Stopping psychomotor agitation algorithm. Convulsive syndromes and types of psychomotor excitations

Many neuropsychiatric pathologies can be accompanied by a condition characterized by hypermobility and abnormal behavior that does not correspond to the situation. It manifests itself in different ways - from fussy obsessive agitation to uncontrollable aggression. The actions of the patient are often accompanied by a violation of objective perception, hallucinations, delusions and other symptoms, depending on the type of disease, against which psychomotor agitation develops. A patient of any age in such a state, especially one who is inaccessible to contact, can be dangerous for others and himself, moreover, he will not seek help on his own, because he is unable to control his behavior. psychomotor agitation involves the development of acute psychosis, therefore, requires the provision of emergency psychiatric care.

Causes of psychomotor agitation

To survive given state You don't have to be mentally ill at all. It can arise as one of the types of reactive psychosis (psychogenic shock), which a person experiences as a result of very strong emotional upheavals. This may be an event that threatens the life of a person or people very close to him - an accident, a message about incurable disease, any significant loss and so on. At risk are people with psychopathic traits character, paranoid tendencies, emotionally labile, prone to hysteria, accentuated personalities, whose deviations from the norm are sufficiently compensated and do not reach a pathological level.

In some periods - age crises, pregnancy, a person becomes more vulnerable to the development of psychomotor agitation as a result of psychogenic shock. Such cases are usually temporary, sometimes isolated, and completely reversible.

The development of psychomotor agitation occurs as a result of brain injuries, infections, complicated inflammatory diseases meninges, intoxications and hypoxias, ischemic processes, hemorrhages and tumors. Psychomotor agitation after a stroke is more likely to develop with hemorrhagic form vascular catastrophe, with ischemia - also not excluded, but less pronounced.

Psychomotor agitation often develops in people with mental (schizophrenia, manic-depressive psychosis, personality disorders), severe mental retardation or neurological (epilepsy, neuroses) diseases.

Risk factors

Risk factors for the development of such a condition - metabolic disorders in brain tissues as a result of chronic or acute direct intoxication with alcohol, drugs, medicines and others chemicals, precomatous and coma; autoimmune and immune processes.

Pathogenesis

The pathogenesis of psychomotor agitation may be different depending on the cause that caused its development. The psychological characteristics of the individual, circumstances, neuroreflex mechanisms, immune disorders, ischemic, hemorrhagic, metabolic disorders in the brain substance, direct toxic effects of toxic substances that caused an imbalance of excitation and inhibition are considered as pathogenetic links.

Symptoms of psychomotor agitation

This state of abnormal hyperactivity is characterized by age characteristics. Psychomotor agitation in children younger age expressed in monotonous repetitions of cries, one phrase or question, movements - nodding the head, swaying from side to side, jumping. Children cry mournfully and monotonously, laugh hysterically, grimace, bark or howl, bite their nails.

Older children are constantly moving, crushing and tearing everything, sometimes manifestations of aggression are frankly sadistic. They can pretend to be babies - suck their thumb for a long time, babble excitedly like a child.

Psychomotor agitation in individuals old age also characterized by motor and speech monotony. Manifested by fussiness, anxiety or irritability and grouchiness.

And although the clinical picture of different types of this condition has symptomatic differences (described below), the first signs always appear unexpectedly and acutely. The patient's behavior attracts attention - inadequate movements, violent emotions, defensive reactions, aggressive actions, attempts to injure oneself.

In the mild stage of psychomotor agitation, the patient is unusually mobile, talkative, he has a clearly hyperthymic mood, however, the abnormal behavior is not yet too noticeable. The middle stage is characterized by already noticeable anomalies, dissociative thinking, unexpected and inadequate actions, the purpose of which is unclear, visible affects (rage, anger, longing, unbridled fun) and the lack of a critical attitude towards one's behavior. Acute psychomotor agitation in the third stage is a very dangerous condition that requires emergency medical attention. Affects go off scale: consciousness is clouded, speech and movements are chaotic, there may be delirium, hallucinations. In this state, the patient is inaccessible to contact and is very dangerous for others and himself.

Forms

Types of psychomotor agitation largely depend on the causes that caused it, and differ in clinical course.

For depressive syndromes characterized by anxiety. Motor reactions in this case are endless monotonous repetitions of simple movements, accompanied by speech repetitions of the same phrase, words, sometimes just groans. Raptuses are periodically observed - sudden impulsive attacks, frantic screams, self-damaging actions.

Psychogenic arousal occurs against the background of a strong mental shock or under life-threatening circumstances. Accompanied by symptoms of an affective-shock disorder: mental and motor overexcitation, autonomic disorders- increased heart rate and respiration, dry mouth, hyperhidrosis, dizziness, tremor of the limbs, fear of death. Possible various options symptoms ranging from catatonic or anxious to mindless panic acts. There may be suicide attempts, escape from the scene. In global cataclysms and catastrophes, psychogenic arousal has a group character.

Psychopathic arousal occurs in people with personality disorders, more often in excitable psychopaths, under the influence of exogenous irritation. In this case, the patient reacts with a force that is absolutely inadequate annoying factor. The use of psychoactive substances (alcohol, drugs) increases the likelihood of psychomotor agitation in a person with psychopathic or neurasthenic features. Aggression, anger, anger is directed at individuals who have offended the patient, who have not appreciated his achievements. Most often expressed in threats, abuse, physical activities, suicide attempts, the demonstrative nature of which is designed to provide a wide audience, which is especially characteristic of the hysterical subspecies of psychopathic arousal, when playing at the viewer is accompanied by violent affects. The facial expressions and gestures of the patient are emphatically expressive and often even pretentious. It is noticeable that the "actor" appeals to the audience in order to achieve empathy. Unlike "real" patients (epileptics, people with organic diseases brain) psychopaths are well versed in the environment and, in most cases, are in control of the situation and can refrain from breaking the law, because they realize that they will be held responsible for their actions. However, there is no guarantee of safety, especially if the psychopath is under the influence of psychoactive substances.

With organic lesions of the brain and in epileptics, dysphoric psychomotor agitation often develops. The patient is tense, gloomy and gloomy, very suspicious. He often takes a defensive position, reacts to attempts to establish contact with sharp irritation and unexpected strong aggression, suicidal intentions are possible.

Manic excitement is accompanied by a euphoric mood, all movements and thoughts are focused on the performance of some purposeful action, while accelerated thinking is characterized by a lack of logic, attempts to prevent an individual in this state can cause violent aggression. Patients often miss words in sentences, it seems that their actions do not keep up with their thoughts. The voice of the patients becomes hoarse and not one of their actions is brought to its logical conclusion.

