1
|
'Calm down' boxes found to help service users manage agitation. Nurs Stand 2015; 29:11. [PMID: 25827989 DOI: 10.7748/ns.29.31.11.s12] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
2
|
Maseda A, Sánchez A, Marante MP, González-Abraldes I, Buján A, Millán-Calenti JC. Effects of Multisensory Stimulation on a Sample of Institutionalized Elderly People With Dementia Diagnosis: A Controlled Longitudinal Trial. Am J Alzheimers Dis Other Demen 2014; 29:463-73. [PMID: 24604894 PMCID: PMC10852778 DOI: 10.1177/1533317514522540] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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] [Indexed: 04/03/2024]
Abstract
Long-term effects of multisensory stimulation were assessed using a "Snoezelen" room on older residents with dementia. Thirty patients were randomly assigned to 3 groups: multisensory stimulation environment (MSSE) group, individualized activities (activity) group, and control group. The MSSE and activity groups participated in two 30-minute weekly individualized intervention sessions over 16 weeks. Pre-, mid-, posttrial, and 8-week follow-up behavior, mood, cognitive, and functional impairment in basic activities of daily living were registered. Items included in the physically nonaggressive behavior factor improved significantly in post- versus pretrial in the MSSE group compared to the activity group, with no significant differences between MSSE and control groups. The MSSE and activity groups demonstrated behavior improvements and higher scores on the Cohen-Mansfield agitation inventory, verbal agitated behavior factor, and Neuropsychiatric Inventory-Nursing Home, with no significant differences between groups. The MSSE could have long-term positive effects on such neuropsychiatric symptoms in older people with dementia.
Collapse
Affiliation(s)
- Ana Maseda
- Department of Medicine, Faculty of Health Sciences, Gerontology Research Group, University of A Coruña, Campus de Oza, A Coruña, Spain
| | - Alba Sánchez
- Department of Medicine, Faculty of Health Sciences, Gerontology Research Group, University of A Coruña, Campus de Oza, A Coruña, Spain
| | - M Pilar Marante
- Department of Medicine, Faculty of Health Sciences, Gerontology Research Group, University of A Coruña, Campus de Oza, A Coruña, Spain
| | - Isabel González-Abraldes
- Department of Medicine, Faculty of Health Sciences, Gerontology Research Group, University of A Coruña, Campus de Oza, A Coruña, Spain
| | - Ana Buján
- Department of Medicine, Faculty of Health Sciences, Gerontology Research Group, University of A Coruña, Campus de Oza, A Coruña, Spain
| | - José Carlos Millán-Calenti
- Department of Medicine, Faculty of Health Sciences, Gerontology Research Group, University of A Coruña, Campus de Oza, A Coruña, Spain
| |
Collapse
|
3
|
Drye LT, Ismail Z, Porsteinsson AP, Rosenberg PB, Weintraub D, Marano C, Pelton G, Frangakis C, Rabins PV, Munro CA, Meinert CL, Devanand DP, Yesavage J, Mintzer JE, Schneider LS, Pollock BG, Lyketsos CG. Citalopram for agitation in Alzheimer's disease: design and methods. Alzheimers Dement 2012; 8:121-30. [PMID: 22301195 PMCID: PMC3333484 DOI: 10.1016/j.jalz.2011.01.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [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: 09/15/2010] [Revised: 01/06/2011] [Accepted: 01/26/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Agitation is one of the most common neuropsychiatric symptoms of Alzheimer's disease (AD), and is associated with serious adverse consequences for patients and caregivers. Evidence-supported treatment options for agitation are limited. The citalopram for agitation in Alzheimer's disease (CitAD) study was designed to evaluate the potential of citalopram to ameliorate these symptoms. METHODS CitAD is a randomized, double-masked, placebo-controlled multicenter clinical trial, with two parallel treatment groups assigned in a 1:1 ratio and randomization stratified by clinical center. The study included eight recruiting clinical centers, a chair's office, and a coordinating center located in university settings in the United States and Canada. A total of 200 individuals having probable AD with clinically significant agitation and without major depression were recruited for this study. Patients were randomized to receive citalopram (target dose of 30 mg/d) or matching placebo. Caregivers of patients in both treatment groups received a structured psychosocial therapy. Agitation was compared between treatment groups using the NeuroBehavioral Rating Scale and the AD Cooperative Study- Clinical Global Impression of Change, which are the primary outcomes. Functional performance, cognition, caregiver distress, and rates of adverse and serious adverse events were also measured. CONCLUSION The authors believe the design elements in CitAD are important features to be included in trials assessing the safety and efficacy of psychotropic medications for clinically significant agitation in AD.
