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1.
Ann Pharmacother ; 55(1): 15-24, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32567359

RESUMO

BACKGROUND: Approximately 17% of intensive care unit (ICU) patients are prescribed at least 1 home neuropsychiatric medication (NPM). When abruptly discontinued, withdrawal symptoms may occur manifesting as agitation or delirium in the ICU setting. OBJECTIVE: To evaluate the impact of early reinitiation of NPMs. METHODS: This was a retrospective, observational cohort of adult ICU patients in a tertiary care hospital. Patients were included if admitted to the ICU and prescribed a NPM prior to arrival. Study groups were based on the timing of reinitiation of at least 50% of NPMs: ≤72 hours (early group) versus >72 hours (late group). RESULTS: The primary outcome was the proportion of patients with at least 1 agitation or delirium episode in the first 72 hours. Agitation and delirium were defined as at least 1 RASS assessment between +2 to +4 and a positive CAM-ICU assessment, respectively. A total of 300 patients were included, with 187 (62%) and 113 (38%) in the early and late groups, respectively. There was no difference in agitation or delirium (late 54 [48%] vs early 62 [33%]; adjusted odds ratio [aOR] = 1.5; 95% CI = 0.8-2.8; P = 0.193). Independent risk factors found to be associated with the primary outcome were restraints (aOR = 12.9; 95% CI = 6.9-24.0; P < 0.001) and benzodiazepines (BZDs; aOR = 2.0; 95% CI = 1.0-3.7; P = 0.038). CONCLUSIONS: After adjustment for baseline differences, there was no difference in agitation or delirium. Independent risk factors were restraint use and newly initiated BZDs.


Assuntos
Antipsicóticos/administração & dosagem , Delírio/prevenção & controle , Unidades de Terapia Intensiva , Agitação Psicomotora/prevenção & controle , Prevenção Secundária/métodos , Síndrome de Abstinência a Substâncias/prevenção & controle , Adulto , Idoso , Antipsicóticos/uso terapêutico , Benzodiazepinas/administração & dosagem , Benzodiazepinas/uso terapêutico , Estudos de Coortes , Cuidados Críticos , Delírio/diagnóstico , Substituição de Medicamentos , Feminino , Humanos , Masculino , Reconciliação de Medicamentos , Pessoa de Meia-Idade , Agitação Psicomotora/diagnóstico , Estudos Retrospectivos , Síndrome de Abstinência a Substâncias/diagnóstico
2.
BMJ Case Rep ; 13(6)2020 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-32540882

RESUMO

A 41-year-old man with no significant medical history presented with acute behavioural disruption on the background of a 1-day history of severe headache and a 10-day history of dry cough and fever. He was sexually disinhibited with pressured speech and grandiose ideas. His behaviour worsened, necessitating heavy sedation and transfer to intensive care for mechanical ventilation despite no respiratory indication. Investigations confirmed that he was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neuroimaging and a lumbar puncture were normal. Initial screening for SARS-CoV-2 in the cerebrospinal fluid was negative although no validated assay was available. The patient's mental state remained abnormal following stepdown from intensive care. Psychiatric assessment found features consistent with acute mania, and he was detained under the Mental Health Act. This case indicates the need to consider COVID-19 in a wider series of clinical presentations and to develop a validated assay for SARS-CoV-2 in the cerebrospinal fluid.


Assuntos
Sintomas Afetivos , Betacoronavirus/isolamento & purificação , Clonazepam/administração & dosagem , Infecções por Coronavirus , Olanzapina/administração & dosagem , Pandemias , Pneumonia Viral , Agitação Psicomotora , Transtornos Psicóticos/diagnóstico , Adulto , Sintomas Afetivos/diagnóstico , Sintomas Afetivos/tratamento farmacológico , Sintomas Afetivos/etiologia , Betacoronavirus/patogenicidade , Líquido Cefalorraquidiano/virologia , Infecções por Coronavirus/líquido cefalorraquidiano , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Diagnóstico Diferencial , Serviços Médicos de Emergência/métodos , Cefaleia/etiologia , Cefaleia/virologia , Humanos , Masculino , Neuroimagem/métodos , Pneumonia Viral/líquido cefalorraquidiano , Pneumonia Viral/diagnóstico , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Escalas de Graduação Psiquiátrica , Agitação Psicomotora/diagnóstico , Agitação Psicomotora/tratamento farmacológico , Agitação Psicomotora/etiologia , Psicotrópicos/administração & dosagem , Resultado do Tratamento
3.
Psychiatr Clin North Am ; 43(1): 59-68, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32008688

