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Miró Ò, Osorio G, Alquézar-Arbé A, Aguiló S, Fernández C, Burillo G, Jacob J, Llorens P, Llauger L, Peláez González Á, Figuera Castro ER, Juarez González R, Blanco Hoffman MJ, Fernandez Salgado F, Pablos Pizarro T, Berenguer Díez MA, Truyol Más M, López-Laguna N, Garcia Acosta J, Fernandez Domato C, Diego Robledo FJ, Ezponda P, Martinez Lorenzo A, Ortega Liarte JV, García Rupérez I, Borne Jerez S, Corugedo Ovies C, Gallardo Sánchez BA, Del Castillo JG. Hyperactive delirium during emergency department stay: analysis of risk factors and association with short-term outcomes. Intern Emerg Med 2024; 19:535-545. [PMID: 37865623 PMCID: PMC10954855 DOI: 10.1007/s11739-023-03440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/14/2023] [Indexed: 10/23/2023]
Abstract
To investigate factors related to the development of hyperactive delirium in patients during emergency department (ED) stay and the association with short-term outcomes. A secondary analysis of the EDEN (Emergency Department and Elderly Needs) multipurpose multicenter cohort was performed. Patients older than 65 years arriving to the ED in a calm state and who developed confusion and/or psychomotor agitation requiring intravenous/intramuscular treatment during their stay in ED were assigned to delirium group. Patients with psychiatric and epileptic disorders and intracranial hemorrhage were excluded. Thirty-four variables were compared in both groups and outcomes were adjusted for age, sex, Charlson Comorbidity Index, Barthel Index and polypharmacy. Hyperactive delirium that needed treatment were developed in 301 out of 18,730 patients (1.6%). Delirium was directly associated with previous episodes of delirium (OR: 2.44, 95% CI 1.24-4.82), transfer to the ED observation unit (1.62, 1.23-2.15), chronic treatment with opiates (1.51, 1.09-2.09) and length of ED stay longer than 12 h (1.41, 1.02-1.97) and was indirectly associated with chronic kidney disease (0.60, 0.37-0.97). The 30-day all-cause mortality was 4.0% in delirium group and 2.9% in non-delirium group (OR: 1.52, 95% CI 0.83-2.78), need for hospitalization 25.6% and 25% (1.09, 0.83-1.43), in-hospital mortality 16.4% and 7.3% (2.32, 1.24-4.35), prolonged hospitalization 54.5% and 48.6% (1.27, 0.80-2.00), respectively, and 90-day post-discharge combined adverse event 36.4% and 35.8%, respectively (1.06, 0.82-2.00). Patients with previous episodes of delirium, treatment with opioids and longer stay in ED more frequently develop delirium during ED stay and preventive measures should be taken to minimize the incidence. Delirium is associated with in-hospital mortality during the index event.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, Barcelona, Catalonia, Spain.
- Department of Medicine, Faculty of Medicine, University of Barcelona, Barcelona, Catalonia, Spain.
| | - Gina Osorio
- Emergency Department, Hospital Clínic, IDIBAPS, Barcelona, Catalonia, Spain
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Catalonia, Spain
| | - Sira Aguiló
- Emergency Department, Hospital Clínic, IDIBAPS, Barcelona, Catalonia, Spain
| | - Cesáreo Fernández
- Emergency Department, Hospital Clínico San Carlos, IDISSC, Complutense University, Madrid, Spain
| | - Guillermo Burillo
- Emergency Department, Hospital Universitario de Canarias, University of La Laguna, San Cristóbal de La Laguna, Canary Islands, Tenerife, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Pere Llorens
- Emergency Department, Hospital Universitario Dr. Balmis, Alicante, Spain
| | - Lluís Llauger
- Emergency Department, Hospital Universitari de Vic, Barcelona, Catalonia, Spain
| | | | | | - Ricardo Juarez González
- Emergency Department, Hospital Nuestra Señora del Prado de Talavera de La Reina, Toledo, Spain
| | | | | | | | | | - Marina Truyol Más
- Emergency Department, Hospital Universitario Son Espases, Palma, Spain
| | - Nieves López-Laguna
- Emergency Department, Clinica Universitaria Navarra de Madrid, Madrid, Spain
| | | | | | | | - Patxi Ezponda
- Emergency Department, Hospital de Zumárraga, Guipúzcoa, Spain
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Dypås LB, Duale N, Olsen AK, Bustamante M, Maitre L, Escaramis G, Julvez J, Aguilar-Lacasaña S, Andrusaityte S, Casas M, Vafeiadi M, Grazuleviciene R, Heude B, Lepeule J, Urquiza J, Wright J, Yang TC, Vrijheid M, Gützkow KB. Blood miRNA levels associated with ADHD traits in children across six European birth cohorts. BMC Psychiatry 2023; 23:696. [PMID: 37749515 PMCID: PMC10521440 DOI: 10.1186/s12888-023-05199-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a prevalent and highly heritable neurodevelopmental disorder of major societal concern. Diagnosis can be challenging and there are large knowledge gaps regarding its etiology, though studies suggest an interplay of genetic and environmental factors involving epigenetic mechanisms. MicroRNAs (miRNAs) show promise as biomarkers of human pathology and novel therapies, and here we aimed to identify blood miRNAs associated with traits of ADHD as possible biomarker candidates and further explore their biological relevance. METHODS Our study population consisted of 1126 children (aged 5-12 years, 46% female) from the Human Early Life Exposome study, a study spanning six ongoing population-based European birth cohorts. Expression profiles of miRNAs in whole blood samples were quantified by microarray and tested for association with ADHD-related measures of behavior and neuropsychological functions from questionnaires (Conner's Rating Scale and Child Behavior Checklist) and computer-based tests (the N-back task and Attention Network Test). RESULTS We identified 29 miRNAs significantly associated (false discovery rate < .05) with the Conner's questionnaire-rated trait hyperactivity, 15 of which have been linked to ADHD in previous studies. Investigation into their biological relevance revealed involvement in several pathways related to neurodevelopment and function, as well as being linked with other neurodevelopmental or psychiatric disorders known to overlap with ADHD both in symptomology, genetic risk, and co-occurrence, such as autism spectrum disorder or schizophrenia. An additional three miRNAs were significantly associated with Conner's-rated inattention. No associations were found with questionnaire-rated total ADHD index or with computer-based tests. CONCLUSIONS The large overlap of our hyperactivity-associated miRNAs with previous studies on ADHD is intriguing and warrant further investigation. Though this study should be considered explorative and preliminary, these findings contribute towards identifying a set of miRNAs for use as blood-based biomarkers to aid in earlier and easier ADHD diagnosis.
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Affiliation(s)
- Lene B Dypås
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Nur Duale
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ann-Karin Olsen
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Mariona Bustamante
- Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Lea Maitre
- Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Geòrgia Escaramis
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Biomedical Sciences, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Jordi Julvez
- Institute for Global Health (ISGlobal), Barcelona, Spain
- Clinical and Epidemiological Neuroscience (NeuroÈpia), Institut d'investigació Sanitària Pere Virgili (IISPV), Reus, Catalonia, Spain
| | - Sofia Aguilar-Lacasaña
- Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Sandra Andrusaityte
- Department of Environmental Science, Vytautas Magnus University, Kaunas, Lithuania
| | - Maribel Casas
- Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Marina Vafeiadi
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | | | - Barbara Heude
- Centre of Research in Epidemiology and Statistics (CRESS), Inserm, Université de Paris, Paris, France
| | - Johanna Lepeule
- Université Grenoble Alpes, INSERM, CNRS, Institute for Advanced Biosciences (IAB), Team of Environmental Epidemiology Applied to Development and Respiratory Health, La Tronche, France
| | - Jose Urquiza
- Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - John Wright
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Tiffany C Yang
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Martine Vrijheid
- Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Kristine B Gützkow
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
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Jang SH, Choi KH. Paroxysmal sympathetic hyperactivity concurrent with hypothalamic injury in a patient with intracerebral hemorrhage: A case report. Medicine (Baltimore) 2022; 101:e30058. [PMID: 35960042 PMCID: PMC9371555 DOI: 10.1097/md.0000000000030058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Paroxysmal sympathetic hyperactivity (PSH) is characterized by exacerbated sympathetic discharge following severe brain injury. Here, we reports a patient diagnosed with PSH after ICH concurrent with hypothalamic injury, as demonstrated by diffusion tensor imaging (DTI). METHODS A 27-year-old man patient was diagnosed with spontaneous intraventricular hemorrhage and intracerebral hemorrhage in both frontal lobes. Two months after onset, brain magnetic resonance imaging of the brain revealed a leukomalactic lesion in the hypothalamus. Three months after the onset, he presented with intermittent high fever, tachycardia, tachypnea, systolic hypertension, diaphoresis, and aggravated rigidity. Infection was ruled out by a physical examination, laboratory tests, and radiological studies. After administrating morphine and bromocriptine, the clinical manifestations improved dramatically. RESULTS PSH after intracranial hemorrhage concurrent with the hypothalamic injury. Fractional anisotropy and mean diffusivity values of DTI were obtained in the hypothalamus. No significant difference in fractional anisotropy value was observed between the patient and control group (10 age-matched healthy male subjects) (P > .05). On the other hand, the mean diffusivity value was higher in the patient group than in the control group (P < .05), indicating hypothalamic injury. CONCLUSION PSH concurrent with hypothalamic injury was observed in a patient with stroke. This study suggests that DTI can be a useful imaging method for evaluating the hypothalamic state of patients presenting with PSH after brain injury.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Kyu Hwan Choi
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
- *Correspondence: Kyu Hwan Choi, MD, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyung Dong, Namgu, Daegu 705-717, Republic of Korea. (e-mail: )
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Hodel V, Flury G. [Restlessness and Syncopes in a Patient from a Home for Elderly]. Praxis (Bern 1994) 2022; 111:283-287. [PMID: 35414251 DOI: 10.1024/1661-8157/a003834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Restlessness and Syncopes in a Patient from a Home for Elderly Abstract. A broad differential diagnosis should be considered when faced with syncopes. Most common causes are cardiovascular and neurological causes. If there is evidence of epilepsy with sudden loss of tone, look for ictal-triggered arrhythmias. Ictal bradycardias and asystoles are usually benign and self-limiting. In contrast, bradycardias and asystoles in the context of SUDEP are usually fatal and are the result of ictally induced cerebral hypoxemia.