Collapse
Affiliation(s)
- Lea T Drye
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Shih CH, Yeh JC, Shih CT, Chang ML. Assisting children with Attention Deficit Hyperactivity Disorder actively reduces limb hyperactive behavior with a Nintendo Wii Remote Controller through controlling environmental stimulation. Res Dev Disabil 2011; 32:1631-1637. [PMID: 21444191 DOI: 10.1016/j.ridd.2011.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 02/09/2011] [Indexed: 05/30/2023]
Abstract
The latest studies have adopted software technology which turns the Wii Remote Controller into a high-performance limb action detector, we assessed whether two persons with multiple disabilities would be able to control an environmental stimulus through limb action. This study extends the functionality of the Wii Remote Controller to the correction of limb hyperactive behavior to assess whether two children with Attention Deficit Hyperactivity Disorder (ADHD) would be able to actively reduce their limb hyperactive behavior through controlling their favorite stimuli by turning them on/off using a Wii Remote Controller. An ABAB design, in which A represented the baseline and B represented intervention phases, was adopted in this study. Result showed that both participants significantly increased their time duration of maintaining a static limb posture (TDMSLP) to activate the control system in order to produce environmental stimulation in the intervention phases. Practical and developmental implications of the findings are discussed.
Collapse
Affiliation(s)
- Ching-Hsiang Shih
- Department of Special Education, National Dong Hwa University, Hualien 970, Taiwan, ROC.
| | | | | | | |
Collapse
|
5
|
|
6
|
Abstract
OBJECTIVE This study aimed to better understand how agitated pregnant women are pharmacologically managed in a psychiatric emergency service (PES). METHOD A retrospective chart review was conducted on 80 women admitted to a PES with HCG-positive urine, from January 1, 2004, to June 30, 2005. Of these, 31 patients required medication for agitation. We describe the demographics (age, ethnicity, housing status, insurance status), chief complaint, medical status, drug use and medical management in the PES, as well as pregnancy awareness, prenatal care and trimester. Patient data were analyzed using simple frequency calculations and cross tabulations with SPSS. RESULTS Thirty-one (39%) patients received 34 doses of psychotropic medication. Haloperidol, alone or in combination with a benzodiazepine, was the most frequently administered psychotropic medication, while risperidone was the second most commonly administered medication. Two patients required brief restraint for assaultive behavior that was unresponsive to any other intervention. CONCLUSION There are algorithms that provide guidance to clinicians regarding the pharmacological management of aggression. However, there are no efficacy or safety studies that recommend strategies for the management of the agitated pregnant patient.
Collapse
Affiliation(s)
- April S Ladavac
- Temple University Hospital, Episcopal Campus, Philadelphia, PA 19125, USA
| | | | | | | |
Collapse
|
7
|
Abstract
BACKGROUND Different methods are often used to deter head injury patients, who have a tendency to wander, from leaving the rehabilitation wards. The extent to which these patients could be restrained is controversial. Despite the fact that the majority of these patients lack mental capacity, Mental Health Act sections are rarely invoked. Under common law, informal patients should have the right to refuse treatment and to leave the hospital whenever they like. OBJECTIVE To examine the current practice in the management of wandering patients following brain injury in rehabilitation units in the UK and to formulate practical guidelines based on this common practice. METHODS A postal survey in the form of a structured questionnaire was sent to 58 consultants in Rehabilitation Medicine and Neuropsychologists based at different neurological rehabilitation units in the UK. RESULTS A total of 30 clinicians (52%) completed the questionnaire. One-to-one supervision was the method most commonly used to manage wandering patients (83%) followed by implementation of a structured daily routine (73%) and the use of different medications (70%). Only 17% would lock the door without giving the patient lock combination/key and another 17% would physically restrain the patient without invoking mental health act (MHA) section; 60% would consider MHA section with great variability in the mental health team response time and the place where patient is managed once under MHA section. CONCLUSIONS The questionnaire showed great variations in the methods and the medico-legal framework used in the management of wandering patients. There was, however, a tendency to avoid physical restraint which may reflect the recognition of the unlawfulness of detaining informal patients.
Collapse
|
8
|
Dean AJ, McDermott BM, Marshall RT. PRN sedation-patterns of prescribing and administration in a child and adolescent mental health inpatient service. Eur Child Adolesc Psychiatry 2006; 15:277-81. [PMID: 16583125 DOI: 10.1007/s00787-006-0532-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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] [Accepted: 02/06/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify utilisation rates of prn (pro re nata) sedation in children and adolescents receiving inpatient psychiatric treatment, and to compare correlates of prn prescribing and administration. METHOD A retrospective chart review examined 122 medical charts from a child and youth mental health inpatient service. RESULTS 71.3% of patients were prescribed prn sedation and 50.8% were administered prn sedation. Patients received an average of 8.0 doses of prn sedation, with 9.8% receiving 10 or more doses. Chlorpromazine and diazepam were the most commonly utilised agents. Prescribing of prn sedation was only related to use of regular medications (p < 0.01), and non-parent carers (p < 0.01). In contrast, administration of prn sedation was associated with multiple diagnoses (p < 0.01), pervasive development disorder (p < 0.01), mental retardation (p < 0.01) ADHD (p < 0.01), longer hospital admission (p < 0.01), use of atypical antipsychotics (p < 0.01) and polypharmacy (p < 0.01). CONCLUSIONS Despite lack of data to inform practice, prn sedation is widely utilised, especially in complex patients. Future research in this area needs to incorporate nurses and examine whether patients benefit from prn sedation, which drugs and dosing patterns optimise safety and efficacy, and what is the role of prn sedation in the context of other medication.