Catatonic excitation - impulsive rhythmic repetitions of monotonous slurred muttering, singing, abuse, grimaces, jumps, shouts, pretentious unnatural movements and postures. Some patients are characterized by mannerisms - they greet everyone in a row and several times, they try to make small talk, asking the same questions.

In schizophrenics, hebephrenic arousal is often observed, a specific sign of which is foolish behavior, however, it, obeying a sudden impulse, can turn into aggression with elements of delirium, illusory visions, and mental automatism.

Epileptiform psychomotor agitation, to which epileptics with temporal form lesions, accompanied by clouding of consciousness, spatial and temporal disorientation, contact with the patient is impossible. It occurs suddenly - it is expressed by motor hyperactivity, aggressive actions. The patient is defending himself from imaginary enemies, trying to escape from them. There is a viciously intense affect, often such attacks of excitement are accompanied by the commission of violent acts. The excited state lasts about one or two minutes, then just as suddenly passes. After that, the patient does not remember his actions and for some time (at least 10 minutes) remains unavailable for contact.

Eretic psychomotor agitation is observed in oligophrenics and in other forms mental retardation. It manifests itself in non-purposeful destructive activity, devoid of any meaning, which is accompanied by abuse or loud meaningless sounds.

Delirious psychomotor agitation occurs under the influence of psychoactive substances or in chronic alcoholics, drug addicts with experience - as a withdrawal syndrome, as well as - with injuries, neuroinfections, tumors. It is expressed by chaotic meaningless movements, intense concentration, incoherent speeches, changeable facial expressions, aggressive gestures. This type of psychomotor agitation is almost always accompanied by delusions and hallucinations, under the influence of which patients are prone to unmotivated attacks on imaginary enemies and / or self-damaging actions.

There are also delusional and hallucinatory excitation. Delusional is characterized by the presence of overvalued ideas for the patient. Patients in a state of delirium are aggressive, they see the surrounding enemies that impede the implementation of delusional ideas. characteristic of schizophrenics and people with organic pathologies central nervous system.

Patients with hallucinatory arousal, first of all, have very rich facial expressions, they are focused on their illusions, they are hostile to others, their speech is usually incoherent.

The diametrically opposite state is psychomotor inhibition or stupor. This condition is characterized by hypo- and akinesia, reduced muscle tone, laconic or just stupid silence. Sometimes the patient is available for contact, sometimes not. The causes and types that caused psychomotor inhibition are similar to arousal, in addition, one state can be replaced by another, sometimes quickly and unexpectedly.

Complications and consequences

The most significant result of psychomotor agitation is the infliction of bodily harm incompatible with life, to oneself or to others. Less significant - minor injuries and damage material assets. Patients with catatonic and hallucinatory delusional types of excitation are especially dangerous, since their impulsive action cannot be predicted.

In addition, the occurrence of such a condition may indicate that the individual has serious illnesses psyche or nervous system requiring urgent action.

Diagnostics of psychomotor agitation

Prehospital diagnosis is carried out visually. It is desirable for the doctor to assess the degree of aggressiveness of the patient and the hypothetical cause of the state of psychomotor agitation. In addition, it is necessary to avoid aggression directed directly at health workers.

Often asking questions to the patient does not make sense, because he does not want to contact.

However, some questions that will help to conduct a differential diagnosis should be clarified, if not from the patient himself, then from his close people: did the patient have such conditions before, which preceded the attack of excitement, does the patient have a psychiatric or neurological diagnosis, did he take psychoactive substances the day before whether he was injured, whether he suffers from alcoholism, whether there have been suicide attempts before, and others.

On examination, the doctor should focus on identifying the specific symptoms of the patient's condition, whether they intensify, whether there is delirium, hallucinations. Pay attention to the severity of affect, the presence of demonstrativeness, try to determine the severity of psychomotor agitation - how the patient speaks and moves (especially loud, non-stop, meaningless speech and hyperkineticism, combined with a lack of response to requests, comments, orders of others) are the basis for hospitalization.

Differential Diagnosis

Differential Diagnosis carried out between psychomotor excitations without psychotic symptoms and with them. Psychogenic and psychopathic excitations should be distinguished from manic, epileptiform, schizophrenia, and delirium.

Delirious disorders caused by the use of psychoactive substances and requiring the neutralization of their action from delirium caused by other causes - neuroinfections, epilepsy, tumors. Affective disorders - from each other, in particular, a large depressive disorder (clinical depression), which is characterized by long-term preservation of mood in one state, is differentiated from intermittent manic and depressive episodes (bipolar disorder). Stress also needs to be differentiated from mental illness, and the severity of the stress response indicates what action needs to be taken.

Treatment of psychomotor agitation

In the vast majority of cases, patients in a state of psychomotor agitation pose a danger, to a greater extent - to others, but sometimes they also show auto-aggression. Can prevent unwanted consequences urgent Care with psychomotor agitation. They try to isolate the patient and not leave him alone, watching him, if possible, not too noticeably, since demonstrative observation can cause an attack of aggression on the part of the patient. Be sure to call an ambulance. Usually, a psychiatric team is sent to such a call, before the arrival of which difficult cases you can call the police, who are required by law to provide psychiatric care.

Help algorithm on prehospital stage– prevention of aggression on the part of the patient with the help of persuasion, distraction and physical strength(retention of the patient). Of course, first of all, if the patient is available for contact, they try to persuade him to take the medicine or allow him to get an injection and voluntarily go to the hospital.

In severe cases (the patient actively resists, behaves threateningly or has a weapon), law enforcement agencies are involved and assistance is provided without the consent of the patient.

Rampant patients are temporarily immobilized or immobilized with improvised means or a straitjacket for the time needed for transport, while the drugs have not yet taken effect.

The main recommendations for knitting a patient in psychomotor agitation are that soft and wide materials are selected from improvised means - sheets, towels, cloth belts, which should not squeeze the vessels and nerve trunks body. It is necessary to securely fix each arm of the patient separately, as well as the shoulder girdle. Basically, this is enough. In especially violent and mobile patients, they are immobilized and lower limbs. In this case, it is necessary to make sure that it is impossible to get rid of the fixing bandages on your own. The state of the immobilized patient must be constantly monitored.

Drug relief of psychomotor agitation, except in cases of emergency surgical intervention when hyperactivity is a sign of progressive brain compression.

The most widely used drugs for psychomotor agitation are neuroleptics with a pronounced sedative effect. Most often, parenteral administration is used - intramuscular or intravenous. If the patient is persuasive, parenteral forms of drugs can be used. Patients who have never been treated with antipsychotics are prescribed the minimum effective dose. For those who have previously been treated psychotropic drugs- the dose is doubled. The patient is constantly monitored for blood pressure, respiratory function and the absence of signs of orthostatic phenomena. In milder cases, as well as in debilitated and elderly patients, tranquilizers are prescribed. Naturally, these drugs are not combined with alcohol.