RESUMO

The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition introduced the specifier "with mixed features" including 3 or more nonoverlapping typical manic symptoms during a major depressive episode in bipolar disorder type I or II or unipolar major depressive disorder. Excluding overlapping excitatory symptoms, which are frequently observed in mixed depression, leaves many patients with mixed depression undiagnosed. As a consequence, alternative diagnostic criteria have been proposed, claiming for the inclusion in the rubric of mixed features the following symptoms: psychomotor agitation, mood lability, and aggressiveness. A deeper diagnostic reconsideration of mixed features in depression should be provided by the new nosologic classification systems.


Assuntos
Transtorno Depressivo Maior/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Agressão , Transtorno Bipolar/diagnóstico , Depressão/diagnóstico , Diagnóstico Diferencial , Humanos , Agitação Psicomotora/diagnóstico
4.
J Autism Dev Disord ; 50(5): 1580-1595, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30778821

RESUMO

Depression-, anxiety-, OCD- and autism-related behaviors were assessed in 118 high-functioning individuals with autism spectrum disorders (ASD) and in 2016 controls. The ASD group had a higher rate of clinical depression and markedly higher "insomnia" and "restlessness" scores. Network analysis and hierarchical cluster analysis in the ASD group revealed that depression and anxiety items clustered together, but separately from autism-related items. Compared to controls, "insomnia" and "restlessness" items in the ASD network of depression items were much more central (higher closeness, and betweenness centrality). Combined networks of depression-, anxiety-, and OCD-related items revealed that the control group depression item module was not preserved in ASD. The results indicate that depression is atypical in autism and suggest specific intervention targets.


Assuntos
Ansiedade/diagnóstico , Transtorno do Espectro Autista/diagnóstico , Análise de Dados , Depressão/diagnóstico , Agitação Psicomotora/diagnóstico , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Adolescente , Ansiedade/epidemiologia , Ansiedade/psicologia , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/psicologia , Criança , Depressão/epidemiologia , Depressão/psicologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Agitação Psicomotora/epidemiologia , Agitação Psicomotora/psicologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/psicologia
5.
Ann Emerg Med ; 75(2): 136-145, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31563402

RESUMO

Agitation and delirium are common reasons for older adults to seek care in the emergency department (ED). Providing care for this population in the ED setting can be challenging for emergency physicians. There are several knowledge translation gaps in how to best screen older adults for these conditions and how to manage them. A working group of subject-matter experts convened to develop an easy-to-use, point-of-care tool to assist emergency physicians in the care of these patients. The tool is designed to serve as a resource to address the knowledge translation and implementation gaps that exist in the field. The purpose of this article is present and explain the Assess, Diagnose, Evaluate, Prevent, and Treat tool. Participants were identified with expertise in emergency medicine, geriatric emergency medicine, geriatrics, and psychiatry. Background literature reviews were performed before the in-person meeting in key areas: delirium, dementia, and agitation in older adults. Participants worked electronically before and after an in-person meeting to finalize development of the tool in 2017. Subsequent work was performed electronically in the following months and additional expert review sought. EDs are an important point of care for older adults. Behavioral changes in older adults can be a manifestation of underlying medical problems, mental health concerns, medication adverse effects, substance abuse, or dementia. Five core principles were identified by the group that can help ensure adequate and thorough care for older adults with agitation or delirium: assess, diagnose, evaluate, prevent, and treat. This article provides background for and explains the importance of these principles related to the care of older adults with agitation. It is important for emergency physicians to recognize the spectrum of underlying causes of behavioral changes and have the tools to screen older adults for those causes, and methods to treat the underlying causes and ameliorate their symptoms.


