Protocol for the management of psychiatric patients with psychomotor agitation.

BACKGROUND: Psychomotor agitation (PMA) is a state of motor restlessness and mental tension that requires prompt recognition, appropriate assessment and management to minimize anxiety for the patient and reduce the risk for escalation to aggression and violence. Standardized and applicable protocols and algorithms can assist healthcare providers to identify patients at risk of PMA, achieve timely diagnosis and implement minimally invasive management strategies to ensure patient and staff safety and resolution of the episode. METHODS: Spanish experts in PMA from different disciplines (psychiatrists, psychologists and nurses) convened in Barcelona for a meeting in April 2016. Based on recently issued international consensus guidelines on the standard of care for psychiatric patients with PMA, the meeting provided the opportunity to address the complexities in the assessment and management of PMA from different perspectives. The attendees worked towards producing a consensus for a unified approach to PMA according to the local standards of care and current local legislations. The draft protocol developed was reviewed and ratified by all members of the panel prior to its presentation to the Catalan Society of Psychiatry and Mental Health, the Spanish Society of Biological Psychiatry (SEPB) and the Spanish Network Centre for Research in Mental Health (CIBERSAM) for input. The final protocol and algorithms were then submitted to these organizations for endorsement. RESULTS: The protocol presented here provides guidance on the appropriate selection and use of pharmacological agents (inhaled/oral/IM), seclusion, and physical restraint for psychiatric patients suspected of or presenting with PMA. The protocol is applicable within the Spanish healthcare system. Implementation of the protocol and the constituent algorithms described here should ensure the best standard of care of patients at risk of PMA. Episodes of PMA could be identified earlier in their clinical course and patients could be managed in the least invasive and coercive manner, ensuring their own safety and that of others around them. CONCLUSION: Establishing specialized teams in agitation and providing them with continued training on the identification of agitation, patient management and therapeutic alternatives might reduce the burden of PMA for both the patient and the healthcare system.

Ingresos hospitalarios de desintoxicación en mujeres con alcoholismo y otras toxicomanías / Hospitalized inpatient detoxification of women with alcoholism and other drug addictions

Objetivos: Analizar las características descriptivas de los ingresos de Desintoxicación por Alcoholismo u otras Toxicomanías en mujeres que requieren un ingreso hospitalario de desintoxicación en nuestro medio. Diseño: Retrospectivo, incluyendo todas las mujeres ingresadas en la Unidad de Desintoxicación de la Corporació Sanitària i Universitària Parc Taulí de Sabadell (Barcelona) entre enero de 2010 y junio 2013. Utilizamos criterios diagnósticos DSM-IV-TR y una estadística descriptiva. De forma secundaria, se compararon mujeres que habían requerido un ingreso por alcohol como sustancia principal de desintoxicación (APD) y aquellas con alcohol como sustancia única de desintoxicación (AUD) en relación al resto de la muestra. Resultados: Desde Enero de 2010 a Junio de 2013 se realizaron 360 ingresos en la Unidad de Desintoxicación, de los cuales 82 fueron mujeres (22,7%). Se trataba de mujeres de edad media (43,3 años) que ingresaron principalmente para la desintoxicación de más de una sustancia. El tóxico principal fue el alcohol con 67,1% (n=55), seguido de las politoxicomanías que incluyeron casos con abuso de varias sustancias como motivo principal de desintoxicación. A nivel de otra comorbilidad psiquiátrica, la mayoría de las mujeres no presentaban ningún diagnostico DSM-IV-TR (53,7%, n=44). Las mujeres AUD (n=33) fueron significativamente mayores de edad, utilizaron más benzodiacepinas y tuvieron menos diagnósticos en el Eje II. Conclusiones: El principal motivo de desintoxicación en mujeres de nuestro medio es el alcohol. Existen diferencias significativas entre las mujeres con desintoxicación de alcohol y aquellas con consumos comórbidos de otras sustancias

Objectives: To analyze the characteristics of inpatient detoxification hospitalizations for alcoholism and other drug addictions in women from our area. Design: We use a retrospective design. The subjects were inpatient women hospitalized in the Detoxification Unit at the Corporació Sanitària i Universitària Parc Taulí de Sabadell (Barcelona) between January 2010 and June 2013. Diagnoses were made by DSM-IV-TR criteria. The statistics were descriptive. In a secondary analysis, we compared women with alcohol as a principal reason of admission (APD) with women with alcohol as an isolated reason of admission (AUD) in relation with the rest of the sample. Results: From January 2010 to June 2013 there were 360 admissions in the Detoxification Unit, 82 of whom were women (22.7%). These were middle-aged women (43.3 years), who were mainly admitted for detoxification from more than one substance. The main drug involved in the abuse was alcohol (67.1%, n=55), followed by multiple drug abuse as a main reason for detoxification. Considering psychiatric comorbidity, most of the women did not display any DSM-IV-TR diagnosis criteria (53.7%,= 44). Women in AUD (n=33) were significantly older, used more benzodiazepines and had fewer Axis II diagnoses. Conclusions: The main reason for inpatient detoxification in women in our area is alcohol. There are significant differences between women with alcohol detoxifications and women with comorbid abuse of other substances