Collapse
Affiliation(s)
- Angela J Dean
- Kids in Mind Research, Mater Child and Youth Mental Health Service, 4101, South Brisbane , QLD, Australia.
| | | | | |
Collapse
|
9
|
Currier GW, Trenton AJ, Walsh PG, van Wijngaarden E. A pilot, open-label safety study of quetiapine for treatment of moderate psychotic agitation in the emergency setting. J Psychiatr Pract 2006; 12:223-8. [PMID: 16883147 DOI: 10.1097/00131746-200607000-00004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The goal of this pilot study was primarily to explore the safety and, secondarily, the efficacy of the use of "prn" quetiapine for treatment of moderate agitation accompanied by psychosis in an emergency department setting. METHODS This was an open-label study in which 20 patients with psychotic agitation were treated in the emergency department with 100, 150, or 200 mg of quetiapine. Physicians who were unaffiliated with the study established the diagnoses and selected the doses to be used for each patient. A rater who was blinded to the dose performed the assessments. The primary safety measure was the onset of orthostatic hypotension. The primary efficacy measure was a 40% reduction in scores on the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) over 120 minutes. The secondary efficacy measure was a reduction of 2 points or more on the Behavioral Activity Rating Scale (BARS) at 120 minutes post-dose. All subjects provided written informed consent. RESULTS With regard to safety outcomes, 40% of subjects exhibited orthostasis by 120 minutes, although only 25% of these patients described clinically significant symptoms. In terms of efficacy, 50% of subjects experienced at least a 40% reduction in PANSS-EC scores at 2 hours, while 68.8% showed reductions of 2 points or more in scores on the BARS over the same time period. CONCLUSION Quetiapine demonstrated some efficacy as a sedative agent in the emergency setting, although no clear dose-response pattern emerged over the narrow dose range tested. Orthostasis was common and did not correlate with dosing. This small study did not support the use of quetiapine to treat acute agitation in potentially volume-depleted patients.
Collapse
Affiliation(s)
- Glenn W Currier
- University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, USA.
| | | | | | | |
Collapse
|
10
|
Pascual JC, Madre M, Puigdemont D, Oller S, Corripio I, Díaz A, Faus G, Perez V, Alvarez E. [A naturalistic study: 100 consecutive episodes of acute agitation in a psychiatric emergency department]. Actas Esp Psiquiatr 2006; 34:239-44. [PMID: 16823684] [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: 05/10/2023]
Abstract
INTRODUCTION Psychomotor agitation is a common event in psychiatric emergency services (PES) with a prevalence of approximately 10 %. There is no general consensus on to how to manage psychomotor agitation; benzodiazepines, typical antipsychotics and now atypical antipsychotics have demonstrated similar efficacy. The aim of our study was to describe the epidemiology and clinical management of agitation in "real-life" in a psychiatric emergency service. METHODS A naturalistic study was performed in acutely agitated patients recruited consecutively in a psychiatric emergency service. Demographics, clinical and therapeutic characteristics were analyzed. Efficacy was assessed by the Excitement Component of the Positive and Negative Syndrome Scale (PANSS-EC) and the Agitation-Calmness Evaluation Scale (ACES). Pragmatic variables such as the need for second pharmacological intervention and the need for physical restraints were assessed. RESULTS The study included 100 patients with psychomotor agitation. Mean age was 36.2 % and 54% were women. The most prevalent diagnoses were psychotic disorder (48 %) and personality disorder (24 %). Physical restraint was required in 39 % of patients and 52 % accepted oral treatment. Haloperidol was the most frequent oral treatment and olanzapine was the most frequent intramuscular treatment. CONCLUSIONS A naturalistic approach provides data based on clinical reality in psychiatric emergency services. Strict research designs of clinical trials of efficacy imply sample selection biases and are generally distanced from the clinical reality. Atypical antipsychotics have become the first-line treatment in acute agitation
Collapse
Affiliation(s)
- J C Pascual
- Servicio de Psiquiatría, Hospital de la Santa Creu i Sant Pau, Barcelona
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Spira AP, Edelstein BA. Behavioral interventions for agitation in older adults with dementia: an evaluative review. Int Psychogeriatr 2006; 18:195-225. [PMID: 16472409 DOI: 10.1017/s1041610205002747] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [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: 02/09/2005] [Accepted: 07/12/2005] [Indexed: 11/06/2022]
Abstract
BACKGROUND Older adults with dementia commonly exhibit agitated behavior that puts them at risk of injury and institutionalization and is associated with caregiver stress. A range of theoretical approaches has produced numerous interventions to manage these behavior problems. This paper critically reviews the empirical literature on behavioral interventions to reduce agitation in older adults with dementia. METHOD A literature search yielded 23 articles that met inclusion criteria. These articles described interventions that targeted wandering, disruptive vocalization, physical aggression, other agitated behaviors and a combination of these behaviors. Studies are summarized individually and then evaluated. RESULTS Behavioral interventions targeting agitated behavior exhibited by older adults with dementia show considerable promise. A number of methodological issues must be addressed to advance this research area. Problem areas include inconsistent use of functional assessment techniques, failure to report quantitative findings and inadequate demonstrations of experimental control. CONCLUSIONS The reviewed studies collectively provide evidence that warrants optimism regarding the application of behavioral principles to the management of agitation among older adults with dementia. Although the results of some studies were mixed and several studies revealed methodological shortcomings, many of them offered innovations that can be used in future, more rigorously designed, intervention studies.