Assuntos
Delírio/diagnóstico , Delírio/terapia , Serviço Hospitalar de Emergência , Avaliação Geriátrica/métodos , Agitação Psicomotora/diagnóstico , Agitação Psicomotora/terapia , Idoso , Idoso de 80 Anos ou mais , Delírio/complicações , Assistência à Saúde , Demência/complicações , Demência/terapia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Guias como Assunto , Humanos
6.
Handb Clin Neurol ; 165: 5-32, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31727229

RESUMO

Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent and represent a significant burden for patients and their caregivers. Early recognition and management of these symptoms is crucial as they are associated with increased risk of institutionalization, impairments in daily functioning, reduced quality of life, and more rapid progression to severe dementia. This chapter will discuss the pathophysiology, proposed diagnostic criteria, clinical features, and management of BPSD, including apathy, depression, agitation/aggression, psychosis, and sleep disturbances. Apathy and depression are the most common overall, and apathy is associated with high symptom severity likely because of its greater persistence. Symptoms such as agitation, aggression, hallucinations, and delusions may be especially distressing and dangerous to patients and caregivers. Nonpharmacologic management should be considered first-line therapy in most cases due to the modest and inconsistent evidence base for pharmacologic agents and greater risk of harm. However, the judicious use of pharmacologic agents may be warranted when symptoms are dangerous and/or severely distressing.


Assuntos
Doença de Alzheimer/diagnóstico , Doença de Alzheimer/psicologia , Demência Vascular/diagnóstico , Demência Vascular/psicologia , Doença de Alzheimer/terapia , Apatia/fisiologia , Demência Vascular/terapia , Depressão/diagnóstico , Depressão/psicologia , Depressão/terapia , Alucinações/diagnóstico , Alucinações/psicologia , Alucinações/terapia , Humanos , Agitação Psicomotora/diagnóstico , Agitação Psicomotora/psicologia , Agitação Psicomotora/terapia , Psicotrópicos/uso terapêutico
7.
BMJ Open ; 9(10): e032726, 2019 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601607

RESUMO

INTRODUCTION: Individuals with psychosis may access emergency services due to aggression and agitation. When the de-escalation technique fails to achieve tranquillisation, several pharmacological options are available. However, evidence on which intervention to prefer in terms of efficacy and tolerability to achieve resolution of the acute episode (ie, rapid tranquillisation) of aggression and agitation is currently fragmentary. METHODS AND ANALYSIS: We will include all randomised controlled trials comparing drugs or drug combinations or placebo for aggression or agitation episodes in adult individuals with psychosis. We will include individuals with psychosis (eg, schizophrenia and related disorders, bipolar disorder with psychotic symptoms, psychotic depression) but not substance or medication-induced psychosis or psychosis due to another medical condition. Our primary outcomes are the change in aggression or agitation scores within few hours since the administration of the intervention (efficacy outcome) and the proportion of participants who dropped out due to adverse effects (tolerability outcome). We will retrieve relevant studies from the register of studies of the Cochrane Schizophrenia Group. Also, we will run additional searches on CENTRAL, Embase and PubMed to retrieve potentially eligible studies focusing on other psychiatric diagnoses than those in the schizophrenia spectrum. We will conduct a random-effects network meta-analysis (NMA) for primary and secondary outcomes. In case of rare events of dichotomous outcomes, a common-effect Mantel-Haenszel NMA will be used instead. We will use the surface under the cumulative ranking curve and the mean ranks to rank all available treatments. Local and global methods of evaluation of inconsistency will be employed. Quality of evidence contributing to network estimates of the main outcomes will also be assessed with Confidence in Network Meta-Analysis. ETHICS AND DISSEMINATION: This study does not require ethical approval. We will disseminate our findings by publishing results in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42019137945.