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Affiliation(s)
- Vera Hodel
- Medizinische Klinik, Ospidal, Center da Sandà Engiadina Bassa, Scuol, Schweiz
| | - Gian Flury
- Medizinische Klinik, Ospidal, Center da Sandà Engiadina Bassa, Scuol, Schweiz
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Isik AT, Kaya D, Altunkalem Seydi K. Akathisia superimposed to Hashimoto's encephalopathy in an old lady. Acta Biomed 2022; 93:e2022120. [PMID: 35786633 PMCID: PMC10510957 DOI: 10.23750/abm.v93is1.11828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/13/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIM Hashimoto's encephalopathy (HE) is a rare clinical entity that is associated with encephalopathy with alteration of consciousness, presence of high levels of antithyroid antibodies, and exclusion of other suspected etiologies. METHODS We describe a 60-year old lady who had been followed up for about 5 years for possible Alzheimer's disease plus Parkinson's disease and presented with akathisia overlapping a progressive encephalopathy compatible with the diagnosis of HE. RESULTS Initial steroid therapy had shown no clinical benefit, whereas a mild to moderate improvement in clinical condition was observed after a 5-day course of plasmapheresis. CONCLUSIONS Given this case, it is clear that this challenging yet treatable clinical syndrome should be considered even in older patients. Furthermore, side effects such as akathisia should also be considered when starting antipsychotic treatment, particularly in patients with an unclear diagnosis. The patient is noteworthy due to the extremely rare occurrence of HE presenting with akathisia, especially in the elderly.
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Affiliation(s)
- Ahmet Turan Isik
- Unit for Brain Aging and Dementia, Department of Geriatric Medicine, Dokuz Eylul University Faculty of Medicine.
| | - Derya Kaya
- Unit for Brain Aging and Dementia, Department of Geriatric Medicine, Dokuz Eylul University Faculty of Medicine.
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O'Donnell L, Hill EC, Anderson AS, Edgar HJH. A biological approach to adult sex differences in skeletal indicators of childhood stress. Am J Biol Anthropol 2022; 177:381-401. [PMID: 36787691 DOI: 10.1002/ajpa.24424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/01/2021] [Accepted: 09/24/2021] [Indexed: 05/05/2023]
Abstract
OBJECTIVES In previous work examining the etiology of cribra orbitalia (CO) and porotic hyperostosis (PH) in a contemporary juvenile mortality sample, we noted that males had higher odds of having CO lesions than females. Here, we examine potential reasons for this pattern in greater detail. Four non-mutually exclusive mechanisms could explain the observed sex differences: (1) sex-biased mortality; (2) sexual dimorphism in immune responses; (3) sexual dimorphism in bone turnover; or (4) sexual dimorphism in marrow conversion. SUBJECTS AND METHODS The sample consists of postmortem computed tomography scans and autopsy reports, field reports, and limited medical records of 488 individuals from New Mexico (203 females; 285 males) aged between 0.5 and 15 years. We used Kaplan-Meier survival analysis, predicted probabilities, and odds ratios to test each mechanism. RESULTS Males do not have lower survival probabilities than females, and we find no indications of sex differences in immune response. Overall, males have a higher probability of having CO or PH lesions than females. CONCLUSIONS All results indicate that lesion formation in juveniles is influenced by some combination of sex differences in the pace of red-yellow conversion of the bone marrow and bone turnover. The preponderance of males with CO and PH likely speaks to the potential for heightened osteoblastic activity in males. We find no support for the hypotheses that sex biases in mortality or immune responses impacted lesion frequency in this sample. Sex differences in biological processes experienced by children may affect lesion formation and lesion expression in later life.
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Affiliation(s)
- Lexi O'Donnell
- Department of Sociology and Anthropology, University of Mississippi, Oxford, Mississippi, USA
| | - Ethan C Hill
- Division of Physical Therapy, Department of Orthopaedics and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Amy S Anderson
- Department of Anthropology, University of California, Santa Barbara, California, USA
| | - Heather Joy Hecht Edgar
- Department of Anthropology, University of New Mexico, Albuquerque, New Mexico, USA
- Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico, USA
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Sanders BJ, Bakar M, Mehta S, Reid MC, Siegler EL, Abrams RC, Adelman RD, Lachs MS. Hyperactive Delirium Requires More Aggressive Management in Patients With COVID-19: Temporarily Rethinking "Low and Slow". J Pain Symptom Manage 2020; 60:e31-e32. [PMID: 32445904 PMCID: PMC7239778 DOI: 10.1016/j.jpainsymman.2020.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Barton J Sanders
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA.
| | - Melissa Bakar
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Sonal Mehta
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Eugenia L Siegler
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Robert C Abrams
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Ronald D Adelman
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Mark S Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
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Morishita S, Arita S. Differential effects of milnacipran, fluvoxamine and paroxetine for inhibited and agitated depression. Eur Psychiatry 2020; 19:450-1. [PMID: 15504656 DOI: 10.1016/j.eurpsy.2004.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2004] [Revised: 04/07/2004] [Accepted: 05/12/2004] [Indexed: 11/26/2022] Open
Affiliation(s)
- Shigeru Morishita
- Depression Prevent Medical Center, Kyoto Jujo Hospital, 32 Kisshoinhattandacho, Minaki-Ku, Kyoto 601-8325, Japan.
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San L, Arranz B, Querejeta I, Barrio S, De la Gándara J, Pérez V. A naturalistic multicenter study of intramuscular olanzapine in the treatment of acutely agitated manic or schizophrenic patients. Eur Psychiatry 2020; 21:539-43. [PMID: 16697151 DOI: 10.1016/j.eurpsy.2006.03.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Revised: 03/07/2006] [Accepted: 03/16/2006] [Indexed: 11/22/2022] Open
Abstract
AbstractBackgroundWe conducted a naturalistic, multicenter, 24-hour, nonrandomized, observational study describing for the first time the effectiveness and safety of intramuscular (IM) olanzapine to control agitation and aggression in “real world” patients with psychosis. The data thus obtained was compared with that reported from randomized double-blind clinical trials.Method92 patients attending psychiatric emergency settings were enrolled. The study subjects were 44 male and 48 female patients with a mean age of 36.5 ± 12 years and DSM-IV-TR diagnoses of schizophrenia (48.9%), psychotic disorder not specified (23.9%) or bipolar disorder (27.2%). 10 mg IM olanzapine was administered to all patients. An optional second injection was permitted ≥ 2 hours later in line with hospital policy. Evaluations (PANSS-EC and CGI-S) were performed at baseline and 2 and 24 hours following the IM injection.ResultsTwo hours after IM olanzapine was administered, a mean decrease of –9.6 in the PANSS-EC from a baseline score of 26.5 was recorded. At the 24-hour endpoint a statistically and clinically significant reduction in the PANSS-EC scores (11.6 ± 5.3) was observed as compared with values at study entry (26.5 ± 5.9) and at 2 hours endpoint (16.9 ± 9.3), which represent a mean decrease of –14.9 and –5.3, respectively.ConclusionThe present naturalistic study provides naturalistic data on the effectiveness of IM olanzapine in the treatment of acute agitation in patients with schizophrenia or bipolar mania that is in line the data obtained in randomized double-blind clinical trials.
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Affiliation(s)
- L San
- Hospital San Rafael, Passeig Vall d'Hebrón, 107-117, 08035 Barcelona, Spain.
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Jalali A, Akbari H, Bahreini M. Post-traumatic stress disorder or emergence phenomena? A case of psychomotor agitation after procedural sedation and analgesia. Drug Metab Pers Ther 2019; 34:/j/dmdi.ahead-of-print/dmpt-2019-0024/dmpt-2019-0024.xml. [PMID: 31874096 DOI: 10.1515/dmpt-2019-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/28/2019] [Indexed: 06/10/2023]
Abstract
Background Psychomotor agitation can be problematic in an overcrowded emergency department (ED) during uncontrolled procedural sedation. Although emergence phenomena have been studied, various presentations may exist. Case presentation During procedural sedation, a 58-year-old man was sedated with a dissociative dose of ketamine in conjunction with propofol. His shoulder dislocation was reduced successfully but eventually, an exaggerated agitation occurred resembling a post-traumatic stress disorder (PTSD) flashback of past war scenes He was controlled by physical and chemical restraint with an intramuscular injection of 0.1 mg/kg midazolam. After resolution of sedation in rather stable psychiatric conditions, he left the ED with his relatives insisting for discharge against medical advice. Conclusions A PTSD flashback may occur from ketamine sedation in patients with a past history of military experience and can be a manifestation of psychologic adverse effects of ketamine.