Collapse
Affiliation(s)
- Adam P Spira
- Veterans Affairs Palo Alto Health Care System, 795 Willow Rd, 16A-MPD, Menlo Park, CA 94025, USA.
| | | |
Collapse
|
12
|
Abstract
OBJECTIVE The authors report the adaptive functioning of hyperactive and control children in southeastern Wisconsin (Milwaukee) followed to young adulthood. METHOD Interviews with participants concerning major life activities were collected between 1992 and 1996 and used along with employer ratings and high school records at the young adult follow-up (mean = 20 years, range 19-25) for this large sample of hyperactive (H; n = 149) and community control (CC; n = 72) children initially seen in 1978-1980 and studied for at least 13 years. Age, duration of follow-up, and IQ were statistically controlled as needed. RESULTS The H group had significantly lower educational performance and attainment, with 32% failing to complete high school. H group members had been fired from more jobs and manifested greater employer-rated attention-deficit/hyperactivity disorder and oppositional defiant disorder symptoms and lower job performance than the CC group. Socially, the H group had fewer close friends, more trouble keeping friends, and more social problems as rated by parents. Far more H than CC group members had become parents (38% versus 4%) and had been treated for sexually transmitted disease (16% versus 4%). Severity of lifetime conduct disorder was predictive of several of the most salient outcomes (failure to graduate, earlier sexual intercourse, early parenthood) whereas attention-deficit/hyperactivity disorder and oppositional defiant disorder at work were predictive of job performance and risk of being fired. CONCLUSIONS These findings corroborate prior research and go further in identifying sexual activity and early parenthood as additional problematic domains of adaptive functioning at adulthood.
Collapse
Affiliation(s)
- Russell A Barkley
- Dr. Barkley is with the Medical University of South Carolina, Charleston; Dr. Fischer and Ms. Smallish are with the Medical College of Wisconsin, Milwaukee; and Dr. Fletcher is with the University of Massachusetts Medical School, Worcester.
| | - Mariellen Fischer
- Dr. Barkley is with the Medical University of South Carolina, Charleston; Dr. Fischer and Ms. Smallish are with the Medical College of Wisconsin, Milwaukee; and Dr. Fletcher is with the University of Massachusetts Medical School, Worcester
| | - Lori Smallish
- Dr. Barkley is with the Medical University of South Carolina, Charleston; Dr. Fischer and Ms. Smallish are with the Medical College of Wisconsin, Milwaukee; and Dr. Fletcher is with the University of Massachusetts Medical School, Worcester
| | - Kenneth Fletcher
- Dr. Barkley is with the Medical University of South Carolina, Charleston; Dr. Fischer and Ms. Smallish are with the Medical College of Wisconsin, Milwaukee; and Dr. Fletcher is with the University of Massachusetts Medical School, Worcester
| |
Collapse
|
13
|
Guedj MJ. [Preventing emergency? Preventing agitation?]. Encephale 2005; 31 Pt 2:S59-61. [PMID: 16673712] [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: 05/09/2023]
Affiliation(s)
- M J Guedj
- Chef de Service du CPOA, Hôpital Sainte-Anne, 7, rue Cabanis, 75014 Paris
| |
Collapse
|
14
|
Abstract
Agitation is a major problem for older people and is present in over half of the hospitalizations for people > 65 years of age. In a previous study by the authors, results indicated that nursing actions often did not meet best-practice standards in the care of older, agitated patients. This paper builds on these results by reviewing the literature pertaining to the use of restraints and contributes to the body of knowledge surrounding the impact of the acute-care experience on rehabilitation outcomes. Successful rehabilitation relies on the improvement of functional health outcomes and, for this to happen, physical and emotional well-being are important. The sequelae of restraint use in acute care have the potential to alter peoples' ability to participate fully in a rehabilitation programme, thereby placing their future placement at risk. This paper explores the outcomes of restraint use in the acute-care setting and presents the argument that their effects are likely to be detrimental to rehabilitation outcomes.