The drugs are dosed individually, depending on the patient's response to the treatment.

In cases of anxiety in the lungs and middle stage medicine is prescribed Atarax. Active substance the drug hydroxyzine dihydrochloride is a blocker of H1-histamine, as well as choline receptors, exhibits a moderate anxiolytic effect, in addition, it provides a hypnotic and antiemetic effect. It is a mild tranquilizer. With anxiety in patients, the process of falling asleep is accelerated, the quality of sleep and its duration improve. The relaxing effect of the drug on the muscles and the sympathetic nervous system contributes to this effect.

In addition, Atarax generally has a beneficial effect on memory, concentration and memorization, but this is a long-term effect. And during the reception, you should refuse to drive a car, work at height, with electrical wiring, etc.

The active ingredient is absorbed at a good rate into gastrointestinal tract. The effect of taking the tablets occurs in half an hour, and with intramuscular injection- almost instantly. As a result of taking the drug, there is no withdrawal syndrome, however, in elderly patients suffering from hepatic and renal insufficiency, dose adjustment is required.

Atarax crosses the placental barrier, accumulates in the tissues of the unborn child, penetrates into breast milk Therefore, the drug is contraindicated for pregnant and lactating women.

It is not prescribed for patients with porphyria and an established allergy to the active substance or an auxiliary contained in the drug, in particular, lactose, as well as to cetirizine, aminophylline, piperazine, ethylenediamine and their derivatives.

The drug can cause an allergic reaction, although it has the ability to eliminate it, rare side effects are increased arousal, hallucinations and delusions.

Basically, it causes drowsiness, weakness, low-grade fever, blurred vision, dyspepsia, hypotension.

With moderate psychomotor agitation, elderly and debilitated patients, as well as in order to stop predilirious arousal or symptoms of psychoactive substance withdrawal syndrome, the drug can be used Grandaxin. The active substance tofisopam belongs to the group of benzodiazepines. This drug reduces mental stress, reduces anxiety, provides a light sedative action. However, it is believed that it does not cause drowsiness, muscle relaxation and anticonvulsant effect, therefore, with severe psychomotor agitation, its use is inappropriate. The drug can provoke increased excitation, dyspeptic symptoms and allergic reactions. In the first three months of pregnancy is prohibited, then - only for health reasons. Breastfeeding women can be taken subject to the cessation of lactation. Side effects are more common in people with hepatic and renal dysfunction, the mentally retarded and the elderly.

In epilepsy, this drug can cause convulsions, in states of depressive anxiety, the risk of attempts to commit suicide increases, special care should be taken with patients who have organic disorders brain, as well as those suffering from personality disorders.

Other benzodiazepine anxiolytic Relanium(the active ingredient is diazepam) is often used in emergency cases of acute psychomotor anxiety. It is used both orally and parenterally - intramuscularly and intravenously. The drug, unlike the previous one, has a pronounced hypnotic, anticonvulsant and muscle-relaxing effect.

Interacts with benzodiazepine receptors located in the center of regulation of the activity of structures of the brain and spinal cord, enhances the action of the inhibitory neurotransmitter - γ -aminobutyric acid, both presynaptic and postsynaptic, and also inhibits polysynaptic spinal reflexes.

The sedative and hypnotic effect is realized mainly through the influence on the neurons of the reticular formation of the brain stem.

Convulsions are stopped by suppressing the spread of epileptogenic activity, however, excitation in the epileptic focus remains intact.

Relanium weakens the delirious excitation of alcoholic etiology, however, it has practically no effect on the productive manifestations of psychotic disorders (delusions, hallucinations).

Contraindicated in severe respiratory failure, a tendency to stop breathing during sleep and muscle weakness of the patient. Also not used in coma, for the treatment of patients with phobic disorders and chronic psychoses. Contraindicated in patients with glaucoma, especially angle-closure glaucoma, with severe dysfunction of the liver and kidneys. Chronic alcoholics and drug addicts are prescribed exclusively for the relief of arousal caused by the withdrawal syndrome.

In bipolar and other types of mixed disorders with a predominance of an anxiety component, the drug can be used to stop an attack of psychomotor agitation. Amitriptyline. Belongs to the class of tricyclic antidepressants, available in both tablet and injectable form. Increases the concentration of catecholamines and serotonin in the synaptic cleft, inhibiting the process of their reuptake. Blocks choline and histamine receptors. Improving mood when taking the drug is simultaneously supported by sedation - a decrease in anxiety.

It is believed that it does not affect the activity of monoamine oxidase. At the same time, it is not prescribed in combination with other antidepressants that inhibit monoamine oxidase. If necessary, replace Amitriptyline with a monoamine oxidase inhibitor, the interval between doses of drugs should be at least two weeks.

Paradoxical side effects, and - increased drowsiness, headache, coordination disorder, dyspepsia. The drug is not recommended for use in manic phase bipolar disorder, epileptics and suicidal patients. Contraindicated in children under the age of twelve, with extreme caution is prescribed to men suffering from adenoma prostate, persons of both sexes with dysfunction thyroid gland, heart and blood vessels, glaucoma, patients with myocardial infarction, pregnant and lactating women.

Sleeping pill with antipsychotic action Tiapride blocks adrenergic receptors in the brainstem. At the same time, it has an antiemetic effect by blocking dopamine neurotransmitter receptors in the chemoreceptor trigger zone of the brain, as well as in the hypothalamic center of thermoregulation.

The drug is indicated for the treatment of patients older than six years of age in a state of psychomotor agitation of various origins, including alcohol, drug and senile aggression. The drug is taken orally with minimum doses, bringing to effective.

Non-contact patients are given injections every four or six hours. The dose is prescribed by the doctor, but per day you can get no more than 0.3 g of the drug for a child and 1.8 g for an adult. The injection form is used to treat patients from seven years of age.

Contraindicated in the first four months of pregnancy, nursing mothers, patients with prolactin-dependent tumors, pheochromocytoma, decompensated and severe cardiovascular and renal pathologies.

Epileptics and elderly patients are prescribed with caution.

Undesirable effects from taking the drug can be expressed in increased hypnotic action or paradoxical effects, hyperprolactinemia, allergic reactions.

The most universal and widely used at present in the relief of the state of psychomotor agitation at different stages are neuroleptics, the most popular of them is Aminazine. This neuroblocker has proven itself effective tool fight against hyperexcitation and is used in many countries of the world under different names: Chlorpromazine (English version), Megafen (Germany), Largactil (France).

This drug has a diverse and complex dose-dependent effect on the work of the central and peripheral nervous system. An increase in the dose causes an increase in sedation, the muscles of the patient's body relax and motor activity decreases - the patient's condition approaches normal physiological state sleep, which differs from narcotic sleep in that it is devoid of side effects of anesthesia - stupor, is characterized by ease of awakening. Therefore, this drug is the drug of choice for stopping the states of motor and speech excitement, anger, rage, unmotivated aggression in combination with hallucinations and delusions.