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Affiliation(s)
- Alireza Jalali
- Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamideh Akbari
- Imam-Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Bahreini
- Tehran University of Medical Sciences, Tehran, Iran
- Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran, Phone: +98-915-1243578, Tel/Fax: +982163121432
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Figueiro MG, Plitnick B, Roohan C, Sahin L, Kalsher M, Rea MS. Effects of a Tailored Lighting Intervention on Sleep Quality, Rest-Activity, Mood, and Behavior in Older Adults With Alzheimer Disease and Related Dementias: A Randomized Clinical Trial. J Clin Sleep Med 2019; 15:1757-1767. [PMID: 31855161 PMCID: PMC7099185 DOI: 10.5664/jcsm.8078] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES We investigated the effectiveness of a lighting intervention tailored to maximally affect the circadian system as a nonpharmacological therapy for treating problems with sleep, mood, and behavior in persons with Alzheimer disease and related dementias (ADRD). METHODS This 14-week randomized, placebo-controlled, crossover design clinical trial administered an all-day active or control lighting intervention to 46 patients with ADRD in 8 long-term care facilities for two 4-week periods (separated by a 4-week washout). The study employed wrist-worn actigraphy measures and standardized measures of sleep quality, mood, and behavior. RESULTS The active intervention significantly improved Pittsburgh Sleep Quality Index scores compared to the active baseline and control intervention (mean ± SEM: 6.67 ± 0.48 after active intervention, 10.30 ± 0.40 at active baseline, 8.41 ± 0.47 after control intervention). The active intervention also resulted in significantly greater active versus control differences in intradaily variability. As for secondary outcomes, the active intervention resulted in significant improvements in Cornell Scale for Depression in Dementia scores (mean ± SEM: 10.30 ± 1.02 at baseline, 7.05 ± 0.67 after active intervention) and significantly greater active versus control differences in Cohen-Mansfield Agitation Inventory scores (mean ± SEM: -5.51 ± 1.03 for the active intervention, -1.50 ± 1.24 for the control intervention). CONCLUSIONS A lighting intervention tailored to maximally entrain the circadian system can improve sleep, mood, and behavior in patients with dementia living in controlled environments. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov, title: Methodology Issues in a Tailored Light Treatment for Persons With Dementia, URL: https://clinicaltrials.gov/ct2/show/NCT01816152, identifier: NCT01816152.
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Affiliation(s)
- Mariana G. Figueiro
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, New York, United States
| | - Barbara Plitnick
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, New York, United States
| | - Charles Roohan
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, New York, United States
| | - Levent Sahin
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, New York, United States
| | - Michael Kalsher
- Cognitive Science Department, School of Humanities, Arts and Social Sciences, Rensselaer Polytechnic Institute, Troy, New York, United States
| | - Mark S. Rea
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, New York, United States
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Suzuki K, Fujita H, Watanabe Y, Matsubara T, Kadowaki T, Sakuramoto H, Hamaguchi M, Nozawa N, Hirata K. Leg restlessness preceding the onset of motor symptoms of Parkinson disease: A case series of 5 patients. Medicine (Baltimore) 2019; 98:e16892. [PMID: 31415433 PMCID: PMC6831196 DOI: 10.1097/md.0000000000016892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Paul B Rosenberg
- Department of Psychiatry and Behavioral Sciences (PBR, APS), Johns Hopkins Bayview Medical Center, Baltimore.
| | - Sarah K Wanigatunga
- Department of Mental Health (SKW, APS), Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Adam P Spira
- Department of Psychiatry and Behavioral Sciences (PBR, APS), Johns Hopkins Bayview Medical Center, Baltimore; Department of Mental Health (SKW, APS), Johns Hopkins Bloomberg School of Public Health, Baltimore; Center on Aging and Health (APS), Johns Hopkins University, Baltimore
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Abstract
ABSTRACTBackground:Nursing home (NH) residents with dementia commonly exhibit persistent vocalizations (PVs), otherwise known in the literature as disruptive or problematic vocalizations. Having a better understanding of PVs and the research completed to date on this phenomenon is important to guide further research and clinical practice in NHs. This integrative review examines the current literature on the phenomenon of PVs among NH residents with dementia. METHODS We conducted a search in the PubMed, Scopus, Ovid Medline, and CINAHL databases for articles published in English. Articles were included if the focus was specifically on research involving vocal behaviors of older adults with dementia residing in NHs. RESULTS Our literature search revealed eight research articles that met the inclusion criteria. These studies were published in 2011 or earlier and involved small sample sizes. Seven of these studies were descriptive and the eighth was a non-pharmacological intervention study for PVs exhibited by NH residents with dementia. These studies were vastly different in their labeling, definitions, and categorization of the PVs as well as methods of measuring PVs. CONCLUSION The heterogeneity of the evidence limits the ability to make recommendations for practice. Given the paucity of research on this phenomenon; recommendations for additional research are given.
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Affiliation(s)
- Justine S. Sefcik
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia,
PA 19104, USA
| | - Mary Ersek
- Professor of Palliative Care, University of Pennsylvania School of Nursing,
418 Curie Blvd, Philadelphia, PA 19104, USA
| | - Sasha C. Harnett
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia,
PA 19104, USA
| | - Pamela Z. Cacchione
- Ralston House Term Chair in Gerontological Nursing, Associate Professor of
Geropsychiatric Nursing Clinician Educator, University of Pennsylvania School of
Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
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Zulfiqar AA, Doucet J, Kadri N. [The use and consequences of physical restraint in geriatric care]. Rev Infirm 2018; 67:23-24. [PMID: 30415682 DOI: 10.1016/j.revinf.2018.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The use of physical restraint with the elderly remains a much-debated topic. Its use remains criticised and is also something of a paradox given its practice in this kind of facilities. All health professionals may use it in their daily practice, in a wide variety of situations.
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Affiliation(s)
- Abrar-Ahmad Zulfiqar
- Département de médecine interne gériatrie thérapeutique, hôpital Saint-Julien, CHU de Rouen, 2, rue Guillaume-Lecointe, 76140 Le Petit-Quevilly, France.
| | - Jean Doucet
- Département de médecine interne gériatrie thérapeutique, hôpital Saint-Julien, CHU de Rouen, 2, rue Guillaume-Lecointe, 76140 Le Petit-Quevilly, France
| | - Nadir Kadri
- Département de médecine interne gériatrie thérapeutique, hôpital Saint-Julien, CHU de Rouen, 2, rue Guillaume-Lecointe, 76140 Le Petit-Quevilly, France
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16
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Schlögl M, Schietzel S, Kunz R, Savaskan E, Kressig RW, Riese F. [The Physical Examination of an 'Uncooperative' Elderly Patient]. Praxis (Bern 1994) 2018; 107:1021-1030. [PMID: 30227797 DOI: 10.1024/1661-8157/a003038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Physical Examination of an 'Uncooperative' Elderly Patient Abstract. The physical examination of uncooperative elderly patients regularly presents physicians in the private practice, in the hospital or nursing home with great challenges. The lack of cooperation itself can be an important indication of an underlying medical problem. Important elements to improve the patient's cooperation include ensuring basic needs, sufficient time and patience, adequate communication and good cooperation with relatives and other healthcare professionals. Targeted clinical observation as well as thinking in geriatric syndromes and unmet needs can help to raise physical findings despite limited cooperation. Pathological findings are indicators of impaired organ and functional systems and must be supplemented by a detailed examination.
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Affiliation(s)
- Mathias Schlögl
- 1 Klinik für Geriatrie, Universitätsspital Zürich
- 2 Klinik für Alterspsychiatrie, Psychiatrische Universitätsklinik Zürich
| | - Simeon Schietzel
- 1 Klinik für Geriatrie, Universitätsspital Zürich
- 2 Klinik für Alterspsychiatrie, Psychiatrische Universitätsklinik Zürich
| | - Roland Kunz
- 3 Universitäre Klinik für Akutgeriatrie, Stadtspital Waid, Zürich
| | - Egemen Savaskan
- 2 Klinik für Alterspsychiatrie, Psychiatrische Universitätsklinik Zürich
| | - Reto W Kressig
- 4 Universitäre Altersmedizin Basel, Felix Platter-Spital, Klinische Professur für Geriatrie, Universität Basel
| | - Florian Riese
- 2 Klinik für Alterspsychiatrie, Psychiatrische Universitätsklinik Zürich
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17
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Rapaport P, Livingston G, Hamilton O, Turner R, Stringer A, Robertson S, Cooper C. How do care home staff understand, manage and respond to agitation in people with dementia? A qualitative study. BMJ Open 2018; 8:e022260. [PMID: 29961036 PMCID: PMC6042579 DOI: 10.1136/bmjopen-2018-022260] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Little is known about how care home staff understand and respond to distress in residents living with dementia labelled as agitation. The aim of this study was to describe how care home staff understand and respond to agitation and the factors that determine how it is managed. DESIGN We conducted a qualitative thematic analysis. SETTING We recruited staff from six care homes in South East England including residential and nursing homes of differing sizes run by both the private and charity sector and located in urban and rural areas. PARTICIPANTS We interviewed 25 care home staff using purposive sampling to include staff of either sex, differing age, ethnicity, nationality and with different roles and experience. RESULTS We identified four overarching themes: (1) behaviours expressing unmet need; (2) staff emotional responses to agitation; (3) understanding the individual helps and (4) constraints on staff responses. Staff struggled with the paradox of trying to connect with the personhood of residents while seeing the person as separate to and, therefore, not responsible for their behaviours. Staff often felt powerless, frightened and overwhelmed, and their responses were constrained by care home structures, processes and a culture of fear and scrutiny. CONCLUSIONS Responding to agitation expressed by residents was not a linear process and staff faced tensions and dilemmas in deciding how to respond, especially when initial strategies were unsuccessful or when attempts to respond to residents' needs were inhibited by structural and procedural constraints in the care home. Future trials of psychosocial interventions should support staff to identify and respond to residents' unmet needs and include how staff can look after themselves.