Collapse
Affiliation(s)
- Sarah Mott
- University of Western Sydney, Sydney, New South Wales, Australia.
| | | | | |
Collapse
|
15
|
Abstract
The practice of physical restraint is relatively frequent in medical emergency and geriatric units. Its use in psychiatry is controversial. Although distinct, it is often associated with seclusion, as a response to or prevention of agitated mentally ill patients'behavior. A detailed review of the literature shows the scarceness of work defining the exclusive use of restraint without seclusion. We report a naturalistic study over 6 Months, covering 76 cases having required restraint. The study of the international literature concerns nursing care, geriatric, child-adolescent psychiatric and adult psychiatric reviews. The restraint is a usual practice in general care like emergency, intensive care or geriatric units in order to prevent the patients from falling or to administrate certain care. Legal action has been reported as a consequence of lack of information or agreement of the family. The psychiatric use of restraint is conceived as an additional measure to seclusion, which is a controversial procedure from a therapeutic point of view as well as because of its long duration of application. The practice of restraint described in French literature, from Pinel (in to Daumézon and from French hospital regulations to "transparency forms", seems to be more easily accepted for its short duration and its careful prescription in order to maintain relations with the patients, including agitated children. We made a 6 Months retrospective study in a Parisian psychiatric emergency unit receiving an average of 30 patients a day. The rate of restraint is 1.4%. The objective was to describe the main clinical, epidemiological and situational characteristics and to define quality criteria concerning restraint regarding to the existing standards. We had at our disposal a restraint protocol in order to avoid its prescription as a punishment or for the comfort or the convenience of an insufficient staff. The decision of the restraint is directly prescribed by a physician or decided in emergency by the nurses and then rapidly confirmed by medical prescription. In short, most restrained patients are male, the average age is 32 Years old, and the diagnoses associated with restraint in order of frequency are schizophrenia, personality disorders, acute psychotic episodes, manic episodes and toxic abuses. The main early-warning signs are aggressiveness, delusions, opposition, paranoiac thoughts and distrust. The average duration is 2 hours with continuous clinical supervision and a relational contact maintained. Our study confirms the notion of cumulate restraint days. Actually, 43% of the restraints happen on the same day as others do. The high rate on those days could be as Fischer hypothesized the result of instinctive, aggressive and sexual release of the staff, as well as the consequence of an increase in anxiety and agitation of the other patients. The legal framework is more the duty of assistance to a person in danger than constrained hospitalization, which is not systematically pronounced. No injury or somatic complication occurred during restraint. Neither complaint from the patient or his family nor sick leave of staff was recorded. The specific use of restraint can be compared to the existing standards for using the seclusion room. Among those standards only 1 of 23 criteria was not verified. The others was applicable or without object. The therapeutic use of restraint requires the development of specific quality standards, and the existing criteria concerning seclusion represent a necessary but insufficient answer. We emphasize the need to take into account the early warning signs, a response to the cumulative restraint days, as well as a satisfaction study on patients and the feasibility of such a study in an emergency service.
Collapse
Affiliation(s)
- M J Guedj
- Praticien Hospitalier, responsable du Centre Psychiatrique d'Orientation et d'Accueil, Centre Hospitalier Sainte-Anne, 1, rue Cabanis, 75674 Paris cedex 14
| | | | | | | |
Collapse
|
16
|
Nobili A, Riva E, Tettamanti M, Lucca U, Liscio M, Petrucci B, Porro GS. The Effect of a Structured Intervention on Caregivers of Patients With Dementia and Problem Behaviors. Alzheimer Dis Assoc Disord 2004; 18:75-82. [PMID: 15249851 DOI: 10.1097/01.wad.0000126618.98867.fc] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [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: 11/25/2022]
Abstract
The objective was to assess the effect of a structured intervention on caregiver stress and the institutionalization rate of patients with dementia and problem behaviors. Caregivers contacting the Federazione Alzheimer Italia (AI) to receive help, advice, or information in relation to problem behaviors of outpatients were enrolled. Eligible caregiver-patient dyads were randomized to receive either a structured intervention or the counseling AI usually provides (control group). After basal assessment, families were reassessed at 6 and 12 months. Problem behavior (particularly agitation) was the only variable significantly correlated (P = 0.006) with the baseline caregivers' stress score. Thirty-nine families completed the 12-month follow-up; the mean problem behavior score was significantly lower in the intervention than the control group (p < 0.03); the time needed for care of the patient increased by 0.5 +/- 9.7 hours/day in the control group and decreased by 0.3 +/- 4.1 in the intervention group (p = 0.4, Wilcoxon test). The main determinant of institutionalization seemed to be the level of caregiver stress (p = 0.03). In patients of the intervention group, there was a significant reduction in the frequency of delusions. This pilot study suggests that caregiver stress is relieved by a structured intervention. The number of families lost to follow-up, the relatively short duration of the study, and the ceiling effect due to the severity of the clinical characteristics of patients probably all partly dilute the observed findings.