In addition, the drug, acting on the thermoregulatory center, is able to lower body temperature, which is valuable when excited due to acute brain injuries, hemorrhagic strokes(when hyperthermia is often observed). This action is potentiated by the creation of artificial cooling.

In addition, Aminazine has antiemetic properties, soothes hiccups, which is also important in the above cases. Potentiates the action of anticonvulsants, painkillers, narcotic, sedative drugs. Able to stop attacks of hypertension caused by the release of adrenaline, and other interoceptive reflexes. The drug has a moderate anti-inflammatory and angioprotective activity.

The mechanisms of its action are still not fully understood, but its effectiveness is not in doubt. Research data in different countries indicate that the active substance (phenothiazine derivative) has a direct effect on the occurrence and conduction nerve impulses transmitting excitation in different parts of both the central and autonomic nervous systems. Under the influence of the drug, metabolic processes in the tissues of the brain, especially in the neurons of its cortex, slow down. Therefore, the neuroplegic effects of the drug are associated with cortical activities. In addition, Aminazin also acts on the subcortex, reticular formation and peripheral nerve receptors, extinguishes almost all types of psychomotor agitation, relieves hallucinatory and delusional symptoms, however, is not hypnotic. A patient under the influence of this drug is able to respond adequately and answer questions.

It is used both alone and in combination with anxiolytics and other psychotropic drugs. Absolute contraindications to the use of the drug are severe systemic pathologies of the brain and spinal cord, dysfunction of the liver and kidneys, hematopoietic organs, myxedema, a tendency to thromboembolism, decompensated heart disease.

Apply at any age, dosed individually, according to age norms and severity of the condition. Available oral intake, as well as parenteral (intramuscular and intravenous). To avoid post-injection complications and pain, the contents of the ampoule are diluted with novocaine or lidocaine, saline, glucose solution (intravenous administration).

After using the drug, especially injections, a drop in blood pressure is possible, so the patient is advised to lie down for several hours and take vertical position no sudden movements.

In addition, other side effects are possible - allergies, dyspepsia, neuroleptic syndrome.

A drug Phenotropil- a new word in improving the work of the central and peripheral nervous system. A nootropic that came to a wide consumer from space medicine. pharmachologic effect the drug approaches the natural - its manufacturers claim that the drug is able to activate more rational use own resource, and not lead to its depletion.

The drug has a beneficial effect on metabolic processes in brain neurons and stimulates blood circulation in cerebral vessels. It activates the course of redox processes, increases the efficiency of glucogenesis, thus increasing the energy potential of the body. The active substance of the drug phenylpiracetam helps to increase the content of mediators of cheerfulness, pleasure and Have a good mood norepinephrine, dopamine and serotonin. It is not necessary to list all of its wonderful qualities, but we note that it is directly related to the relief of psychomotor arousal. The drug has a psychostimulating effect - it accelerates the transmission of nerve impulses, improves performance, cognitive qualities, and has a moderate anti-anxiety activity. True, in the features of the application, it is noted that people who are prone to panic attacks and psychotic arousal attacks should be treated with caution. The drug is rather suitable for the prevention of psychomotor agitation and increasing the body's resistance to stress. He has no direct indications for stopping the state of motor and mental hyperactivity. On the contrary, it is indicated in cases of decreased mobility, lethargy, memory impairment and manifestations of anxious inhibition.

Used to treat psychomotor agitation different means with sedative properties: barbiturates - veronal, medinal, luminal, chloral hydrate and others. They have a pronounced hypnotic effect. They are sometimes given rectally (in an enema). The effectiveness of such drugs increases with the simultaneous intravenous administration of magnesium sulfate.

In severe cases, they resort to fast-acting, often narcotic, drugs (thiopental-sodium, Hexenal) and their intravenous administration. Sleep apnea and acute disorder activity of the heart muscle.

Effect reserpine in cases of psychomotor agitation, it resembles the action of Aminazine. It is not a hypnotic, but potentiates natural sleep and relieves arousal, exerting a central effect. Patients feel calm, muscle relaxation, fall asleep calm and deep sleep. This process is accompanied by a decrease in blood pressure. Hypotension remains after the abolition of Reserpine. Normalization of pressure after discontinuation of the drug occurs as gradually as its decrease under the influence of the drug. This drug is indicated for hypertensive patients with acute psychomotor agitation. Contraindicated in epileptics and other patients prone to seizures.

After placing a patient with psychomotor agitation in an inpatient department and providing first aid (stopping arousal), he is continued to be monitored in a special ward, since the stability of his condition is questionable and there is a possibility of resuming an attack.

Prevention

It is almost impossible to prevent an accident or catastrophe, other serious stress factors. However, it is necessary to try to increase your stress resistance.

First, it concerns the general state of health. Proper nutrition, absence bad habits, physical activity provides the highest possible immunity and reduces the likelihood of developing acute psychogenic reactions.

Secondly, a positive outlook on the world, an adequate and objective self-assessment of the individual also reduces the risk of pathology.

Thirdly, in the presence of diseases of any etiology, one should not run them and take courses of the necessary treatment.

People who are prone to stress and react sharply to them should engage in psychocorrection - use any relaxation factors (yoga, meditation, music, nature, pets, different types trainings under the guidance of specialists). You can take pharmacocorrection courses under the guidance of a phytotherapist, homeopath, neurologist.

Forecast

Timely assistance can prevent the danger of this condition both for others and for the patient himself. Psychomotor agitation of mild and sometimes moderate severity can be eliminated without hospitalization by a psychiatric emergency team. Severe cases with non-contact patients require special care, use special measures and mandatory hospitalization. After stopping the attack of excitation further development events is determined by the nature of the underlying disease.

Psychomotor agitation is a state of the body, which is characterized by mental and motor activity. May appear at any age. There are a large number of types of this condition, each of which occurs with certain underlying pathologies of the patient and is expressed by specific clinical signs. When the first symptoms of psychomotor agitation appear, it is necessary to provide emergency assistance and call a medical team. Treatment is carried out in stationary conditions.

Psychomotor agitation: description of the disease

Psychomotor agitation - pathological condition, which manifests itself in increased mental and motor activity varying degrees expressiveness. This disease occurs in both children and adults, in particular the elderly. The age at which pathology manifests itself depends on the time of development of the underlying disease that provoked it.

This disease occurs as a reaction to stressful circumstances. Psychomotor agitation develops against the background of a traumatic situation or a life-threatening condition. It also arises from the transfer acute infections or traumatic brain injury.