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Affiliation(s)
- Penny Rapaport
- UCL Department of Old Age Psychiatry, Division of Psychiatry, University College London, London, UK
- North Thames CLAHRC, London, UK
| | - Gill Livingston
- UCL Department of Old Age Psychiatry, Division of Psychiatry, University College London, London, UK
| | - Olivia Hamilton
- UCL Department of Old Age Psychiatry, Division of Psychiatry, University College London, London, UK
| | - Rebecca Turner
- UCL Department of Old Age Psychiatry, Division of Psychiatry, University College London, London, UK
| | - Aisling Stringer
- UCL Department of Old Age Psychiatry, Division of Psychiatry, University College London, London, UK
| | - Sarah Robertson
- UCL Department of Old Age Psychiatry, Division of Psychiatry, University College London, London, UK
- North Thames CLAHRC, London, UK
| | - Claudia Cooper
- UCL Department of Old Age Psychiatry, Division of Psychiatry, University College London, London, UK
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18
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Davies SJC, Burhan AM, Kim D, Gerretsen P, Graff-Guerrero A, Woo VL, Kumar S, Colman S, Pollock BG, Mulsant BH, Rajji TK. Sequential drug treatment algorithm for agitation and aggression in Alzheimer's and mixed dementia. J Psychopharmacol 2018; 32:509-523. [PMID: 29338602 PMCID: PMC5944080 DOI: 10.1177/0269881117744996] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Behavioural and psychological symptoms of dementia (BPSD) include agitation and aggression in people with dementia. BPSD is common on inpatient psychogeriatric units and may prevent individuals from living at home or in residential/nursing home settings. Several drugs and non-pharmacological treatments have been shown to be effective in reducing behavioural and psychological symptoms of dementia. Algorithmic treatment may address the challenge of synthesizing this evidence-based knowledge. METHODS A multidisciplinary team created evidence-based algorithms for the treatment of behavioural and psychological symptoms of dementia. We present drug treatment algorithms for agitation and aggression associated with Alzheimer's and mixed Alzheimer's/vascular dementia. Drugs were appraised by psychiatrists based on strength of evidence of efficacy, time to onset of clinical effect, tolerability, ease of use, and efficacy for indications other than behavioural and psychological symptoms of dementia. RESULTS After baseline assessment and discontinuation of potentially exacerbating medications, sequential trials are recommended with risperidone, aripiprazole or quetiapine, carbamazepine, citalopram, gabapentin, and prazosin. Titration schedules are proposed, with adjustments for frailty. Additional guidance is given on use of electroconvulsive therapy, optimization of existing cholinesterase inhibitors/memantine, and use of pro re nata medications. CONCLUSION This algorithm-based approach for drug treatment of agitation/aggression in Alzheimer's/mixed dementia has been implemented in several Canadian Hospital Inpatient Units. Impact should be assessed in future research.
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Affiliation(s)
- Simon JC Davies
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Amer M Burhan
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Geriatric Psychiatry, Western University, London, ON, Canada
| | - Donna Kim
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Philip Gerretsen
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Multimodal Imaging Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Multimodal Imaging Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Vincent L Woo
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sanjeev Kumar
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sarah Colman
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Bruce G Pollock
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benoit H Mulsant
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K Rajji
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
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19
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Ton J, Ramji J, Allan GM. Antipsychotics for agitation in dementia. Can Fam Physician 2018; 64:369. [PMID: 29760258 PMCID: PMC5951653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Joey Ton
- Knowledge Translation Expert with the PEER Group in the Department of Family Medicine and in the Physician Learning Program at the University of Alberta in Edmonton
| | - Jamil Ramji
- Knowledge Translation Expert with the PEER Group in the Department of Family Medicine and in the Physician Learning Program at the University of Alberta in Edmonton
| | - G Michael Allan
- Professor with the PEER Group in the Department of Family Medicine at the University of Alberta
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20
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Dimitriou TD, Verykouki E, Papatriantafyllou J, Konsta A, Kazis D, Tsolaki M. Non-pharmacological interventions for agitation/aggressive behaviour in patients with dementia: a randomized controlled crossover trial. Funct Neurol 2018; 33:143-147. [PMID: 30457967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Agitation/aggressive behaviour is a common behavioural and psychological symptom in people with dementia (PwD), occurring with a frequency of between 13-50.4% according to recent studies, and the rate increases as the severity of cognitive decline increases. The burden on caregivers is considerable. This trial is a randomized controlled crossover trial conducted in Greece. The following measures were used: the Mini-Mental State Examination, Addenbrooke's Cognitive Examination Revised, Geriatric Depression Scale, Functional Rating Scale for Symptoms in Dementia and Neuropsychiatric Inventory. According to the results the most effective nonpharmacological intervention for reducing agitation/aggressive behaviour in PwD was music therapy, followed by aromatherapy and massage, and finally physical exercise.
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21
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Chookalayia H, Heidarzadeh M, Hassanpour-Darghah M, Aghamohammadi-Kalkhoran M, Karimollahi M. The Critical care Pain Observation Tool is reliable in non-agitated but not in agitated intubated patients. Intensive Crit Care Nurs 2017; 44:123-128. [PMID: 28927578 DOI: 10.1016/j.iccn.2017.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/08/2017] [Accepted: 07/30/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The Critical-Care Pain. OBSERVATION Tool is one of the instruments developed to assess pain in patients who are unable to communicate verbally. The study aimed to survey the psychometric properties of Critical-Care Pain. OBSERVATION Tool in four groups of non-verbal patients according to their Richmond Agitation Sedation Score (RASS). STUDY DESIGN AND METHODOLOGY 65 critically ill patients (medical, surgical, trauma) were assessed using the critical care pain observation tool on six occasions (before, during and after nociceptive and non-nociceptive procedures). Patients were divided into four groups according to their RASS score: 1. All patients (RASS -3 to +2), 2. Sedated patients (RASS -3 to -1), 3. Restless patients (RASS +1), 4. Agitated patients (RASS +2). RESULTS Discriminant and criterion validity, confirmatory factor analysis and internal reliability showed good validity and reliability in the critical care pain observation tool in all groups except agitated patients. The results showed that, in general, the CPOT has good version of the critical care pain observation tool has good psychometric properties to evaluate pain in non-verbal patients admitted to intensive care units who have a RASS score ranging from -3 to +1, but it is not a good tool to evaluate pain in patients who are agitated according to RASS.
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Affiliation(s)
- Hoda Chookalayia
- Student Research Committee of Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mehdi Heidarzadeh
- Nursing and Midwifery School, Ardabil University of Medical Sciences, Ardabil, Iran.
| | | | | | - Mansoreh Karimollahi
- Nursing and Midwifery School, Ardabil University of Medical Sciences, Ardabil, Iran
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22
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Weissberger GH, Melrose RJ, Narvaez TA, Harwood D, Mandelkern MA, Sultzer DL. 18F-Fluorodeoxyglucose Positron Emission Tomography Cortical Metabolic Activity Associated with Distinct Agitation Behaviors in Alzheimer Disease. Am J Geriatr Psychiatry 2017; 25:569-579. [PMID: 28215899 DOI: 10.1016/j.jagp.2017.01.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/23/2016] [Accepted: 01/26/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to investigate the neurobiologic correlates of two distinct clusters of agitation symptoms to identify the unique biologic substrates underlying agitated behaviors. METHODS Eighty-eight outpatients with mild to moderate Alzheimer disease (AD) were recruited from the VA Greater Los Angeles Healthcare System Geropsychiatry Outpatient Program. A cross-sectional investigation was conducted of the relationship between cerebral glucose metabolism measured via 18F-fluorodeoxyglucose positron emission tomography and agitated symptoms from the Neuropsychiatric Inventory (NPI) in patients with AD. Two empirically derived clusters of agitation symptoms were investigated: an Agitation factor comprising agitation/aggression and irritability/lability items of the NPI, and a Behavioral Dyscontrol factor comprising elation/euphoria, disinhibition, aberrant motor behavior, sleep, and appetite items of the NPI. Mean cerebral metabolism for patients who scored positively on each of the two factors was compared with mean cerebral metabolism for those who did not. RESULTS Patients with AD who scored positively on the Agitation factor showed reduced glucose metabolism of the right temporal, right frontal, and bilateral cingulate cortex. In contrast, the Behavioral Dyscontrol factor did not show specific neurobiologic correlates. CONCLUSION Symptoms encompassed within the Agitation factor have distinct neurobiologic underpinnings. The precipitants, course, and outcomes related to these symptoms may be unique from other neuropsychiatric symptoms characteristic of AD. Special attention to treatment of agitated behaviors involving anger, aggressiveness, hostility, and irritability/emotional lability is warranted, because they appear to reflect a clinically relevant symptom cluster with unique underlying neurobiologic correlates.
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Affiliation(s)
- Gali H Weissberger
- Brain Behavior and Aging Research Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA; Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA.
| | - Rebecca J Melrose
- Brain Behavior and Aging Research Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA; Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Theresa A Narvaez
- Brain Behavior and Aging Research Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Dylan Harwood
- Brain Behavior and Aging Research Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Mark A Mandelkern
- Imaging Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - David L Sultzer
- Brain Behavior and Aging Research Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Tachere RO, Modirrousta M. Beyond anxiety and agitation: A clinical approach to akathisia. Aust Fam Physician 2017; 46:296-298. [PMID: 28472575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND When patients suddenly become restless and are unable to sit or stand still, especially in general medical settings, anxiety is often the topmost differential on every clinician's mind. However, the possibility of the very subjectively distressing condition called 'akathisia' should always be considered. OBJECTIVE The aim of this article is to discuss a clinical approach to the management of akathisia, drawing on the presentation of a patient who was admitted to a general medical ward. DISCUSSION Akathisia, a subjective and very distressing feeling of restlessness, has been found to be caused by a wide range of medications used in general medical settings, such as azithromycin, antiemetics and antipsychotics. Despite its high incidence and association with an increase in suicidal thoughts, it often goes unrecognised. This paper highlights the need for its early recognition, provides a diagnostic guide and an approach to its management.
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Schaub C, von Gunten A, Morin D. [Scoping review on the concepts of touch and massage and their effects on agitation and stress in aged hospitalized patients suffering from dementia]. Rech Soins Infirm 2016:7-23. [PMID: 28169814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This scoping review examines the effects of touch/massage on agitation and stress in aged hospitalized patients suffering from dementia. This intervention is multidimensional, at the edges of medical neurosciences, nursing sciences, and social sciences. This review is primarily supported by a biological model of social relations, describing the interconnection between cognition, affect, and endocrine aspects of attachment modes. It is also guided by nursing sciences conceptualizations which anchors touch/massage in the heart of nursing practice. The importance of touch/massage and its emotional regulation capacity is discussed in the light of these conceptualizations. The needs for that kind of contact in aged demented inpatients appears to be related to sensory loss and to a lack of emotional and social contacts. Evidence of the benefits of touch/massage is synthesized and indicate that this intervention is sometimes difficult to provide for agitated patients. Finally, proposals are made to develop a scientific agenda in clinical settings in order to continue the development of evidence and thus contribute to better inform nursing practice.