Assuntos
Agressão/psicologia , Agitação Psicomotora/prevenção & controle , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/terapia , Antipsicóticos/uso terapêutico , Protocolos Clínicos , Humanos , Metanálise em Rede , Agitação Psicomotora/diagnóstico , Agitação Psicomotora/etiologia , Transtornos Psicóticos/diagnóstico , Revisões Sistemáticas como Assunto
9.
Trends psychiatry psychother. (Impr.) ; 41(4): 401-408, Oct.-Dez. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1059184

RESUMO

Abstract Introduction Although bipolar disorder (BD) is traditionally included among mood disorders, some authors believe that changes in energy and motor activity, rather than mood changes, represent the true cardinal symptoms in mania and depression. The aim of the current study was to identify which cluster of the Hamilton Depression Rating Scale (HAM-D) better distinguishes between mania, depression and euthymia. Method A group of 106 patients with BD were followed for 13 years and repeatedly assessed with the HAM-D as well as with other clinical scales. To perform a comparison, HAM-D items were classified according to clinical criteria into three clusters: energy/activity symptoms, mood symptoms, and other symptoms. Item response theory (IRT) analyses were performed to provide a test information curve for those three clusters. We measured the prevalence of one cluster of symptoms over the other two throughout the latent trait. Results Considering HAM-D items individually, the IRT analysis revealed that there was a mixture of mood and energy/activity symptoms among the most discriminative items, both in depression and in euthymia. However, in mania, only energy/activity symptoms - i.e., general somatic symptoms and retardation - were among the most informative items. Considering the classification of items, both in depression as in mania, the energy/activity cluster was more informative than the mood cluster according to the IRT analysis. Conclusion Our data reinforce the view of hyperactivity and motor retardation as cardinal changes of mania and depression, respectively.


Resumo Introdução Embora o transtorno bipolar (TB) seja tradicionalmente incluído entre os transtornos do humor, alguns autores acreditam que as alterações na energia e na atividade motora, em vez das alterações no humor, representam os verdadeiros sintomas cardinais na mania e na depressão. O objetivo do presente estudo foi identificar qual grupo da Escala de Depressão de Hamilton (HAM-D) distingue melhor entre mania, depressão e eutimia. Método Um grupo de 106 pacientes com TB foram acompanhados por 13 anos e avaliados repetidamente com a HAM-D e com outras escalas clínicas. Para realizar uma comparação, os itens da HAM-D foram classificados de acordo com critérios clínicos em três grupos: sintomas de energia/atividade, sintomas de humor e outros sintomas. Foram realizadas análises da teoria da resposta ao item (TRI) para fornecer uma curva de informações de teste para esses três grupos. Medimos a prevalência de um grupo de sintomas em comparação aos outros dois através do traço latente. Resultados Considerando os itens da HAM-D individualmente, a análise da TRI revelou que havia uma mistura de sintomas de humor e de energia/atividade entre os itens mais discriminativos, tanto na depressão quanto na eutimia. No entanto, na mania, apenas os sintomas de energia/atividade - ou seja, sintomas somáticos gerais e retardo - estavam entre os itens mais informativos. Considerando a classificação dos itens, tanto na depressão quanto na mania, o grupo energia/atividade foi mais informativo que o grupo humor, de acordo com a análise da TRI. Conclusão Nossos dados reforçam a visão da hiperatividade e do retardo motor como as alterações cardinais de mania e depressão, respectivamente.