The factors in the development of this disease include poisoning with quinacrine, caffeine and atropine. Psychomotor agitation occurs against the background of alcoholic delirium, epilepsy, hysteria during and after a stroke. A factor in the development of pathology are precomatous and coma cases. Depression, schizophrenia, manic-depressive psychosis are also among the causes of psychomotor agitation.

Main clinical manifestations and types

The duration of psychomotor agitation ranges from several minutes to 1 week. It depends on the symptoms of the underlying disease, since this syndrome is a concomitant manifestation of another disease. The main signs of psychomotor agitation are:

sudden onset;
inadequacy of movements;
change in the emotional state of the patient;
aggressive behavior;
excessive irritability;
suicidal thoughts, as well as suicide attempts;
lack of control over their own behavior.

There are several types of psychomotor agitation, each of which differs in symptoms and their severity:

View	Characteristic
Catatonic	There are impulsiveness and impaired coordination of movements. Rhythmic stereotypical actions and increased talkativeness are noted. A characteristic feature is echo symptoms (repetition of words heard or seen movements). Patient long time may lie in awkward posture. This type of psychomotor agitation occurs against the background of schizophrenia.
hebephrenic	In behavior, foolishness, antics and meaningless movements are observed. Sometimes aggression develops. Manifested in schizophrenia
hallucinatory	The facial expressions of such patients are variable. Patients are tense and overly concentrated. Aggressiveness and incoherent speech are observed. Occurs in patients who suffer from alcohol dependence, schizophrenia, and brain damage
delusional	Marked aggressiveness. Patients can threaten people around them. The main feature is delusional and overvalued ideas. Occurs with schizophrenia, lesions of the brain and nervous system
Manic	There is a good, high spirits. There is an acceleration of thinking, fussiness, an increased desire for action. There are delusions, hallucinations and disturbances of consciousness. seen in schizophrenia
alarming	The patient is constantly disturbed by anxiety and fear. There is a desire to move and perform any actions, to carry out some kind of activity. Patients cannot sit still. This condition is characterized by patients repeating short phrases or words. Occurs with depression
Dysphoric	The presence of an evil mood is noted. Patients are gloomy, distrustful and constantly in tension. This condition develops with epilepsy and brain damage.
epileptiform	Sharp sudden movements, aggression, delirium, hallucinations and fear are noted. Amnesia after an attack and disorientation in space and time are observed. Occurs with epilepsy
Eretic	It is noted in oligophrenia and is characterized by the appearance destructive actions that can harm both the patient and those around him
Psychogenic	Accompanied by narrowness of consciousness, fear, panic. There is aggression towards people around. Observed with the appearance of psychotrauma

Urgent Care

In a state of psychomotor agitation, the patient requires hospitalization in a psychiatric hospital. When the first symptoms of this disease appear, you need to call the doctors. Emergency assistance is as follows:

1. To protect the patient from injury and protect other people, it must be fixed with a soft cloth and piercing and cutting objects should be removed. In this case, pronounced compression of the vessels and nerve trunks should not be allowed, since this will lead to complications.
2. It is necessary to carry out continuous monitoring of the patient, but not to show this to the patient himself.
3. It is recommended to create a calm environment so that the paramedic can establish contact and obtain consent for hospitalization.
4. If the patient's condition is controlled, then it is recommended to use drugs such as Aminazine, Risperidone, Tizercin or Klopiksol and then transport to the hospital.
5. In the absence of control over the condition, Diazepam or Amitriptyline should be used, the patient should be temporarily fixed and transported to a medical facility.
6. After this, the patient should be examined by a psychiatrist and prescribed treatment.

Acute mental disorders are often accompanied by movement disorders. In a state of excitement, a person makes such movements that have a certain character, most often destructive. Psychomotor agitation requires increased attention, and a person who has undergone such a pathology needs qualified assistance psychiatrist.

Motor excitation is characteristic of many mental disorders, in other cases it is the only manifestation of the disease. The duration of psychomotor agitation can be different: from several minutes to one week. Much depends on the intensity of movements, clinical manifestations of the underlying disease. However, any state of arousal develops in the same pattern with similar signs:

Acute onset, sometimes unexpected for others;
Violation of the generally accepted model of behavior in society, manifested by completely inadequate movements;
Change in the patient's mood, emotionally colored, up to the state of passion;
Aggression in the actions of the patient, aimed at defense, attack, or having suicidal overtones.

Persons who develop psychomotor agitation pose a danger both to others and to their own lives. Therefore, manifestations of acute psychosis are among the conditions requiring immediate medical attention.

Psychomotor agitation, types

Depending on the background against which pathological motor activity develops, the following types of psychomotor agitation are distinguished:

depressive;
Manic;
Delirious;
epileptic;
psychopathic;
Hallucinatory-delusional;
catatonic;
hebephrenic;
Psychogenic.

Each of these states has specific features and characteristics.

Psychomotor agitation, types of depression are suicidal. Patients try to commit suicide, not paying attention to the reaction of others.

The state of mania is characterized by irrepressible energy. A person takes on a huge number of cases, but he cannot finish any of them, since there are a lot of thoughts in his head. However, some of them may be aggressive. Manic psychomotor agitation is accompanied by verbosity and high spirits.

Delirious excitation, characteristic of the manifestation of "delirious tremens", is accompanied by fear and is aimed at protection. At the same time, the surrounding people may seem to be "accomplices" of the aggressors, and the patient may be dangerous for loved ones.

Twilight clouding of consciousness in epilepsy is the most dangerous state mental health. The consciousness of the patient is completely absent, and the actions are extremely aggressive. When the twilight psychomotor arousal stops, the patient does not remember anything. He is horrified by what he has done, feels remorse, but cannot control his own consciousness.

Psychopathic psychomotor agitation occurs as a response to a well-defined cause and is directed directly at the "offender". In this case, a completely meaningful action is noted. The movements of the psychopathic personality are demonstrative, theatrical.

Hallucinatory-delusional disorder is characterized by movements of the "other reality" in which the patient resides. He talks to only him “visible” people, he can suddenly attack anyone standing next to him.

Catatonic psychomotor agitation is characterized by fanciful movements that do not make any sense. However, the patient is capable of active resistance when trying to limit the freedom of his movements.

Changes in motor activity in the hebephrenic form of schizophrenia have a foolish character. However, patients are quite capable of injuring themselves and those around them.

Psychogenic psychomotor agitation is caused by a specific cause and is characterized by manifestations panic fear in all my life.

Psychomotor agitation, treatment

A patient in a state of arousal needs emergency hospitalization to the psychiatric ward. For this purpose, it is necessary to call a specialized ambulance team. When psychomotor agitation develops, treatment is prescribed only by a psychiatrist.