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25
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Yesavage JA, Taylor JL, Friedman L, Rosenberg PB, Lazzeroni LC, Leoutsakos JMS, Kinoshita LM, Perlow MJ, Munro CA, Devanand DP, Drye LT, Mintzer JE, Pollock BG, Porsteinsson AP, Schneider LS, Shade DM, Weintraub D, Lyketsos CG, Noda A. Principal components analysis of agitation outcomes in Alzheimer's disease. J Psychiatr Res 2016; 79:4-7. [PMID: 27115509 PMCID: PMC4891245 DOI: 10.1016/j.jpsychires.2016.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/05/2016] [Accepted: 04/14/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND We developed a composite measure of agitation as a secondary outcome of change over time in the Citalopram for Agitation in Alzheimer's disease study (CitAD). CitAD demonstrated a positive effect of citalopram on agitation on the Neurobehavioral Rating Scale agitation subscale (NBRS-A). CitAD included additional agitation measures such as the Cohen-Mansfield Agitation Inventory and the Neuropsychiatric Inventory. METHODS We performed principal components analyses on change in individual item of these scales for the same, original CitAD subjects. RESULTS The first principal component accounted for 12.6% of the observed variance and was composed of items that appear to reflect agitation. The effect size for citalopram calculated using this component was 0.53 (95% CI 0.22-0.83) versus 0.32 for the NBRS-A (95% CI 0.01-0.62). CONCLUSIONS Results suggest that a composite measure of change in agitation might be more sensitive than change in a single primary agitation measure.
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Affiliation(s)
- Jerome A Yesavage
- Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, United States; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, United States; Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, 94305, United States.
| | - Joy L Taylor
- Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, United States; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, United States
| | - Leah Friedman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, United States
| | - Paul B Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States
| | - Laura C Lazzeroni
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, United States
| | - Jeannie-Marie S Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States
| | - Lisa M Kinoshita
- Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, United States
| | - Mark J Perlow
- Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, United States
| | - Cynthia A Munro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States
| | - D P Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, 10032, United States; College of Physicians and Surgeons of Columbia University, New York, NY, 10032, United States
| | - Lea T Drye
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States
| | - Jacobo E Mintzer
- Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston, SC, 29401, United States; Ralph H. Johnson VA Medical Center, Charleston, SC, 29401, United States
| | - Bruce G Pollock
- Campbell Institute, CAMH, University of Toronto, Toronto, Ontario, M5S 2S1, Canada
| | - Anton P Porsteinsson
- University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, United States
| | - Lon S Schneider
- University of Southern California Keck School of Medicine, Los Angeles, CA, 90089, United States
| | - David M Shade
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States
| | - Daniel Weintraub
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, United States; Department of Veterans Affairs, Philadelphia, PA, 19104, United States
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States
| | - Art Noda
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, United States
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McConnell ES, Karel MJ. Improving Management of Behavioral and Psychological Symptoms of Dementia in Acute Care: Evidence and Lessons Learned From Across the Care Spectrum. Nurs Adm Q 2016; 40:244-254. [PMID: 27259128 DOI: 10.1097/naq.0000000000000167] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
As the prevalence of Alzheimer disease and related dementias increases, dementia-related behavioral symptoms present growing threats to care quality and safety of older adults across care settings. Behavioral and psychological symptoms of dementia (BPSD) such as agitation, aggression, and resistance to care occur in nearly all individuals over the course of their illness. In inpatient care settings, if not appropriately treated, BPSD can result in care complications, increased length of stay, dissatisfaction with care, and caregiver stress and injury. Although evidence-based, nonpharmacological approaches to treating BPSD exist, their implementation into acute care has been thwarted by limited nursing staff expertise in behavioral health, and a lack of consistent approaches to integrate behavioral health expertise into medically focused inpatient care settings. This article describes the core components of one evidence-based approach to integrating behavioral health expertise into dementia care. This approach, called STAR-VA, was implemented in Veterans' Health Administration community living centers (nursing homes). It has demonstrated effectiveness in reducing the severity and frequency of BPSD, while improving staff knowledge and skills in caring for people with dementia. The potential for adapting this approach in acute care settings is discussed, along with key lessons learned regarding opportunities for nursing leadership to ensure consistent implementation and sustainability.
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Affiliation(s)
- Eleanor S McConnell
- Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, and Duke University School of Nursing, Durham, North Carolina (Dr McConnell) and Mental Health Services, US Department of Veterans Affairs (VA) Central Office, Washington, DC (Dr Karel)
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Akil A, Bies RR, Pollock BG, Avramopoulos D, Devanand DP, Mintzer JE, Porsteinsson AP, Schneider LS, Weintraub D, Yesavage J, Shade DM, Lyketsos CG. A population pharmacokinetic model for R- and S-citalopram and desmethylcitalopram in Alzheimer's disease patients with agitation. J Pharmacokinet Pharmacodyn 2015; 43:99-109. [PMID: 26611790 PMCID: PMC4720707 DOI: 10.1007/s10928-015-9457-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 11/14/2015] [Indexed: 11/26/2022]
Abstract
The citalopram for Alzheimer’s disease trial evaluated citalopram for the management for agitation in Alzheimer’s disease patients. Sparse data was available from this elderly patient population. A nonlinear mixed effects population pharmacokinetic modeling approach was used to describe the pharmacokinetics of R- and S-citalopram and their primary metabolite (desmethylcitalopram). A structural model with 4 compartments (one compartment/compound) with linear oral absorption and elimination described the data adequately. Overall, the model showed that clearance of the R-enantiomer was slower than the clearance of the S-enantiomer. Without accounting for any patient-specific covariates, the population estimate of the metabolic clearance of citalopram was 8.6 (R-citalopram) and 14 L/h (S-citalopram). The population estimate of the clearance of desmethylcitalopram was 23.8 (R-Dcit) and 38.5 L/h (S-Dcit). Several patient-specific covariates were found to have a significant effect on the pharmacokinetics of R,S-citalopram and desmethylcitalopram. A significant difference in the metabolic clearance of R-citalopram between males and females (13 vs 9.05 L/h) was identified in this analysis. Both R- and S-citalopram metabolic clearance decreased with age. Additionally, consistent with literature reports S-citalopram metabolic clearance increased with increasing body weight and was significantly influenced by CYPC19 genotype, with a difference of 5.8 L/h between extensive/rapid and intermediate/poor metabolizers. R,S-desmethylcitalopram clearance increased with increasing body weight. This model may allow for the opportunity to delineate the effect of R- and S-citalopram on pharmacodynamics outcomes related to the management of agitation in Alzheimer’s disease.
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Affiliation(s)
- Ayman Akil
- Division of Clinical Pharmacology, Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Robert R Bies
- Division of Clinical Pharmacology, Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA.
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, State University of New York at Buffalo, Buffalo, NY, 14214, USA.
| | - Bruce G Pollock
- Campbell Institute, CAMH, University of Toronto, Toronto, ON, Canada
| | - Dimitrios Avramopoulos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D P Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Jacobo E Mintzer
- Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston, SC, USA
| | | | - Lon S Schneider
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Daniel Weintraub
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jerome Yesavage
- Stanford University School of Medicine and VA Palo Alto Health Care System, Stanford, CA, USA
| | - David M Shade
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Perren A, Corbella D, Iapichino E, Di Bernardo V, Leonardi A, Di Nicolantonio R, Buschbeck C, Boegli L, Pagnamenta A, Malacrida R. Physical restraint in the ICU: does it prevent device removal? Minerva Anestesiol 2015; 81:1086-1095. [PMID: 25338282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Physical restraint is frequently used in the intensive care setting but little is known regarding its clinical scenario and effectiveness in preventing adverse events (AEs), defined as device removal. METHODS We carried out a prospective observational study in three Intensive Care Units on 120 adult high-risk patients. The effectiveness of physical restraint was evaluated using the propensity score methodology in order to obtain comparable groups. RESULTS Physical restraint was applied in 1371 of 3256 (43%) nurse shifts accounting for 120 patients. Substantial agitation, the nurse's judgement of insufficient sedation and sedative drug reduction were positively associated with physical restraint, whereas the presence of analgesics at admission, increased disease gravity and the treating hospital as the most substantial variable showed a negative association. Eighty-six AEs were observed in 44 patients. Quiet (SAS=1-4), unrestrained patients accounted for 40 cases, and agitated (SAS≥5) but physically restrained patients for 17 cases. The presence of any type of physical restraint had a protective effect against any type of AE (OR=0.28; CI 0.16-0.51). The observed AEs showed a limited impact on the patients' course of illness. No physical harm related to physical restraint was reported. CONCLUSION Physical restraint efficiently averts AEs. Its application is mainly driven by local habits. Typically, the almost recovered, apparently calm and hence unrestrained patient is at greatest risk for undesirable device removal. The control/interpretation of the patient's analgo-sedation might be inappropriate.
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Affiliation(s)
- A Perren
- ICU, Ospedale Regionale Bellinzona e Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland -
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Keller K, Desuki A, Hobohm L, Münzel T, Ostad MA. Acute episode of cyclic vomiting syndrome preceded by arterial hypertension – Case presentation and review. Neth J Med 2015; 73:379-382. [PMID: 26478548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cyclic vomiting syndrome (CVS) is a functional disorder with recurrent episodes of vomiting. Between these episodes patients recover to well-being. Lack of awareness often leads to a delay in making the diagnosis. The diagnosis is based on a typical medical history and exclusion of other causes. We present a case report of a middle-aged patient who had recurrent episodes of vomiting for 12 years coinciding with hypertension. After excluding other causes, CVS was diagnosed. The episodes of acute vomiting were stopped by administration of antiemetic and sedative drugs and urapidil reduced the hypertension. Treatment with sedatives stops vomiting caused by the emetic centre of the central nervous system.
