Psychomotor agitation: types, symptoms, treatment

2024 Author: Miguel Ramacey | [email protected]. Last modified: 2023-12-17 06:11

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

Main signs of psychomotor agitation

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

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

As is clear from the listed symptoms, the patient's he alth is dangerous and requires urgent medical attention. But what could lead to this state of affairs?

Causes of psychomotor agitation

Acute psychomotor agitation can be provoked by a variety of reasons, both severe stress and organic brain damage (for example, epilepsy).

Most common:

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

Degrees of severity of psychomotor agitation

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

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

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

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

Types of psychomotor agitation

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

• Hallucinatory-delusional arousal - characterized by a feeling of fear, anxiety, confusion or malice andvoltage. Patients can talk with an invisible interlocutor, answer their questions, listen to something, and in other cases, attack imaginary enemies or, on the contrary, flee from them, without looking at the road and obvious obstacles.
• Catatonic psychomotor agitation - its symptoms are manifested in the chaotic and unfocused movements of the patient - they are sudden, senseless and impulsive, with transitions from excitement to stupor. The patient is foolish, grimacing, acting ridiculous and pretentious.
• Manic excitement is expressed by transitions from cheerfulness to anger, irritability and spitefulness. The patient cannot sit still - he sings, dances, interferes in everything, takes everything and does not bring anything to the end. He speaks quickly, continuously, changing the subject every now and then without finishing his sentences. Clearly overestimates his abilities, can express ideas of greatness, and when objected, show aggression.

Several more types of psychomotor agitation

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

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

How to provide emergency care for acute psychomotor agitation

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

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

Before her arrival, you should try to distract the patient (this advice is not suitable for the twilight state, because the patient is not contactable),and, if necessary, immobilization.

Providing assistance in immobilization of the patient

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

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

It is important to be careful when holding to avoid causing damage.

Features of assistance with psychomotor agitation

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

• only soft materials (towels,sheets, fabric belts, etc.);
• securely fix each limb and shoulder girdle, otherwise the patient can easily free himself;
• should not be allowed to squeeze the nerve trunks and blood vessels, because this can lead to dangerous conditions;
• A fixed patient is not left unattended.

After the action of neuroleptics, he is released from fixation, but observation should continue, as the state remains unstable and a new attack of excitement may occur.

Treatment of psychomotor agitation

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

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

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

Use of drugs depending on the type of psychosis

Usually againthe admitted patient is prescribed general sedative drugs, but after the diagnosis is clarified, further relief of psychomotor agitation will directly depend on its type. So, with hallucinatory-delusional arousal, the drugs "Haloperidol", "Stelazin" are prescribed, and with manic, the drugs "Klopiksol" and "Lithium oxybutyrate" are effective. The reactive state is removed with the drugs "Aminazin", "Tizercin" or "Phenazepam", and the catotonic excitation is cured with the drug "Mazhepril".

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

A few words in conclusion

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

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