Assuntos
Humanos , Masculino , Feminino , Escalas de Graduação Psiquiátrica , Agitação Psicomotora/diagnóstico , Transtorno Bipolar/diagnóstico , Afeto , Depressão/diagnóstico , Agitação Psicomotora/psicologia , Transtorno Bipolar/psicologia , Depressão/psicologia , Entrevista Psicológica , Pessoa de Meia-Idade , Atividade Motora
10.
Psychiatr Pol ; 53(3): 655-672, 2019 Jun 30.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-31522204

RESUMO

OBJECTIVES: Misdiagnosis of bipolar disorder may result in a non-optimal treatment, higher servicecosts and increase in the patient's suffering and risk of suicidal behavior. Lack of clinically approved and suitable for widely use biomarkers of BD led clinicians to focus on clinical course and symptomatology of depression in BD. The aim of this study was the retrospective evaluation of symptomatic differences and symptoms stability between MDD and BD patients during three subsequent depressive episodes in the inpatient setting. METHODS: Retrospective chart review of 99 patients with diagnosis of MDD and BD during three subsequent depressive episodes. Chi-squared test and logistic regression was used to analyze the symptomatic profile. Cohen's kappa value used to estimate symptoms stability. RESULTS: Statistical differences were observed in the case of 7 out of 22 depressive symptoms. Somatization (pain and non-pain complains), psychomotor agitation and pathological guilt were more frequent in MDD patients. Anhedonia, attention deficit, and suicidal ideation were more frequent in BD group. In MDD group relatively highest symptom stability was observed for somatization, middle insomnia, early wakening, and attention deficit. In BD group relatively highest symptom stability was observed for delusions, somatization (pain and non-pain complains), initial and middle insomnia, memory disturbance, psychomotor retardation, and pathological guilt. CONCLUSIONS: The observed symptomatic differences may be an additional factor of MDD/DB differential diagnosis. Lower than previously reported symptoms stability highlights the need to evaluate more than one depressive episode in differential diagnosis.


Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Agitação Psicomotora/diagnóstico , Adulto , Transtorno Bipolar/complicações , Transtorno Bipolar/psicologia , Comorbidade , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/psicologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Escalas de Graduação Psiquiátrica , Agitação Psicomotora/complicações , Agitação Psicomotora/psicologia , Recidiva , Estudos Retrospectivos
11.
PLoS One ; 14(9): e0222242, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509578

RESUMO

BACKGROUND: Different psychiatric diagnostic groups have been reported to have cytokine levels deviating from healthy controls. In acute clinical settings however, the specific challenging symptoms and signs are more important than a diagnostic group. Thus, exploration of cytokines and immune activity and their role in specific symptoms is important. Reports in this field so far are sparse. OBJECTIVE: In the present study, we aimed to examine the association between immune activity measured as levels of cytokines and agitation (independent of diagnostic group) in patients admitted to an acute psychiatric inpatient department. METHODS: A total of 316 patients admitted to an acute psychiatric inpatient department were included. Thirty-nine patients with psychosis were subject to subgroup analyses. Agitation was assessed by the Positive and Negative Syndrome Scale, Excitement Component (PANSS-EC). Based on PANNS-EC patients were stratified into two groups: 67 agitated patients and 249 non-agitated patients. Serum concentrations of the following immune markers were measured: interleukin (IL) -1ß, IL-4, IL-6, IL-10, tumor necrosis factor (TNF) -α, interferon (IFN) -γ and transforming growth factor (TGF) -ß. RESULTS: Serum levels of TNF-α were significantly higher in patients with agitation compared to those without, both when all patients were included in the analyses (p = 0.004) and in the psychosis group (p = 0.027). After correcting for multiple testing, only the findings in the total population remained significant. CONCLUSIONS: Our findings suggest an association between TNF-α and agitation in an acute psychiatric population. A similar trend was reproduced to the psychosis subgroup. This suggests that agitation might be an independent entity associated with cytokines across different diagnostic groups.