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Affiliation(s)
- K Keller
- Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany
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30
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Roy A, Roy M, Deb S, Unwin G, Roy A. Are opioid antagonists effective in attenuating the core symptoms of autism spectrum conditions in children: a systematic review. J Intellect Disabil Res 2015; 59:293-306. [PMID: 24589346 DOI: 10.1111/jir.12122] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND ASC (autism spectrum conditions) may result from a failure of striatal beta endorphins to diminish with maturation. Many symptoms of ASC resemble behaviours induced in animals or humans by opiate administration, including decreased socialisation, diminished crying, repetitive stereotypies, insensitivity to pain and motor hyperactivity. Naltrexone, an opioid antagonist, has been used in the management of children with ASC and can produce a clinically significant reduction in the serious and life-threatening behaviour of self-injury for individuals who have not been responsive to any other type of treatment and is important for this reason. It was therefore appropriate to reconsider the available evidence and a systematic review was undertaken. METHODS Four electronic databases were searched for relevant journal articles. In addition, cross-referencing of pertinent reviews and a hand search for articles in major international intellectual disability (ID) journals between the years 2010 and 2012 was carried out to ensure that all relevant articles were identified. We also searched databases for unpublished clinical trials to overcome publication bias. Each database was searched up to present (February 2013) with no restrictions on the date of publication. The search terms consisted of broad expressions used to describe ID and autistic spectrum disorder as well as terms relating to opioid antagonists and specific drugs. All studies identified by the electronic database search and hand search were examined on the basis of title alone for relevance and duplication. The abstracts of the remaining papers were then scrutinised against the inclusion criteria. Where abstracts failed to provide adequate information, the full texts for these papers were obtained. All the full texts were then evaluated against the inclusion proforma. Two reviewers carried out all the stages of the process independently. The reviewers met to discuss their selections and where disagreements arose, these were settled by discussion with a member of the study group. Data from each study meeting the inclusion criteria were extracted on a pre-piloted data extraction form. The quality of each study was further assessed using the Jadad scale, a tool developed to assess the quality of randomised controlled trials. RESULTS 155 children participated in 10 studies; 27 received placebo. Of the 128 that received naltrexone 98 (77%) showed statistically significant improvement in symptoms of irritability and hyperactivity. Side effects were mild and the drug was generally well tolerated. CONCLUSIONS Naltrexone may improve hyperactivity and restlessness in children with autism but there was not sufficient evidence that it had an impact on core features of autism in majority of the participants. It is likely that a subgroup of children with autism and abnormal endorphin levels may respond to naltrexone and identifying the characteristics of these children must become a priority.
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Affiliation(s)
- A Roy
- Manchester Medical School, Manchester, UK
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Morris S, Patel N, Baio G, Kelly L, Lewis-Holmes E, Omar RZ, Katona C, Cooper C, Livingston G. Monetary costs of agitation in older adults with Alzheimer's disease in the UK: prospective cohort study. BMJ Open 2015; 5:e007382. [PMID: 25770235 PMCID: PMC4360590 DOI: 10.1136/bmjopen-2014-007382] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE While nearly half of all people with Alzheimer's disease (AD) have agitation symptoms every month, little is known about the costs of agitation in AD. We calculated the monetary costs associated with agitation in older adults with AD in the UK from a National Health Service and personal social services perspective. DESIGN Prospective cohort study. SETTING London and the South East Region of the UK (LASER-AD study). PARTICIPANTS 224 people with AD recruited between July 2002 and January 2003 and followed up for 54 months. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was health and social care costs, including accommodation costs and costs of contacts with health and social care services. Agitation was assessed using the Neuropsychiatric Inventory (NPI) agitation score. RESULTS After adjustment, health and social care costs varied significantly by agitation, from £29,000 over a 1 year period with no agitation symptoms (NPI agitation score=0) to £57,000 at the most severe levels of agitation (NPI agitation score=12; p=0.01). The mean excess cost associated with agitation per person with AD was £4091 a year, accounting for 12% of the health and social care costs of AD in our data, and equating to £2 billion a year across all people with AD in the UK. CONCLUSIONS Agitation in people with AD represents a substantial monetary burden over and above the costs associated with cognitive impairment.
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Affiliation(s)
- Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Nishma Patel
- Department of Applied Health Research, University College London, London, UK
| | - Gianluca Baio
- Department of Statistical Science and PRIMENT Clinical Trials Unit, University College London, London, UK
| | - Lynsey Kelly
- Division of Psychiatry, University College London, London, UK
| | | | - Rumana Z Omar
- Department of Statistical Science and PRIMENT Clinical Trials Unit, University College London, London, UK
| | | | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
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Tanios M, Epstein S, Grzeskowiak M, Nguyen HM, Park H, Leo J. Influence of sedation strategies on unplanned extubation in a mixed intensive care unit. Am J Crit Care 2014; 23:306-14; quiz 315. [PMID: 24986171 DOI: 10.4037/ajcc20144446] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Identifying risk factors for unplanned extubation in patients receiving mechanical ventilation can help guide prevention strategies. OBJECTIVE To assess the risk of unplanned extubation with different sedation strategies. METHODS A 36-month quality improvement study in a 33-bed intensive care unit at a tertiary-care center. RESULTS A total of 92 unplanned extubations occurred (7.5 events/1000 days of mechanical ventilation): patients who were receiving continuous sedation protocol with daily interruption of sedatives had 1.5 events/1000 ventilator days, patients receiving the intermittent sedation protocol had 5.0 events/1000 days, and patients with no sedation protocol had 16 events/1000 days (P < .05). Median duration of mechanical ventilation before unplanned extubation was 2 days. Most unplanned extubations (94%) were deliberate, and 53% occurred in patients scheduled for weaning. Most unplanned extubations in the continuous sedation protocol group (71%) occurred during weaning, in comparison to the intermittent sedation protocol (54%) and no sedation protocol groups (48%, P< .05). The highest incidences of agitation were in patients receiving the intermittent sedation protocol as compared with the other 2 groups (77% vs 50% vs 49%, P < .05). Overall, 73% of patients who had an unplanned extubation did not require reintubation; those who did were older (mean age: 68 vs 53 years, P = .01) and were male (80% vs 20%, P= .02). Reintubation was unrelated to the time of unplanned extubation. CONCLUSION Strategies of no sedation or intermittent sedation are both associated with higher rates of unplanned extubation when compared to a strategy of continuous sedation with daily interruption of sedatives. Sedation strategies that allow agitation may increase the risk of unplanned extubation.
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Affiliation(s)
- Maged Tanios
- Maged Tanios is an associate clinical professor of medicine, University of California Irvine, Irvine, California, and director of the medical intensive care unit, Long Beach Memorial Medical Center, Long Beach, California. Scott Epstein is dean for educational affairs and professor of medicine, Tufts University School of Medicine, Boston, Massachusetts. Mark Grzeskowiak is manager, education and quality, Department of Respiratory Care Services, and Hyunsoon Park is a clinical nurse specialist in the intensive care unit, Long Beach Memorial Medical Center. Huan Mark Nguyen is an assistant professor of pharmacy practice, Western University of Health Sciences, College of Pharmacy, Pomona, California. James Leo is medical director, best practice and clinical outcomes, MemorialCare Health System, Fountain Valley, California.
| | - Scott Epstein
- Maged Tanios is an associate clinical professor of medicine, University of California Irvine, Irvine, California, and director of the medical intensive care unit, Long Beach Memorial Medical Center, Long Beach, California. Scott Epstein is dean for educational affairs and professor of medicine, Tufts University School of Medicine, Boston, Massachusetts. Mark Grzeskowiak is manager, education and quality, Department of Respiratory Care Services, and Hyunsoon Park is a clinical nurse specialist in the intensive care unit, Long Beach Memorial Medical Center. Huan Mark Nguyen is an assistant professor of pharmacy practice, Western University of Health Sciences, College of Pharmacy, Pomona, California. James Leo is medical director, best practice and clinical outcomes, MemorialCare Health System, Fountain Valley, California
| | - Mark Grzeskowiak
- Maged Tanios is an associate clinical professor of medicine, University of California Irvine, Irvine, California, and director of the medical intensive care unit, Long Beach Memorial Medical Center, Long Beach, California. Scott Epstein is dean for educational affairs and professor of medicine, Tufts University School of Medicine, Boston, Massachusetts. Mark Grzeskowiak is manager, education and quality, Department of Respiratory Care Services, and Hyunsoon Park is a clinical nurse specialist in the intensive care unit, Long Beach Memorial Medical Center. Huan Mark Nguyen is an assistant professor of pharmacy practice, Western University of Health Sciences, College of Pharmacy, Pomona, California. James Leo is medical director, best practice and clinical outcomes, MemorialCare Health System, Fountain Valley, California
| | - Huan Mark Nguyen
- Maged Tanios is an associate clinical professor of medicine, University of California Irvine, Irvine, California, and director of the medical intensive care unit, Long Beach Memorial Medical Center, Long Beach, California. Scott Epstein is dean for educational affairs and professor of medicine, Tufts University School of Medicine, Boston, Massachusetts. Mark Grzeskowiak is manager, education and quality, Department of Respiratory Care Services, and Hyunsoon Park is a clinical nurse specialist in the intensive care unit, Long Beach Memorial Medical Center. Huan Mark Nguyen is an assistant professor of pharmacy practice, Western University of Health Sciences, College of Pharmacy, Pomona, California. James Leo is medical director, best practice and clinical outcomes, MemorialCare Health System, Fountain Valley, California
| | - Hyunsoon Park
- Maged Tanios is an associate clinical professor of medicine, University of California Irvine, Irvine, California, and director of the medical intensive care unit, Long Beach Memorial Medical Center, Long Beach, California. Scott Epstein is dean for educational affairs and professor of medicine, Tufts University School of Medicine, Boston, Massachusetts. Mark Grzeskowiak is manager, education and quality, Department of Respiratory Care Services, and Hyunsoon Park is a clinical nurse specialist in the intensive care unit, Long Beach Memorial Medical Center. Huan Mark Nguyen is an assistant professor of pharmacy practice, Western University of Health Sciences, College of Pharmacy, Pomona, California. James Leo is medical director, best practice and clinical outcomes, MemorialCare Health System, Fountain Valley, California
| | - James Leo
- Maged Tanios is an associate clinical professor of medicine, University of California Irvine, Irvine, California, and director of the medical intensive care unit, Long Beach Memorial Medical Center, Long Beach, California. Scott Epstein is dean for educational affairs and professor of medicine, Tufts University School of Medicine, Boston, Massachusetts. Mark Grzeskowiak is manager, education and quality, Department of Respiratory Care Services, and Hyunsoon Park is a clinical nurse specialist in the intensive care unit, Long Beach Memorial Medical Center. Huan Mark Nguyen is an assistant professor of pharmacy practice, Western University of Health Sciences, College of Pharmacy, Pomona, California. James Leo is medical director, best practice and clinical outcomes, MemorialCare Health System, Fountain Valley, California
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Abstract
The prion diseases are rare neurodegenerative conditions that cause complex and highly variable neuropsychiatric syndromes, often with remarkably rapid progression. Prominent behavioral and psychiatric symptoms have been recognized since these diseases were first described. While research on such symptoms in common dementias has led to major changes in the way these symptoms are managed, evidence to guide the care of patients with prion disease is scarce. The authors review the published research and draw on more than 10 years' experience at the U.K. National Prion Clinic, including two large prospective clinical research studies in which more than 300 patients with prion disease have been followed up from diagnosis to death, with detailed observational data gathered on symptomatology and symptomatic treatments. The authors group behavioral and psychiatric symptoms into psychotic features, agitated features, and mood disorder and describe their natural history, showing that they spontaneously improve or resolve in many patients and are short-lived in many others because of rapid progression of global neurological disability. Diagnostic category, disease severity, age, gender, and genetic variation are or may be predictive factors. The authors review the observational data on pharmacological treatment of these symptoms in the U.K. clinical studies and make cautious recommendations for clinical practice. While nonpharmacological measures should be the first-line interventions for these symptoms, the authors conclude that there is a role for judicious use of pharmacological agents in some patients: antipsychotics for severe psychosis or agitation; benzodiazepines, particularly in the late stages of disease; and antidepressants for mood disorder.