The primary tactic of medical professionals is to immediately immobilize the patient. For this purpose, methods of fixation with wide bandages are used. IN special occasions Assistance to doctors is required to provide law enforcement agencies.

When contact with the patient is possible, the doctor conducts an explanatory conversation. The patient must be told that his condition requires hospitalization and treatment in a specialized hospital.

Medical treatment is also performed on an emergency basis. Large or small tranquilizers are used. The achievements of modern pharmacology make it possible to quickly remove psychomotor agitation and prevent undesirable consequences, both for the patient and for the people around him.

Psychomotor agitation in children

In pediatric practice, such a disorder is quite rare and its appearance is primarily associated with organic brain damage. This may be a consequence birth injury or acute neuroinfection.

With epilepsy, psychomotor agitation in children, according to clinical manifestations, proceeds in exactly the same way as in adults. Twilight clouding of consciousness leads to extremely aggressive actions.

The syndrome of "negativism" in adolescence is often one of the manifestations of the onset of schizophrenia. Psychopathic disorders are caused by heredity, therefore dangerous behavior children is also equated with similar disorders in adults and requires emergency medical attention.

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Psyche and is manifested by increased motor activity, which may be accompanied by confusion, anxiety, aggressiveness, fun, hallucinations, clouding of consciousness, delirium, etc. More about what this condition is, why it can happen and how treated, will be discussed later in the article.

The main signs of psychomotor agitation

The state of psychomotor agitation is characterized by an acute onset, pronounced and motor restlessness (this can be both fussiness and destructive impulsive actions). The patient may experience euphoria or, conversely, anxiety, fear.

His movements acquire a chaotic, inadequate character, they may be accompanied by verbal excitement - verbosity, sometimes in the form of a continuous stream of words with the shouting of individual sounds or phrases. The patient may be haunted by hallucinations, he has a clouding of consciousness, thinking becomes accelerated and broken (dissociative). There is aggression directed both at others and at oneself (suicidal attempts). By the way, the patient has no criticism of his condition.

As is clear from the listed symptoms, the patient's well-being is a danger and requires urgent medical attention. But what can lead to such a state of affairs?

Causes of psychomotor agitation

Acute psychomotor agitation can be provoked by the most different reasons both severe stress and organic brain damage (for example, epilepsy).

Most often it occurs:

during a long stay mentally healthy person in a state of panic fear or as a result of a life-threatening situation he has endured (for example, after a car accident, the so-called reactive psychosis may develop);
for acute or chronic alcohol intoxication, as well as in case of poisoning with caffeine, quinacrine, atropine, etc.;
after leaving a coma or after a traumatic brain injury that provoked a pathological lesion of parts of the brain;
may be a consequence of damage to the central nervous system by toxins, as a result of a severe infectious disease;
with hysteria;
often occurs in mental illness: schizophrenia, depressive psychosis, manic arousal or bipolar affective disorder.

Degrees of severity of psychomotor agitation

In medicine, psychomotor agitation is divided into three degrees of severity.

Easy degree. Patients in this case look only as unusually lively.
The average degree is expressed in manifestations of non-purposefulness of their speech and actions. Actions become unexpected, pronounced ones appear (gaiety, anger, melancholy, malice, etc.).
A sharp degree of arousal is manifested by extreme chaotic speech and movements, as well as clouding of consciousness.

By the way, how this excitation manifests itself, to a large extent, depends on the age of the patient. So, in childhood or old age it is accompanied by monotonous speech or motor acts.

In children, this is monotonous crying, screaming, laughing or repeating the same questions, rocking, grimacing or smacking are possible. And in older patients, excitement is manifested by fussiness, with an air of businesslike concern and complacent talkativeness. But it is not uncommon in such situations and manifestations of irritability or anxiety, accompanied by grouchiness.

Types of psychomotor agitation

Depending on the nature of the excitation of the patient, different types of this condition are differentiated.

A few more types of psychomotor agitation

In addition to those listed above, there are several more types of psychomotor agitation that can develop both in a healthy person and in those with organic brain lesions.

Thus, epileptic excitation is characteristic of the twilight state of consciousness in patients with epilepsy. It is accompanied by a viciously aggressive affect, complete disorientation, impossibility of contact. The beginning and end of it, as a rule, is sudden, and the condition can reach a high degree of danger to others, since the patient can attack them and cause severe damage, as well as destroy everything that they meet on the way.
Psychogenic psychomotor agitation occurs immediately after acute stressful situations (catastrophes, crashes, etc.). It is expressed varying degrees motor anxiety. It can be monotonous excitement with inarticulate sounds, and chaotic excitement with panic, flight, self-mutilation, suicide attempt. Quite often excitement is replaced by a stupor. By the way, in case of mass disasters similar condition can cover large groups of people, becoming general.
Psychopathic arousal is outwardly similar to psychogenic, as it also occurs under the influence of external factors, but the strength of the response in this case, as a rule, does not correspond to the reason that caused it. This condition is associated with psychopathic characteristics of the patient's character.

How to provide emergency care for acute psychomotor agitation

If a person has psychomotor agitation, emergency care is needed immediately, as the patient can injure himself and others. For this, all outsiders are asked to leave the room where he is.

Communicate calmly and confidently with the patient. It should be isolated in a separate room, which is preliminarily inspected: windows and doors are closed, sharp objects and everything that can be used to strike are removed. The psychiatric team is urgently called.

Before her arrival, you should try to distract the patient (to a twilight state this advice not suitable, because the patient is not in contact), and, if necessary, to carry out immobilization.

Assistance in immobilization of the patient

Psychomotor agitation, the symptoms of which have been discussed above, often requires the use of restraints. This usually requires the help of 3-4 people. They come from behind and from the sides, hold the patient's arms pressed to the chest and sharply grab him under his knees, thus laying him on a bed or couch, previously moved away from the wall so that it can be approached from 2 sides.

If the patient resists by waving an object, helpers are advised to hold blankets, pillows, or mattresses in front of them. One of them should throw a blanket over the patient's face, this will help put him on the bed. Sometimes you have to hold your head, for which a towel (preferably wet) is thrown over your forehead and pulled by the ends to the bed.

It is important to be careful when holding so as not to cause damage.

Features of assistance with psychomotor agitation

Medical care for psychomotor agitation should be provided in a hospital setting. For the period while the patient is transported there, and for the time before the onset of the drugs, temporary application of fixation is allowed (which is recorded in the medical documents). In this case, the following mandatory rules are observed:

during the application of restraint measures, only soft materials are used (towels, sheets, fabric belts, etc.);
securely fix each limb and shoulder girdle, otherwise the patient can easily free himself;
do not compress the nerve trunks and blood vessels because it can lead to dangerous conditions;
the fixed patient is not left unattended.

After the action of neuroleptics, he is released from fixation, but observation should be continued, since the state remains unstable and a new attack of excitation may occur.