Assuntos
Ansiedade/imunologia , Transtornos Psicóticos/imunologia , Fator de Necrose Tumoral alfa/metabolismo , Adulto , Ansiedade/psicologia , Biomarcadores/sangue , Estudos Transversais , Citocinas/análise , Citocinas/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Agitação Psicomotora/diagnóstico , Agitação Psicomotora/metabolismo , Transtornos Psicóticos/psicologia , Fator de Necrose Tumoral alfa/análise , Fator de Necrose Tumoral alfa/sangue
12.
Medicine (Baltimore) ; 98(33): e16892, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31415433

RESUMO

Patients with Parkinson disease (PD) often show restless legs syndrome (RLS), leg motor restlessness (LMR) and other leg restlessness (OLR) related to sensorimotor symptoms.Here, we describe 5 patients who presented with leg restlessness as an early manifestation of PD.In case 1, the patient had leg restlessness that was not LMR or RLS and preceded the onset of motor symptoms by 1 year. In case 2, LMR preceded motor symptoms by 2 years. Case 3 had unilateral RLS symptoms on the left side of the body for 33 years. Two and a half years after the spread of RLS symptoms to the right leg with increased frequency of left-sided RLS symptoms, the patient developed PD at the age of 58 years. In cases 4 and 5, RLS symptoms preceded motor symptoms by 3 months and 1 month, respectively. All patients developed Parkinsonism within 3 years (median, 1.0 year; range 0.083-2.5 years) after initial onset or exacerbation of leg restlessness. All patients had frequent leg restlessness symptoms (6-7 days per week). In our series, the preceding leg restlessness was unilateral and confined to the dominant side of the subsequent Parkinsonism, or preceding leg restlessness was bilateral but dominant on the dominant side of the subsequent Parkinsonism.Clinicians should be aware that late-onset leg restlessness (>50 years of age) including RLS, LMR, and OLR, particularly if frequent and asymmetrical, can be an early nonmotor manifestation of PD.


Assuntos
Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico , Agitação Psicomotora/complicações , Síndrome das Pernas Inquietas/complicações , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Agitação Psicomotora/diagnóstico , Síndrome das Pernas Inquietas/diagnóstico
13.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 41(4): 324-335, July-Aug. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1011506

RESUMO

Objective: To present the essential guidelines for pharmacological management of patients with psychomotor agitation in Brazil. Methods: This is a systematic review of articles retrieved from the MEDLINE (PubMed), Cochrane Database of Systematic Reviews, and SciELO databases published from 1997 to 2017. Other relevant articles in the literature were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools. Results: Of 5,362 articles retrieved, 1,731 abstracts were selected for further reading. The final sample included 74 articles that met all inclusion criteria. The evidence shows that pharmacologic treatment is indicated only after non-pharmacologic approaches have failed. The cause of the agitation, side effects of the medications, and contraindications must guide the medication choice. The oral route should be preferred for drug administration; IV administration must be avoided. All subjects must be monitored before and after medication administration. Conclusion: If non-pharmacological strategies fail, medications are needed to control agitation and violent behavior. Once medicated, the patient should be monitored until a tranquil state is possible without excessive sedation. Systematic review registry number: CRD42017054440.


Assuntos
Humanos , Agitação Psicomotora/tratamento farmacológico , Antipsicóticos/administração & dosagem , Benzodiazepinas/administração & dosagem , Guias de Prática Clínica como Assunto , Escalas de Graduação Psiquiátrica , Agitação Psicomotora/diagnóstico , Antipsicóticos/classificação , Benzodiazepinas/classificação , Brasil , Gerenciamento Clínico
15.
J Clin Psychiatry ; 80(4)2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31265768