Collapse
Affiliation(s)
- Alessandro Nobili
- Geriatric Neuropsychiatry Laboratory, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
| | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
This article has presented a 12-step approach to general medical evaluation in child and adolescent psychiatric emergencies (Box 2). It is hoped that the article, which suggests targeted consideration of key specific issues, will stimulate further interest and work in this area and help optimize child psychiatrists' ability to exclude general medical conditions and work effectively with colleagues in providing children and families with safe medical care.
Collapse
Affiliation(s)
- Anthony P Guerrero
- Department of Psychiatry, University of Hawai'i John A. Burns School of Medicine, 1356 Lusitana Street, 4th Floor, Honolulu, HI 96813, USA.
| |
Collapse
|
18
|
|
19
|
Vacheron-Trystram MN, Cheref S, Gauillard J, Plas J. [A case report of mania precipitated by use of DHEA]. Encephale 2002; 28:563-6. [PMID: 12506269] [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: 02/28/2023]
Abstract
Dehydroepiandrosterone (DHEA) and its sulfate ester metabolite (DHEA-S) are precursors to testosterone and, to a lesser extent, to estrogen, and, for both sexes, they are produced in the adrenal cortex. They are among the most abundant steroids in the human body, yet their physiological roles remain unknown. DHEA and DHEA-S appear to have diverse biochemical activities, including actions within the central nervous system. So DHEA is produced in the central nervous system as well as the human adrenals and is present in the brain, concentrated in limbic regions, in levels much higher than other steroids. DHEA has been postulated to function as an excitory neuroregulator, antagonizing g-aminobutyric acid transmission. The main characteristic of DHEA is that its level of concentration in plasma varies throughout life, such level being low during the early childhood and after the age of 60 years. Adrenal production and serum concentrations of DHEA are then known to peak between ages 25 and 30 years and thereafter decrease with age, severe illness and chronic stress. The decrease of DHEA over time would appear to be responsible for morbidity related to aging process. Previous reports have found low levels of DHEA in association with physical and with frailty in the elderly (immunosenescence, increased incidence of osteoporosis, atherosclerosis and cancer, decreased cognitive functions and/or well-being). As it has been touted as a fountain of youth and a sexual tonic and promoted for a variety of illnesses associated with aging, DHEA is widely available over all the United States (since 1994) as a dietary supplement. In France, as a result of a massive advertising campaign, DHEA is already the subject of a widespread use and a growing demand although it has not yet been approved by the relevant authorities for sale as drug to the public. In practice, DHEA is prescribed and delivered under the sole responsibility of both doctor and chemist who ascertain the benefit-risk ratio and the quality of the product. DHEA may then be purchased on the internet or in the form of magistral preparations delivered on the basis of such prescription. Accordingly, there is little information or data on efficacy, drug interactions, results of long-term use, abrupt discontinuation or potential adverse effects related to the use of DHEA. We report a case of mania possibly precipitated by the use of high doses of DHEA (150-200 mg/day at the time of presentation) during several weeks in a 68 years old man who had already been hospitalized for an acute mania many years ago. Although, in this case, the patient suffered a bipolar diathesis in the past, oral DHEA may have played a role in the induction of his acute manic episode. Further research is required to assess the mood effects of DHEA, including its potential risk for patients with bipolar disorder.
Collapse
Affiliation(s)
- M N Vacheron-Trystram
- Secteur 13, Service du Docteur Caroli, Hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris
| | | | | | | |
Collapse
|
20
|
Abstract
This study sought to enhance the well-being of older nursing home residents who pace and wander by enriching their nursing home environment. Visual, auditory, and olfactory stimuli were added to the nursing home unit environment to simulate two types of environments: a home environment and an outdoor nature environment. Participants seemed to prefer the enhanced environments by choosing to spend more time in them, and by sitting on benches in those environments. There was a trend toward less trespassing, exit-seeking, and other agitated behaviors being exhibited in the enhanced environment, and residents were observed to manifest more pleasure in it. Staff members and family members definitely expressed a preference for the enhanced environment over the regular one. Although effects on residents were limited, this approach offers a low-cost method for making the nursing home environment a better place for those residents.