Treatment of psychomotor agitation

To stop the severity of an attack, a patient with any psychosis is injected sedatives: "Seduxen" - intravenously, "Barbital-sodium" - intramuscularly, "Aminazine" (in/in or/m). If the patient can take drugs inside, then he is prescribed tablets "Phenobarbital", "Seduxen" or "Aminazin".

No less effective are the neuroleptics Clozapine, Zuklopentiksol and Levomepromazine. It is very important at the same time to control the patient's blood pressure, since these funds can cause it to decrease.

In the conditions of a somatic hospital, the treatment of psychomotor agitation is also carried out with drugs used for anesthesia (Droperidol and a solution with glucose) with mandatory control of respiration and blood pressure. And for weakened or elderly patients, tranquilizers are used: Tiaprid, Diazepam, Midazolam.

The use of drugs depending on the type of psychosis

As a rule, a newly admitted patient is prescribed general sedatives, but after the diagnosis is clarified, further relief of psychomotor agitation will directly depend on its type. So, with hallucinatory-delusional arousal, the drugs "Haloperidol", "Stelazin" are prescribed, and with manic, the drugs "Klopiksol" and "Lithium oxybutyrate" are effective. it is removed with drugs "Aminazine", "Tizercin" or "Phenazepam", and catotonic excitation is cured with the drug "Mazhepril".

Specialized medicines are combined, if necessary, with general sedatives, adjusting the dose.

A few words in conclusion

Psychomotor agitation can occur in a domestic situation or occur against the background of pathological processes related to neurology, surgery or traumatology. Therefore, it is very important to know how to stop an attack of psychosis without causing damage to the patient.

As is clear from what was said in the article, the main thing during first aid is to be collected and calm. No need to try to apply physical impact on the patient independently and at the same time do not show aggression towards him. Remember, such a person most often does not realize what he is doing, and everything that happens is just symptoms of his serious condition.

Psychomotor agitation with psychotic symptoms includes conditions that develop against the background of acute stages infectious diseases, severe TBI, epilepsy, acute and chronic intoxication due to substance abuse, hypoxia and toxic brain damage, precomatous and coma states of various etiologies, as well as on the background of affective psychoses and mental disorders of the schizophrenic spectrum. A special place is occupied by states that occur with an affectively narrowed consciousness (for example, acute reactions to stress in extreme situations - reactive psychoses).

Excitation exacerbates metabolic disorders in the body, leads to excessive consumption of energy and plastic resources.

CLINICAL PICTURE

Acute psychomotor agitation includes conditions characterized by disorganization of speech and motor components, behavioral disorders, aggressiveness, confusion, anxiety, and fear. An excited patient performs a lot of non-purposeful actions, does not give in to persuasion and attempts to calm him down. cognitive activity in advanced cases, it is accompanied by a complete loss of the ability to reflect the surrounding reality, which leads to ridiculous actions and speech incoherence. The following states of psychomotor agitation with clouding of consciousness are distinguished.

Amentative excitation is observed in the structure of somatogenic, postpartum, intoxication psychoses. Excitation is usually limited to the outside of the bed.

Arousal in dementia(fussy senile) observed with severe atherosclerosis cerebral vessels and atrophic processes of the brain in elderly and old age. Patients are disoriented, arrange "travel fees", put things together, look for something, tend to leave the house. When trying to hold them, they actively resist, sometimes they show aggression.

epileptic excitation occurs in epilepsy and is characterized by a sudden onset, disorientation in place and time. In the structure of affect - causeless longing, anxiety, vital fear, anger, anger, ecstasy. Aggressive-destructive actions often lead to serious consequences (mutilation, murder). There may be illusory-hallucinatory episodes, fragmentary crazy ideas. The duration of the attack varies from several minutes to several hours, in rare cases up to 2-3 days. The condition may be preceded by a series of convulsive seizures, stupor, and often dysphoria. Exit is sudden, often through sleep. According to the severity of individual symptoms, hallucinatory, delusional and dysphoric variants are distinguished. The dysphoric variant with violent excitement represents the greatest social danger.

Delirious excitation described in Delirium not due to alcohol and other psychoactive substances and Alcoholic delirium.

Psychogenic(reactive-conditioned) excitation is observed in acute reactions to stress, occurs with extreme psychogenic effects, in situations of acute life threatening, and is characterized by an experience of horror, despair, a deep affective-narrowed state of consciousness, loss of contact with others, motor and autonomic disorders. It manifests itself as purposeless, devoid of a conscious plan, non-purposeful motor excitation: patients run in opposite directions, neglect danger, an expression of fear and horror on their faces. Sometimes patients shout out incomprehensible, abrupt phrases, make inarticulate sounds.

Excitation during hysterical twilight clouding of consciousness develops at the height or decline of affective tension in a traumatic situation. Orientation in time is disturbed, partly in place, often there is a double orientation. Affective coloring is determined by the content mental trauma: in the structure of affect, either despair, hopelessness, bewilderment, confusion, fear, or tenderness, joy, contentment, stormy fun. The perception of the situation is selective; illusions, hallucinations reflect dominant experiences. Thinking is also conditioned by the nature of the psychic trauma; real relationships are pushed aside or replaced. Memory is partially impaired: the selective ability to reproduce individual emotionally intense moments of psychotraumatic situations remains. The course of the syndrome is undulating, duration - from several hours to two weeks. The exit is gradual, subsequent memories of the experience are fragmentary.

With schizophrenia psychomotor agitation is observed in the following forms.

Hallucinatory-delusional arousal occurs with a combination of threatening, often auditory, hallucinations and delusions of persecution, poisoning, exposure. Experiences of contempt, hatred, threats from others are accompanied by the affect of fear, anxiety. Patients are tense, anxious, angry. At the height of delusional affect, delusional activity increases, there is a transition to the stage of "delusional attack", sometimes with attempts to implement an action of reprisal, "delusional revenge". In some cases, patients arm themselves, barricade themselves, and resist hospitalization.

Catatonic excitation manifested by pathetic excitement, while the patients are animated, exalted, enthusiastic. Characterized by pathos, verbosity, the predominant use of grandiloquent expressions in combination with singing and recitation. Perhaps the adoption of theatrical poses, "freezing", the inclusion of pictures of substupor and stupor. Impulsive arousal is characterized by sudden, unmotivated rage and aggression, when patients jump out of bed, rush forward, pounce on others and sweep away everything in their path. Sometimes they rip off their clothes and openly masturbate. In speech, along with obscene language, there are echolalia (repetition of the same words and phrases). Silent (silent) excitement is frantic in nature, accompanied by chaotic actions, throwing, aggression.

hebephrenic arousal: motor excitement is combined with mannerisms, foolishness, grimacing, ridiculous, senseless laughter.