RESUMO

BACKGROUND: Current evidence suggests that women are more sensitive to the effects of cannabinoids. The aim of this study was to investigate the relevance of sex in the association of synthetic cannabinoid (SC) use with psychosis and agitation. METHODS: A retrospective chart review was conducted for patients admitted to a psychiatric unit (2014-2016) to extract information on demographic factors, use of substances, clinical symptoms, and pharmacologic treatments. Study groups were defined as SC users (anyone who reported use of SCs over the past 3 months), cannabis users (positive toxicology screen for Δ9-tetrahydrocannabinol [THC]), and controls (those who denied use of SCs over the past 3 months and had negative toxicology for THC). RESULTS: Digital charts of 983 patients were reviewed. A total of 162 subjects reported use of SCs over the past 3 months (76% male), and 292 subjects had positive toxicology screen for THC (67% male). A total of 38.9% of SC users (n = 63) had positive urine toxicology screen for THC. SC users had higher risks of psychotic presentations (adjusted odds ratio [AOR] = 3.390; 95% CI, 1.390-8.267) and agitation (AOR = 4.643; 95% CI, 1.974-10.918) compared to the controls. While women had lower rates of psychosis than men in the cannabis and control groups, the rates were markedly potentiated with SC use to high levels (79%) approximately equal to that seen in men (80%). There was also a significant interaction between SC use and sex for agitation (AOR = 0.308; 95% CI, 0.117-0.808). Female SC users were significantly more agitated than male SC users (73.7% vs 47.6%, respectively, P = .005). CONCLUSIONS: SC users are more likely than nonusers to be psychotic or agitated in an inpatient setting. The potentiated rates of psychosis and agitation with SC use in women suggest that they may have a greater sensitivity to these synthetic compounds.​.


Assuntos
Canabinoides/farmacologia , Dronabinol , Pacientes Internados , Agitação Psicomotora , Psicoses Induzidas por Substâncias , Adulto , Dronabinol/análise , Dronabinol/farmacologia , Feminino , Humanos , Pacientes Internados/psicologia , Pacientes Internados/estatística & dados numéricos , Masculino , Agitação Psicomotora/diagnóstico , Agitação Psicomotora/epidemiologia , Agitação Psicomotora/etiologia , Psicoses Induzidas por Substâncias/diagnóstico , Psicoses Induzidas por Substâncias/epidemiologia , Psicoses Induzidas por Substâncias/etiologia , Psicoses Induzidas por Substâncias/psicologia , Psicotrópicos/farmacologia , Fatores de Risco , Fatores Sexuais , Detecção do Abuso de Substâncias/métodos , Estados Unidos
16.
J Alzheimers Dis ; 70(1): 25-34, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31127783

RESUMO

BACKGROUND: Neuropsychiatric symptoms (NPS) are prevalent in mild cognitive impairment (MCI), but we do not know much about their role in progression to dementia. OBJECTIVE: To investigate NPS and the risk of progression to probable Alzheimer's disease dementia (AD) among subjects with MCI. METHODS: 96 MCI participants were followed for 4 years. Progression to probable AD was defined by the change of CDR total score from 0.5 to ≥1, reviewed by an expert consensus panel. NPS were determined using the Neuropsychiatric Inventory (NPI) 12-items. This study analyzed prognostic value of each NPI item and 5 sub-syndromes of NPS (apathy, psychosis, affective, hyperactivity, and vegetative) for prediction of progression to probable AD. A Cox proportional hazard model was used; hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with time dependent variable to compare the incidence of progression considering presence/absence of any NPS or sub-syndromes throughout the study. RESULTS: The presence of symptoms "agitation/aggression", "delusions", and "aberrant motor behavior" significantly increased the risk of probable AD (HR = 3.9; 95% CI = 1.9-8.2; HR = 13.9; 95% CI = 4.1-48.9; HR = 4.3; 95% CI = 1.7-10.3, respectively). The presence of sub-syndromes "psychosis" and "hyperactivity" were also predictors of progression (HR = 14.0; 95% CI = 4.4-44.5; HR = 2.0; 95% CI = 1.1-3.7, respectively). These results did not change after adjusting by potential confounders. CONCLUSION: Presence of delusions, agitation/aggression, and aberrant motor behavior is predictor of progression to probable AD.