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Pritchard A, Le Cong M. Ketamine sedation during air medical retrieval of an agitated patient. Air Med J 2014; 33:76-77. [PMID: 24589325 DOI: 10.1016/j.amj.2013.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 08/13/2013] [Accepted: 10/23/2013] [Indexed: 06/03/2023]
Abstract
Air medical retrieval of acutely agitated patients is challenging in terms of safety for all parties involved. We describe a case in which the largest recorded dose of ketamine sedation in air medical history allowed the successful transport of an acutely agitated patient from a remote community.
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Affiliation(s)
- Adam Pritchard
- Royal Flying Doctor Service, Queensland Section, Australia
| | - Minh Le Cong
- Royal Flying Doctor Service, Queensland Section, Australia.
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35
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Abstract
A short-cut review was carried out to establish whether morbidity and mortality from excited delirium syndrome (EXDS) can be predicted in the emergency department (ED). Seventy-three papers were found of which 11 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are shown in table 1. The clinical bottom line is that the early recognition of EXDS remains paramount as patients may have sudden cardiovascular collapse with little warning. Several authors do describe laboured respiratory efforts before death, so prompt airway and haemodynamic control may be necessary. Patients may benefit from chemical rather than physical restraint. Acidosis and hyperthermia should also be aggressively managed. Law enforcement and prehospital personnel should also be educated regarding potential complications of EXDS.
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Tsai CF, Hung CW, Lirng JF, Wang SJ, Fuh JL. Differences in brain metabolism associated with agitation and depression in Alzheimer's disease. East Asian Arch Psychiatry 2013; 23:86-90. [PMID: 24088401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Agitation and depression are among the commonest behavioural and psychological symptoms exhibited by Alzheimer's disease patients. However, their pathophysiology remains unclear. We therefore investigated the relationship between the brain metabolism in the posterior cingulate gyrus and the dorsolateral prefrontal cortex, and agitation and depression in patients diagnosed with Alzheimer's disease. METHODS We recruited 26 patients (14 women and 12 men) with a mean age of 75 years and probable Alzheimer's disease. All patients completed the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale-Short Form (GDS) assessment, and the Cohen-Mansfield Agitation Inventory (CMAI) in order to evaluate cognition, depression, and agitation, respectively. All subjects underwent magnetic resonance imaging and (1)H-magnetic resonance spectroscopy of the brain. The ratios of N-acetylaspartate (NAA), choline (Cho), and myo-inositol (mI) to creatine (Cr) in the posterior cingulate gyrus and the dorsolateral prefrontal cortex were measured and compared with neuropsychological test results. RESULTS The MMSE scores correlated positively with the NAA/Cr ratio in the left posterior cingulate gyrus (r = 0.56; p = 0.001). The CMAI scores correlated negatively with the NAA/Cr ratio in the left posterior cingulate gyrus (r = -0.46; p = 0.02). The GDS scores correlated positively with the Cho/Cr ratio in the left dorsolateral prefrontal cortex (r = 0.59; p = 0.01), and mI/Cr in both left (r = 0.47; p = 0.03) and right (r = 0.47; p = 0.03) cingulate gyri. CONCLUSIONS Agitation and depression levels correlated with different neurochemical metabolites in specific brain areas. We conclude that various neuropsychiatric symptoms might have separate pathophysiologies.
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Affiliation(s)
- C F Tsai
- Department of Psychiatry, Taipei Veterans General Hospital; Institute of Brain Science / Faculty of Medicine / Brain Research Center, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
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Penders TM, Gestring RE, Vilensky DA. Excited delirium following use of synthetic cathinones (bath salts). Gen Hosp Psychiatry 2012; 34:647-50. [PMID: 22898445 DOI: 10.1016/j.genhosppsych.2012.06.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 06/11/2012] [Accepted: 06/12/2012] [Indexed: 02/04/2023]
Abstract
Synthetic analogs of the cathinone molecule have seen increasing recreational use as substitutes for cocaine, 3,4-methylenedioxymethamphetamine (ecstasy) and methamphetamine. Repeated use of these drugs is associated with a paranoid hallucinatory delirium. A subset of patients using these substances develops a syndrome of extreme agitation and violent behavior that has been reported following the use of other stimulant drugs that also produce rapid changes in brain monoamines. This syndrome, characterized as "excited delirium," presents to the acute care setting with a challenging combination of paranoia, severe agitation and violent behavior. These patients frequently suffer from dehydration, skeletal muscle damage and renal failure that may lead to multiorgan failure and death. Management of these individuals requires careful consideration of the consequences of interventions commonly implemented in medical settings to control dangerous aggressive behavior.
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Affiliation(s)
- Thomas M Penders
- Department of Psychiatric Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
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Devanand DP, Mintzer J, Schultz SK, Andrews HF, Sultzer DL, de la Pena D, Gupta S, Colon S, Schimming C, Pelton GH, Levin B. Relapse risk after discontinuation of risperidone in Alzheimer's disease. N Engl J Med 2012; 367:1497-507. [PMID: 23075176 PMCID: PMC3490406 DOI: 10.1056/nejmoa1114058] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Among patients with Alzheimer's disease who have had a response to antipsychotic medication for psychosis or agitation-aggression, the risk of a recurrence of symptoms after discontinuation of the medication has not been established. METHODS Patients with Alzheimer's disease and psychosis or agitation-aggression received open-label treatment with risperidone for 16 weeks. Those who had a response to risperidone therapy were then randomly assigned, in a double-blind fashion, to one of three regimens: continued risperidone therapy for 32 weeks (group 1), risperidone therapy for 16 weeks followed by placebo for 16 weeks (group 2), or placebo for 32 weeks (group 3). The primary outcome was the time to relapse of psychosis or agitation. RESULTS A total of 180 patients received open-label risperidone (mean dose, 0.97 mg daily). The severity of psychosis and agitation were reduced, although there was a mild increase in extrapyramidal signs; 112 patients met the criteria for response to treatment, of whom 110 underwent randomization. In the first 16 weeks after randomization, the rate of relapse was higher in the group that received placebo than in the groups that received risperidone (60% [24 of 40 patients in group 3] vs. 33% [23 of 70 in groups 1 and 2]; P=0.004; hazard ratio with placebo, 1.94; 95% confidence interval [CI], 1.09 to 3.45; P=0.02). During the next 16 weeks, the rate of relapse was higher in the group that was switched from risperidone to placebo than in the group that continued to receive risperidone (48% [13 of 27 patients in group 2] vs. 15% [2 of 13 in group 1]; P=0.02; hazard ratio, 4.88; 95% CI, 1.08 to 21.98; P=0.02). The rates of adverse events and death after randomization did not differ significantly among the groups, although comparisons were based on small numbers of patients, especially during the final 16 weeks. CONCLUSIONS In patients with Alzheimer's disease who had psychosis or agitation that had responded to risperidone therapy for 4 to 8 months, discontinuation of risperidone was associated with an increased risk of relapse. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT00417482.).
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Affiliation(s)
- D P Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York 10032, USA.
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Sørensen PS. [Deaths related to physical restraint of very agitated persons should be possible to avoid]. Ugeskr Laeger 2012; 174:2367. [PMID: 23031295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Leth PM, Thomsen JL. [Sudden deaths by hobble restraint of severely hyperactive persons]. Ugeskr Laeger 2012; 174:2369-2372. [PMID: 23031297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cardiac arrest may occur while persons are being kept in hobble restraint. It has been suggested that asphyxia caused by the restraint position, so-called restraint asphyxia, is the cause, but experimental evidence has not confirmed this theory. Some of the sudden deaths are associated with excited delirium syndrome (EDS), an acute condition characterized by a hyperactive, combative behaviour in individuals, who are influenced by psychoactive drugs or suffer from psychiatric illness. Autopsy findings fail to explain this type of deaths. The pathophysiology of EDS is complex and poorly understood. Sensibilisation of the heart by a hyperadrenergic autonomous dysfunction, metabolic acidosis and hyperthermia offer possible mechanisms.