Tratamiento antidepresivo y asociación con el ingreso urgente en unidades médicas en pacientes de 65 años o mayores / Association of antidepressant treatment with emergency admission to medical units for patients 65 years or older

Introducción. Existe una creciente evidencia acerca de la interrelación entre presencia de depresión en la tercera edad y riesgo de ingreso hospitalario médico. Objetivo. Determinar el impacto del tratamiento antidepresivo (ATD) como factor protector de ingreso hospitalario desde Urgencias en personas mayores. Método. Se incluyó a personas de 65 años o mayores que acudieron por cualquier motivo a Urgencias de la Corporació Sanitària i Universitària Parc Taulí de Sabadell (Barcelona) entre enero y octubre del 2012. Se obtuvieron datos sociodemográficos básicos, consumo de alcohol y tabaco, antecedentes y tratamiento actual. Se realizó el cálculo de tamaño muestral y una aleatorización simple. Posteriormente se realizó un análisis estadístico descriptivo y pruebas paramétricas. Resultados. Se evaluó a 674 pacientes (53% mujeres), con una edad media de 78,45 años. Un 27,6% de los casos (71% mujeres) recibían tratamiento antidepresivo. Del total de 337 pacientes ingresados (50%), 83 individuos (24,6%) utilizaban previamente ATD, mientras que entre los no ingresados, utilizaban ATD el 30,6%. Tras el análisis comparativo, se objetivó una relación significativa negativa entre recibir ATD y riesgo de ingreso solo en aquellos pacientes de 75 años o mayores (sig. 0,012). Conclusiones. En nuestro estudio, el tratamiento antidepresivo se relaciona con una disminución del riesgo de ingreso hospitalario urgente por enfermedad médica en personas de 75 años o mayores. El tratamiento de la depresión en personas mayores podría tener efecto protector general frente a la severidad de las enfermedades atendidas en Urgencias en nuestra población y puede suponer un criterio de calidad en orden a prevenir complicaciones (AU)

Introduction. There is increasing evidence relating the presence of depression in seniors and the risk of hospital admission in medical departments from the Emergency Services. Objective. To determine the impact of antidepressant treatment (ATD) as a protective factor for emergency hospitalization in older people. Method. All patients aged 65 and over who required urgent attention for medical reasons at the Emergency Department of the Corporació Sanitària i Universitària Parc Taulí (Sabadell, Barcelona, Spain) for the period between January and October 2012 were included in the study. Sociodemographic variables, alcohol and tobacco use, medical history and psychopharmacological treatment were obtained. The necessary sample size was calculated and a simple randomization was performed. Subsequently, a descriptive statistical analysis and parametric tests were conducted. Results. A total of 674 patients (53% women) were evaluated, with a mean age of 78.45 years, and 27.6% of the cases (71% women) were receiving ATD. Among the 333 admitted patients (50%), 83 individuals (24.6%) had previously received ATD; this contrasts with the 103 cases (30.6%) of prior ATD treatment among the patients who were not admitted. After comparative analysis, the relationship between previous use of ATD and being admitted to hospital was not statistically significant in our global sample. This relationship was only statistically significant among the group aged 75 and over (neg. sig. 0.012). Conclusions. In our study, ATD was associated with a decreased risk of hospital admission for urgent medical conditions in people aged 75 and over. Treating depression may protect the elderly against admission to the Emergency department and may potentially be a quality criterion in preventing complications in this population (AU)

Association of antidepressant treatment with emergency admission to medical units for patients 65 years or older. / Tratamiento antidepresivo y asociación con el ingreso urgente en unidades médicas en pacientes de 65 años o mayores.

INTRODUCTION: There is increasing evidence relating the presence of depression in seniors and the risk of hospital admission in medical departments from the Emergency Services. OBJECTIVE: To determine the impact of antidepressant treatment (ATD) as a protective factor for emergency hospitalization in older people. METHOD: All patients aged 65 and over who required urgent attention for medical reasons at the Emergency Department of the Corporació Sanitària i Universitària Parc Taulí (Sabadell, Barcelona, Spain) for the period between January and October 2012 were included in the study. Sociodemographic variables, alcohol and tobacco use, medical history and psychopharmacological treatment were obtained. The necessary sample size was calculated and a simple randomization was performed. Subsequently, a descriptive statistical analysis and parametric tests were conducted. RESULTS: A total of 674 patients (53% women) were evaluated, with a mean age of 78.45 years, and 27.6% of the cases (71% women) were receiving ATD. Among the 333 admitted patients (50%), 83 individuals (24.6%) had previously received ATD; this contrasts with the 103 cases (30.6%) of prior ATD treatment among the patients who were not admitted. After comparative analysis, the relationship between previous use of ATD and being admitted to hospital was not statistically significant in our global sample. This relationship was only statistically significant among the group aged 75 and over (neg. sig. 0.012). CONCLUSIONS: In our study, ATD was associated with a decreased risk of hospital admission for urgent medical conditions in people aged 75 and over. Treating depression may protect the elderly against admission to the Emergency department and may potentially be a quality criterion in preventing complications in this population.