only 1 case). In 71 cases (83%), only the first dose was needed. There were no significant complications.

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Elzainy, Passant, Wael Hussein, Ahmed Hashem, and Mahmoud Badr. "Post-operative Pain after Different Root Canal Irrigant Activation Methods in Patients with Acute Apical Periodontitis (Randomized Clinical Trial)." Open Access Macedonian Journal of Medical Sciences 10, no. D (July 4, 2022): 331–37. http://dx.doi.org/10.3889/oamjms.2022.10156.

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Objective To evaluate the degree of postoperative pain in patients with necrotic teeth with symptomatic apical periodontitis after applying ultrasonic irrigation or manual dynamic agitation. Methods Seventy-eight patients diagnosed with necrotic mandibular first molar with symptomatic apical periodontitis were randomly allocated into 1 of 3 separate groups (n=26); Manual Dynamic Agitation group, Ultra X group, or NaviTip group (control). After a single-visit root canal treatment and a specific method of agitation, depending on each group, the patients were given a questionnaire on which they would mark the degree of pain in a scale from 0 to 10 at 6, 12, 24, 48, 72 hours and 7 days post-operative. Data were statistically analyzed with a significance level of P ≤ 0.05. Results Final irrigation protocol including Ultrasonic agitation and NaviTip (control) groups showed significantly lower values of pain than the MDA group. There was a reduction in pain values by time in all groups. Conclusion There was significantly less pain associated with passive ultrasonic agitation and side vented needle (NaviTip) irrigation compared to Manual Dynamic Agitation.

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Schleifer, Justin J. "Management of acute agitation in psychosis: an evidence-based approach in the USA." Advances in Psychiatric Treatment 17, no. 2 (March 2011): 91–100. http://dx.doi.org/10.1192/apt.bp.109.007310.

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SummaryAgitation in psychiatric settings, particularly in psychosis, presents a staggering challenge for clinicians, who must both manage the patient's acute symptoms and simultaneously make an accurate diagnosis. Too often, the management of the former confounds the latter. Patients are very often sedated medically, which masks their underlying condition, rendering accurate diagnosis delayed and inherently difficult. Significant data are available regarding both pharmacological and non-pharmacological interventions for agitation that maximise symptom control while minimising confounding side-effects. In this article, a review of the historical evolution of agitation management in psychotic illness is presented, followed by an evidence-based clinical guideline for managing agitation in psychosis in the USA.

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Jehane H. Dagher, Jennifer Massad, Julie Lamoureux, Elaine de Guise, and Mitra Feyz. "A Retrospective Review on Post Traumatic Agitation Predictors in Hospitalized Patients with Acute Traumatic Brain Injury." Journal of Basic & Applied Sciences 15 (January 5, 2019): 106–13. http://dx.doi.org/10.29169/1927-5129.2019.15.13.

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Objectives: To determine if socio-demographic, medical and radiological variables have an impact on the risk of developing post-traumatic agitation in patients with mild complex to severe Traumatic Brain Injury (TBI). In addition, determine prognosis using the Extended Glasgow Outcome Scale (GOS-E), length of stay (LOS) and orientation at discharge of agitated patients with TBI.Methods: A retrospective observational study of all 778 patients admitted to the Montreal General Hospital, a tertiary specialized trauma centre, following a TBI that occurred between 2013 and 2015. Data was collected from the national trauma registry and TBI program database. Independent variables collected were socio-demographic, clinical, and neurological information. Dependent variables were LOS in days, non-pharmacological treatment, GOS-E at discharge, and discharge destination.Results: 55 patients (7.1%) suffered from post-traumatic agitation. The group with agitation had a significantly higher proportion of men, psychiatric history and suffered in a greater proportion a moderate TBI. The median GCS was significantly lower and post traumatic amnesia was longer in subjects with agitation. A higher percentage of patients with agitation were transferred to long-term care (LTC) facilities.

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Moukaddam, Nidal, Raymond Choi, and Veronica Tucci. "Managing Acute Agitation and Psychotic Symptoms in the Emergency Department." Adolescent Psychiatry 9, no. 2 (January 10, 2020): 118–28. http://dx.doi.org/10.2174/2210676609666191015123943.

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Background and goals: It is fairly common for adolescents with a presenting problem of acute agitation to present to the Emergency Department. These patients present challenges with respect to both differential diagnosis and management. Furthermore, with many adolescents having extended stays in emergency departments, it is important for ED physicians to have a basic familiarity with diagnosis and treatment. Method: In this paper, we present a primer on the conditions underlying acute agitation and review approaches to management in the emergency department. Discussion: Psychotic disorders, such as schizophrenia, are distinct from other conditions presenting with psychotic symptoms, which can range from depression to substance use to non-psychiatric medical conditions. Agitation, a state of excessive verbal and physical activity, can accompany any of these conditions. Unlike the case for adults, practice guidelines do not exist, and there is no fully agreed upon expert consensus yet. Emergency physicians should have a working knowledge of antipsychotic medications and need to consider pharmacological as well as non-pharmacological treatments for optimal management.

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Journal articles on the topic 'Acute Agitation'

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