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Affiliation(s)
- Peter Mygind Leth
- Retsmedicinsk Institut, Syddansk Universitet, J.B. Winsløws Vej 17, Odense.
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Gershon A, Thompson WK, Eidelman P, McGlinchey EL, Kaplan KA, Harvey AG. Restless pillow, ruffled mind: sleep and affect coupling in interepisode bipolar disorder. J Abnorm Psychol 2012; 121:863-73. [PMID: 22845651 DOI: 10.1037/a0028233] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Disturbances in sleep and affect are prominent features of bipolar disorder, even during interepisode periods. Few longitudinal studies have prospectively examined the relationship between naturally occurring sleep and affect, and no studies to date have done so during interepisode periods of bipolar disorder and using the entire set of "gold standard" sleep parameters. Participants diagnosed with bipolar I disorder who were interepisode (n = 32) and healthy controls (n = 36) completed diagnostic and symptom severity interviews, and a daily sleep and affect diary, as well as an actigraphy sleep assessment, for eight weeks (M = 54 days, ± 8 days). Mutual information analysis was used to assess the degree of statistical dependence, or coupling, between time series data of sleep and affect. As measured by actigraphy, longer sleep onset latency was coupled with higher negative affect more strongly in the bipolar group than in the control group. As measured by sleep diary, longer wakefulness after sleep onset and lower sleep efficiency were coupled with higher negative affect significantly more strongly in the bipolar group than in the control group. By contrast, there were no significant differences between groups in the degree of coupling between any measures of sleep and positive affect. Findings support the coupling of sleep disturbance and negative affect during interepisode bipolar disorder. Ongoing monitoring of sleep-affect coupling may provide an important target for intervention in bipolar disorder.
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Affiliation(s)
- Anda Gershon
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305-5717, USA.
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Beck C, Richards K, Lambert C, Doan R, Landes RD, Whall A, Algase D, Kolanowski A, Feldman Z. Factors associated with problematic vocalizations in nursing home residents with dementia. Gerontologist 2011; 51:389-405. [PMID: 21292752 PMCID: PMC3140256 DOI: 10.1093/geront/gnq129] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 12/13/2010] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Problematic vocalizations (PVs) are the most frequent and persistent disruptive behaviors exhibited by nursing home residents with dementia. Understanding factors associated with these behaviors are important to prevent or reduce them. We used the Need-Driven Dementia-Compromised Behavior model to identify the characteristics of persons with dementia who are likely to display nonaggressive and aggressive PVs and the conditions under which these behaviors are likely to occur and persist. DESIGN AND METHODS This multisite descriptive study included 138 residents of 17 nursing homes, and approximately half had a history of PVs. Background data were gathered through interviews, chart reviews, and administration of physical and neuropsychological assessments. Proximal data were obtained from observations and videotapes. RESULTS When the 2 subscales of the Verbal Behavior Scale were used as the dependent variables, agreeableness and conscientiousness, positive affect, and discomfort were associated with nonaggressive vocalizations, and general health state (GHS), age, and negative and positive affect were associated with aggressive vocalizations. When the verbally agitated (nonaggressive) section of the Cohen-Mansfield Agitation Inventory was the dependent variable, the background factors of gender, agreeableness, GHS, and age remained predictors, as did the proximal factors of affect and discomfort. IMPLICATIONS We identified 5 background factors and 3 proximal factors as risk factors for PVs in persons with dementia, with variation between nonaggressive or aggressive PVs. These data provide direction for caregiving for persons with dementia and design of interventions to prevent or reduce PVs.
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Affiliation(s)
- Cornelia Beck
- University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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Abstract
The majority of residents in a nursing home have some degree of dementia. The prevalence is commonly from 70% to 80% of residents. This article covers the following topics on caring for patients with dementia in long-term care: (1) the efficacy of cholinesterase inhibitors and memantine, (2) the optimal environment for maintenance of function in moderate dementia, (3) the treatment of depression and agitation, and (4) the evaluation and management of eating problems.
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Affiliation(s)
- Jennifer Rhodes-Kropf
- Division of Geriatrics, Center Communities of Brookline, Hebrew SeniorLife and Beth Israel Deaconess Medical Center, Harvard University Medical School, Boston, MA 02446, USA.
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Zadik Z. What brings a child to the doctor? A lesson from hyperthyroidism. J Pediatr Endocrinol Metab 2011; 24:115. [PMID: 21648275 DOI: 10.1515/jpem.2011.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Burbidge C, Oliver C, Moss J, Arron K, Berg K, Furniss F, Hill L, Trusler K, Woodcock K. The association between repetitive behaviours, impulsivity and hyperactivity in people with intellectual disability. J Intellect Disabil Res 2010; 54:1078-1092. [PMID: 20977516 DOI: 10.1111/j.1365-2788.2010.01338.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND There is a need for assessments of psychological difference and disorder in people who have more severe intellectual disability (ID). Hyperactivity and impulsivity are two behavioural domains of importance as they are correlated with self-injury and aggression and this alludes to a shared cognitive correlate of compromised behavioural inhibition. Additionally, compromised behavioural inhibition is demonstrably related to repetitive behaviour and the latter might be expected to be associated with impulsivity and hyperactivity. METHODS The Activity Questionnaire (TAQ) was developed for this study. Three sub-scales with high levels of face validity were supported by factor analysis of the scoring of 755 intellectually disabled participants on the TAQ items. These sub-scales mapped onto the constructs of Overactivity, Impulsivity and Impulsive Speech. Test-retest, inter-rater reliability and internal consistency were robust. TAQ scores and scores on the Repetitive Behaviour Questionnaire (RBQ) were collected for a sample of 136 participants with varying degrees of ID. RESULTS Scores on the TAQ at sub-scale and full-scale level were not related to level of adaptive functioning. There were significant positive associations between overactivity (TAQ) and stereotyped behaviour (RBQ), impulsivity (TAQ) and restricted preferences (RBQ), and impulsive speech (TAQ) and repetitive speech (RBQ). CONCLUSIONS The TAQ is a reliable assessment of hyperactivity and impulsivity for people with ID with robust factor structure. Validity requires evaluation. The relationship between impulsivity and restricted preferences may result from a common cognitive impairment in inhibition, which may underpin these two classes of behaviour.
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Affiliation(s)
- C Burbidge
- Department of Psychology, Solihull NHS Trust, Birmingham, UK
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Andoh H, Kato K, Sato R, Akama F, Sakaguchi T, Matsumoto H. Case of delirium complicated with pneumonia that improved with blonanserin administration. Psychiatry Clin Neurosci 2010; 64:588-9. [PMID: 20923437 DOI: 10.1111/j.1440-1819.2010.02124.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Al Shuaibi KM. Awake craniotomy using initial sleep with laryngeal mask airway in depressed agitated patient--a case report. Middle East J Anaesthesiol 2010; 20:877-880. [PMID: 21526678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Depressed patients with brain tumors are often not referred to awake craniotomy because of concern of uncooperation which may increase the risk of perioperative complications. This report describes an interesting case of Awake Craniotomy for frontal lobe glioma in 41 year old woman undergoing language and motor mapping intra-operatively. As she was fearful and apprehensive and was on antidepressant therapy to control depression the author adapted general anesthesia with laryngeal mask airway during initial stage of skull pinning and craniotomy procedures. Then patient reverted to awake state to continue the intended neurosurgical procedure. Patient tolerated the situation satisfactory and was cooperative till the finish without any event.
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Affiliation(s)
- Khalid M Al Shuaibi
- Department of Anesthesia, King Fahad Medical City, Riyadh, Kingdom Saudi Arabia.
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Mercadante S, Villari P, David F, Agozzino C. Noninvasive ventilation for the treatment of dyspnea as a bridge from intensive to end-of-life care. J Pain Symptom Manage 2009; 38:e5-7. [PMID: 19559565 DOI: 10.1016/j.jpainsymman.2009.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 04/01/2009] [Indexed: 11/29/2022]
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Agitation in Alzheimer's disease: no to donepezil. Psycho-behavioural measures are better option. Prescrire Int 2008; 17:212. [PMID: 19536942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Christensen DD, Lin P. Practical treatment strategies for patients with Alzheimer's disease. J Fam Pract 2007; 56:S17-S23. [PMID: 18664338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
With the "baby boomers" entering retirement and beyond and the life expectancy of the entire population increasing, the burden of Alzheimer's Disease (AD) grows alarmingly greater. Over 5 million people in the United States currently have AD, and that number could triple by 2050. The financial impact of caring for these patients is substantial. Estimates of direct and indirect costs are as high as $148 billion per year. In addition to its substantial economic impact, AD has devastating effects on patients and their families. Alzheimer's disease begins with gradual memory loss and progresses to personality change, behavioral disturbance, loss of executive function, and loss of the ability to perform basic activities of daily living, including eating, walking, dressing, and grooming. These impairments strain families and caregivers and create challenges to the care and safety of the patient as well as threaten the health and well-being of the caregiver. As the number of patients diagnosed with AD increases, there is an ever-growing need for early diagnosis, which often is first observed in the primary care setting. While AD cannot be reversed or stopped, disease progression can be delayed and quality of life enhanced with early diagnosis and treatment. Early and accurate diagnosis has become increasingly important and will become even more so with the anticipated new generation of medications. Though several consensus statements on diagnosis and treatment of AD have been developed, few primary care physicians routinely follow evidence-based guidelines in their clinical practices. A 2006 survey conducted by the American Academy of Family Physicians identified a moderate to high level of need for education on AD in a majority of respondents. This article illustrates the primary care management of AD beginning with diagnosis and concluding with autopsy. Enhancing diagnostic and treatment skills in primary care will promote earlier diagnosis, improved patient management, and ongoing research into this increasingly important dilemma of aging.
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Affiliation(s)
- Daniel D Christensen
- Neuropsychiatric Institute, University of Utah School of Medicine, Salt Lake City, UT USA
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