Collapse
Affiliation(s)
- J Cohen-Mansfield
- Research Institute of Hebrew Home of Greater Washington, Rockville, MD 20852, USA.
| | | |
Collapse
|
21
|
Abstract
During passive dorsiflexion, the angle of stretch-reflex onset was earlier in the dorsiflexion range for children with spastic cerebral palsy (CP) (N=10) compared with controls (P<0.001) at comparable velocities of stretch. Isometric plantar-flexor force was lower in children with CP (P<0.0001) and a leftward shift in the length-tension curve reflected that peak forces were produced in greater plantar flexion in children with CP than in controls (P<0.0001). Seven children with CP underwent 3 weeks of serial casting resulting in increased dorsiflexion at postcasting and at 6 weeks follow-up (P<0.002). There was no associated loss in plantar-flexor strength (P>0.32), but increased reflex threshold (P<0.03) and a decline in restraint to imposed stretch (P<0.002) were evident. A rightward shift in the length-tension curve illustrated that peak tension was generated in dorsiflexion rather than plantar flexion following casting (P<0.001). The gains were still evident at follow-up although generally to a lesser extent.
Collapse
Affiliation(s)
- B Brouwer
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
| | | | | | | |
Collapse
|
22
|
Silver BV, Yablon SA. Akathisia resulting from traumatic brain injury. Brain Inj 1996; 10:609-14. [PMID: 8836518] [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: 02/02/2023]
Abstract
Restlessness and agitation are commonly reported early sequelae of traumatic brain injury (TBI). Severe restlessness (akathisia) is also observed in psychiatric patients as a result of the use of dopamine receptor blocking agents. A recent case study described akathisia in a patient with bilateral orbitofrontal lesions following TBI. We report a case of unusually marked motor restlessness (akathisia) following TBI in a 17-year-old woman. When admitted for rehabilitation she was alert but agitated, severely restless, and mute. She constantly paced her room and the hospital unit, repeatedly retracing the same route. MRI scan revealed large, well-delineated bifrontal contusions. During baseline evaluation prior to anticipated psychopharmacological intervention her restlessness began to resolve rapidly. She became verbal and oriented within expected limits without medication. This case lends support to the observation that akathisia is related to lesions of the prefrontal cortex.
Collapse
Affiliation(s)
- B V Silver
- Department of Neuropsychology, Institute for Rehabilitation and Research, Houston, Texas 77030-3405, USA
| | | |
Collapse
|
23
|
Abstract
All skilled nursing facilities (SNF) in the state of Connecticut were surveyed to determine the number of residents with a primary diagnosis of brain injury, the incidence of agitation among these residents, and management strategies utilized for agitation in these residents, including consultation with brain injury specialists. One hundred and sixty-two, or 64%, of the SNF responded to the survey, and reported on 140 individuals with a primary diagnosis of brain injury. These individuals were residing in 39, or 24%, of the 162 facilities. Forty-five percent of these 39 facilities had brain-injured residents who met the definition of agitation presented in the survey. Management of agitation was equally distributed between environmental manipulation, formal behaviour care plans and medications. The availability of specialist consultation was variable and included physiatrists (38%), psychiatrists (67%), neurologists (41%), and psychologists (36%). This survey study defined the prevalence of brain-injured residents in Connecticut's SNF, and examined management strategies for agitation in this patient population.
Collapse
Affiliation(s)
- A P Wolf
- Connecticut Subacute Corporation, Waterbury, CT 06705, USA
| | | | | | | |
Collapse
|
24
|
Abstract
Confusion, agitation, and non-compliance are some of the most common behaviours exhibited by individuals with brain injury. The presence of these behaviours affects their daily functioning and social interactions with others. Management of these behaviours ranges from prevention and total ignoring to restraint, with the strategy of redirection cited most often in the literature. However, few guidelines exist on how to use redirection to manage clients who exhibit confusion and agitation beyond the acute phase of rehabilitation. This paper describes some of the intervention strategies that use guidance and redirection for individuals with brain injury in post-acute rehabilitation. Case examples are used to illustrate the various interventions.
Collapse
Affiliation(s)
- H K Yuen
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | | |
Collapse
|
25
|
Abstract
This study was designed to assess two aspects of behavioural relaxation training with subjects who have severe mental retardation. The first was whether or not cue words could be linked effectively to training so that they would eventually produce a relaxation effect in the absence of a full relaxation procedure. The second was to determine the effects of relaxation training and subsequent cue control on concentration and attention to an occupational task. Five subjects participated, and individual case designs were used. Cue Control, behavioural relaxation training (BRT), and new therapists were introduced at different times for each subject to ascertain the effects of each variable. Subjects were assessed at baseline and following each training session on a behavioural relaxation scale to judge the direct effects of relaxation training and on the amount of time spent concentrating on an occupational task. BRT produced reductions in rated anxiety and improvements in concentration for all subjects. The cue control words were effective only after they had been linked to BRT. In most cases, the introduction of a new therapist had no appreciable effect on anxiety or concentration. There was some suggestion that in the final cue only phases concentration was better and more consistent than during the BRT phases of the study.