Arousal in affective psychoses also includes varieties.

manic excitement characterized by a pronounced rise in mood, acceleration of verbal and mental activity and motor activity with manifestations of delight, optimism with grandiosity of ideas. The ideational excitement reaches the level of a leap of ideas. Ideas of greatness, persecution, love charm are characteristic. The state of manic excitement may be accompanied by irritability, malice, aggression (angry mania).

Agitated depression. Depression is combined with motor speech excitation. Patients are not left with painful premonitions of impending misfortune. Experiences are filled with expectations of something terrible, terrible. A painful sense of guilt, self-condemnation, demands for immediate execution are combined with severe anxiety and anxiety. Patients rush about, do not find a place for themselves, wring their hands. In a state of melancholic raptus, they can inflict self-harm, including with suicidal intent.

DIFFERENTIAL DIAGNOSIS

Differential diagnosis is carried out between diseases accompanied by psychomotor agitation. When conducting differential diagnosis, it is necessary to assess the somatic state of the patient, to qualify the type of excitation, to determine the state of consciousness.

Questions to the caller

Before the arrival of the ambulance team, it is necessary to find out the nature and degree of psychomotor agitation: whether it is accompanied by physical aggression, whether it poses a danger to others, whether there are piercing and cutting objects in the room where the patient is located.

Caller Advice

Before the arrival of the SMP team, you must try to calm the patient. From the room where the patient is located, one should try to remove piercing and cutting objects and other things that can be used as weapons of attack.

RENDERING EMERGENCY ASSISTANCE

Diagnostics

A patient in a state of psychomotor agitation is inaccessible to productive contact. An approximate list of questions addressed to the relatives of the patient is as follows.

The presence of chronic somatic diseases, current infections, intoxications.

Use of alcohol or other psychoactive substances.

The presence of a chronic mental disorder (schizophrenia, affective psychosis, epilepsy).

Mode of reception of psychotropic and other drugs.

It is necessary to find out the nature of the patient's actions (randomness, lack of focus, impulsiveness), the presence of aggressive tendencies (threats of reprisals, ambushes, storage of sharp objects).

Indications for hospitalization

Indications for hospitalization are absolute.

Patients whose psychomotor agitation is caused by exacerbation of chronic mental illness are admitted to a psychiatric hospital. Patients with organic mental disorders in whom psychomotor agitation develops against a background of severe, life-threatening somatic condition are hospitalized in multidisciplinary hospitals. With severe anxiety, stunning and confusion, the absence of anamnestic data, hospitalization is indicated in a multidisciplinary hospital (specific drug therapy do not use), where it is possible to conduct a survey to identify toxic substances and infectious agents and the study of vital signs.

Activities at the prehospital stage

It is advisable to remove piercing, cutting and other objects that can be used as weapons of attack or suicide.

It is necessary to place the persons providing assistance in such a way as to exclude a possible attempt to jump out of the window or run out through the door.

If the patient is armed, barricaded, that is, creates a real danger to the health and life of others, the participation of police officers should be organized.

In exceptional cases, if it is impossible to prevent the dangerous actions of the patient by other methods, measures of physical restraint are applied by the decision of the psychiatrist (see the section "Safety").

In many cases, it is possible to gently and sympathetically calm the patient, explain that he is not in danger, that doctors will protect him, provide assistance, help to sort out problems, etc.

The introduction of drugs is shown. Medicines are best administered intramuscularly. They stop psychomotor agitation strictly individually, depending on the severity of mental disorders, somatic condition, age, transportation time, etc. If there is a suspicion that the patient is receiving psychopharmacotherapy, or that his condition is associated with an overdose of an unknown drug, it is better to avoid prescribing drugs until the situation is clarified.

It is also necessary to refrain from administering drugs if an exogenous (traumatic, toxic, infectious) origin of psychomotor agitation is suspected, as well as in senile patients.

Method of application and doses of drugs

Use one of the following tranquilizers.

Bromodihydrochlorophenylbenzodiazepine (Phenazepam): The initial dose for adults is 0.5-1 mg (0.5-1 ml of a 0.1% solution) intravenously or intramuscularly with a possible single or double repeated administration after 30-40 minutes.

diazepam: medium single dose for adults is 10 mg (2 ml of a 0.5% solution) intravenously and intramuscularly with a possible single or double repeated administration after 30-40 minutes.

Most Common Mistakes

■ Underestimation of the somatic status (as a result, a patient in need of emergency therapeutic, surgical or toxicological care will not receive it or will receive it late).

■ Leaving the patient without proper supervision and control of his behavior.

■ Underestimation of the danger of the state of psychomotor agitation for the patient himself and those around him (including ignoring the need to involve police officers in help).

■ Neglect of safety practices.

■ Non-use of correctors with the introduction of neuroleptic drugs that can cause side extrapyramidal disorders.

Activities at the stationary stage

With severe arousal, especially with signs of aggression, sedatives are administered every 30-60 minutes until the symptoms of arousal, hostility and aggression decrease (see the section on helping with aggression).

The modern algorithm for the treatment of psychotic arousal in schizophrenia and affective psychoses involves the use of oral forms of second-generation antipsychotics with a sedative component of action: olanzapine at a dose of 10-20 mg / day, quetiapine at a dose of 400-800 mg / day, clozapine at a dose of 200-600 mg / day. In case of difficulties with taking pills, oral forms of antipsychotics with rapid absorption should be used: risperidone in drops at a dose of 4-8 mg / day, lingual tablets olanzapine at a dose of 10-20 mg / day, etc. In case of refusal, the appointment of injection forms is indicated olanzapine(10-30 mg/day), ziprasidone(80-160 mg / day) and / or traditional antipsychotics: chlorpromazine at a dose of up to 300 mg / day, levomepromazine at a dose of 50-150 mg / day, haloperidol at a dose of 10-40 mg / day, zuclopenthixol at a dose of 50-200 mg once every 1-3 days, droperidol i / m at a dose of 40-60 mg / day, together with anticholinergic drugs ( biperidine at a dose of 3-12 mg / day or trihexyphenidyl at a dose of 3-12 mg / day) and tranquilizers ( phenazepam, diazepam, lorazepam). With the ineffectiveness of these appointments, electroconvulsive therapy and / or anesthesia are indicated.

Due to the risk of developing respiratory failure, it is necessary to avoid combined administration intramuscular form benzodiazepines with clozapine. Due to the risk of developing sudden death the combined administration of intramuscular olanzapine and benzodiazepines should be avoided.

For senile arousal, use haloperidol(0.75-3 mg/day orally or 2.5 mg/day IM). For anxiety at night, benzodiazepine tranquilizers may be used in short courses ( nitrazepam 5 mg / day, phenazepam 0.5-1 mg / day).