Assuntos
Agressão/psicologia , Doença de Alzheimer/diagnóstico , Disfunção Cognitiva/diagnóstico , Delusões/diagnóstico , Agitação Psicomotora/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/psicologia , Apatia/fisiologia , Cognição/fisiologia , Disfunção Cognitiva/psicologia , Delusões/psicologia , Progressão da Doença , Feminino , Humanos , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , Agitação Psicomotora/psicologia , Fatores de Risco , Avaliação de Sintomas
18.
Am J Geriatr Psychiatry ; 27(8): 865-869, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30952608

RESUMO

OBJECTIVE: To evaluate the feasibility and validity of actigraphy as a measurement of agitation in dementia. METHODS: Participants aged 65 and older, diagnosed with dementia, residing in a geriatric psychiatry inpatient unit or long-term care facility were included in a cross-sectional study. Agitation was assessed using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory (NPI). Actigraphy was measured over seven days and compared across groups categorized as low or high agitation based on a CMAI cutoff score of 50. RESULTS: Twenty participants were enrolled (mean age = 74.3 years, standard deviation [SD] = 8.69). The 24-hour mean motor activity as measured with actigraphy was significantly different between the low and high agitation groups (180.23, SD = 86.34 versus 81.51, SD = 30.29, Z = 2.29; p = 0.02). Most actigraph variables had significant correlations with CMAI and NPI scores. CONCLUSION: Actigraphy was highly correlated with informant-based methods for measuring agitation in individuals with dementia and actigraphy may be useful tool for measuring agitation.


Assuntos
Actigrafia/normas , Demência/diagnóstico , Avaliação Geriátrica , Escalas de Graduação Psiquiátrica , Agitação Psicomotora/diagnóstico , Índice de Gravidade de Doença , Idoso , Idoso de 80 Anos ou mais , Demência/complicações , Estudos de Viabilidade , Feminino , Humanos , Masculino , Agitação Psicomotora/etiologia , Reprodutibilidade dos Testes
19.
Rev. bras. psiquiatr ; 41(2): 153-167, Mar.-Apr. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-990823

RESUMO

Objective: To present the essential guidelines for non-pharmacological management of patients with psychomotor agitation in Brazil. Methods: These guidelines were developed based on a systematic review of articles published from 1997 to 2017, retrieved from MEDLINE (PubMed), Cochrane Database of Systematic Review, and SciELO. Other relevant articles identified by searching the reference lists of included studies were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools. Results: We initially selected 1,731 abstracts among 5,362 articles. The final sample included 104 articles that fulfilled all the inclusion criteria. The management of agitated patients should always start with the least coercive approach. The initial non-pharmacological measures include a verbal strategy and referral of the patient to the appropriate setting, preferably a facility designed for the care of psychiatric patients with controlled noise, lighting, and safety aspects. Verbal de-escalation techniques have been shown to decrease agitation and reduce the potential for associated violence in the emergency setting. The possibility of underlying medical etiologies must be considered first and foremost. Particular attention should be paid to the patient's appearance and behavior, physical signs, and mental state. If agitation is severe, rapid tranquilization with medications is recommended. Finally, if verbal measures fail to contain the patient, physical restraint should be performed as the ultimate measure for patient protection, and always be accompanied by rapid tranquilization. Healthcare teams must be thoroughly trained to use these techniques and overcome difficulties if the verbal approach fails. It is important that healthcare professionals be trained in non-pharmacological management of patients with psychomotor agitation as part of the requirements for a degree and graduate degree. Conclusion: The non-pharmacological management of agitated patients should follow the hierarchy of less invasive to more invasive and coercive measures, starting with referral of the patient to an appropriate environment, management by a trained team, use of verbal techniques, performance of physical and mental assessment, use of medications, and, if unavoidable, use of the mechanical restraint. Systematic review registry number: CRD42017054440.


Assuntos
Humanos , Agitação Psicomotora/diagnóstico , Agitação Psicomotora/terapia , Guias de Prática Clínica como Assunto , Gerenciamento Clínico , Escalas de Graduação Psiquiátrica , Brasil
20.
West J Emerg Med ; 20(2): 409-418, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30881565

RESUMO

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.


Assuntos
Serviços Médicos de Emergência , Psiquiatria , Agitação Psicomotora/terapia , Adolescente , Criança , Consenso , Gerenciamento Clínico , Humanos , Guias de Prática Clínica como Assunto , Agitação Psicomotora/diagnóstico , Estados Unidos
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