Collapse
Affiliation(s)
- W R Lindsay
- Tayside Area Clinical Psychology Department, Strathmartine Hospital, Dundee, Scotland
| | | | | | | |
Collapse
|
26
|
Abstract
This study evaluated the prevalence and clinical characteristics of akathisia in a tertiary care Parkinson's disease (PD) practice, and assessed the agreement between investigators for the diagnosis of akathisia in PD, and the sensitivity and specificity of a brief patient questionnaire. Fifty-six consecutive PD patients completed an akathisia questionnaire and then were clinically evaluated for akathisia by two examiners blinded to the patient questionnaire. Overall, 45% of PD patients had akathisia as determined by clinical evaluation. Interrater reliability for the diagnosis of akathisia was high (K = 0.89). Patient self-report of restlessness agreed with examiner diagnosis in 89% of the patients. The presence of akathisia was associated with the severity and age of onset of PD. Symptoms most frequently affected the legs, and associated movements were suppressible for brief periods.
Collapse
Affiliation(s)
- C L Comella
- Department of Neurological Sciences, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612
| | | |
Collapse
|
27
|
Abstract
The Agitated Behavior Scale (ABS; Corrigan, 1989) is a 14-item scale developed to monitor agitation during the acute phase of recovery from acquired brain injury. While previous studies have supported the reliability, internal consistency, and concurrent validity of the ABS, the current study was designed to investigate its underlying factor structure, as well as to determine systematic effects of time-of-day on the occurrence of agitation. Subjects were 212 patients with traumatic or other recently acquired brain injury who exhibited agitation during their treatment on a specialized brain-injury unit of an acute rehabilitation hospital. Confirmatory factor analysis revealed that agitation is best represented by one general construct with three underlying factors: Aggression, Disinhibition, and Lability. Analysis of agitation by nursing shift in which ratings were made confirmed that overall level was lowest during the night shift; however, the relationship between time-of-day and underlying factors deviated from this pattern. Results are discussed in terms of the necessity for objective measurement, definition of the construct of agitation, and time-of-day issues in sampling agitated behavior.
Collapse
Affiliation(s)
- J D Corrigan
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus 43210
| | | |
Collapse
|
28
|
Abstract
A retrospective archival study of 129 moderate to severe closed head-injury patients from a university-based rehabilitation hospital was conducted to investigate the effect of blood alcohol level (BAL) at time of trauma on the length of post-traumatic amnesia (PTA), length of hospitalization and cognitive status on clearing PTA. While no statistical significance was obtained for the effect of BAL on length of PTA, a mean difference of 15.4 days between 'no alcohol' and 'intoxicated' patient groups was observed. A low, but significant correlation, r = 0.249, p less than 0.05, indicated that as blood alcohol level increased, time to rehabilitation admission increased. The sex of the patient had a significant effect on length of PTA, BAL and time of recovery variable F (6,81) = 2.468, p less than 0.05. Females experienced longer length of PTA, but had lower BALs than males. Measures of cognitive status on clearing PTA did not show a statistically significant effect of BAL. Results are discussed in terms of mediating variables in the relationship between BAL and the length of acute hospitalization, prolonged PTA in patients with a positive BAL, and potential physiological bases for the interaction among sex, BAL and PTA duration.
Collapse
Affiliation(s)
- C P Kaplan
- Department of Psychology, Ohio State University, Columbus 43210
| | | |
Collapse
|
29
|
Abstract
During the early phases of recovery from traumatic head injury, the level of functional cognition and the presence of agitation in patients appear to co-vary. However, it has been observed that there appears to be some temporal disassociation in the recovery of cognition and agitation. The purpose of this study was to investigate the degree to which attention accounts for the co-variation previously observed. Over a 1-year period, 130 patient-weeks of independent monitoring of cognition, agitation and attention were obtained from 20 head-injured patients in the acute phase of recovery. Weekly scores for measures of cognition, agitation and attention were each found to share approximately 50% of the variance when paired with one of the other two. When attention was extracted, only 7% of the variation in cognition was accounted for by agitation, and 40% of the variance could not be accounted for by either agitation or attention. These results support previous findings that cognition and agitation co-vary with most of the co-variance due to the effect of attention on each. Concomitantly, these results allow that significant portions of the variance in cognition and agitation may be temporally dissociated during the acute phases of recovery from traumatic head injury.
Collapse
Affiliation(s)
- J D Corrigan
- Ohio State University, Department of Physical Medicine and Rehabilitation, Columbus
| | | | | | | |
Collapse
|
30
|
Abstract
Recovery from head injury is long process. Agitation is a well-known stage in the recovery. Unfortunately, patients in agitation are often unable to participate in rehabilitation programmes and disrupt the rehabilitation ward activities. Several medications have been used in the treatment of agitation. The following is a report of the patient treated with a new medication, buspirone, in the treatment of agitation. Two other patients responded to buspirone. Their agitation did not recur after the medication was stopped. A causal effect could not clearly be documented except in this case.
Collapse
|