Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0085631 (agitation)
 12,064 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Agitated, psychotic patients with the potential for violence pose significant management problems for emergency department staff. With the advent of rapid tranquilization (RT), clinicians were offered a safe, effective method for controlling such patients, eliminating the need for restraints or seclusion rooms. While RT is regarded as a major treatment innovation in psychiatry, nonpsychiatrists are reluctant or unaware of the uses of antipsychotic medication as it pertains to RT. This article provides a brief overview of the pharmacokinetics of antipsychotic medication and reviews the following aspects of RT: route of administration, dosing, time intervals between doses, side effects, and alternative medications for RT. The authors also offer practical guidelines for RT use in the emergency department.
 ...
PMID:Rapid tranquilization of the violent patient. 256 24

The neuroleptic-induced akathisia (NIA) often appears as a side effect of neuroleptic therapy in psychotic individuals. It can accompany or outlive the period of neuroleptic treatment. Besides the objective symptoms of motor restlessness it is especially the subjective symptoms and complaints as inner restlessness, anxiety, and depression, which cause severe annoyance or even torment patients. Exacerbations of disease symptoms treated with neuroleptics can occur. After outlining development of the concept of akathisia and of the knowledge of NIA some relevant findings in the field of NIA, especially in respect to their clinical pictures and their connections to related neuroleptic-induced side effects, are discussed. Development and present stand of treatment of NIA are described. Treatment with betablockers plays a central role. Pathophysiological aspects are touched in context with therapeutical considerations. The current state of knowledge of NIA allows a better understanding of pathophysiology in neuroleptic side effects in general, enables an almost sufficient treatment of NIA with betablockers, demonstrates the necessity of responsible and cautious use of neuroleptics by physicians and the necessity of careful guidance of such patients who are treated with neuroleptics.
 ...
PMID:[Phenomenology and therapy of neuroleptic-induced akathisia--a review of the literature]. 257 2

Systematic and detailed psychopathological examination of 400 consecutive primary major depressives failed to confirm common clinical stereotypes which ascribe greater somatisation, hypochondriasis, agitation, psychotic tendencies, and chronicity to old age. Those above 65 were more likely to suffer from single episodes of depression that were often precipitated, whereas subjects whose illness began earlier were more likely to express depression as part of a recurrent unipolar or bipolar disorder, with higher rates of affective temperamental pathology and familial affective illness. The acute clinical picture was relatively uniform in older and younger depressives and, taken together with the other findings, tends to favour a spectrum model of primary mood disorders.
 ...
PMID:Depression before and after age 65. A re-examination. 261 42

Six new cases of psychogenic water intoxication are discussed in the light of 150 observations published in the literature since 1935. 87% of all patients were schizophrenic, and 13% had other psychoses and a variety of functional and organic psychopathies. Psychogenic polydipsia is a prerequisite of psychogenic water intoxication. Water intake either overrides an intact osmoregulation (46% of all cases) or, allied to an inadequate urinary dilutional capacity (54%), leads to a transitory, sometimes repeated, and (in 8% of all cases) lethal water intoxication and hypoosmolality. - The consequence of hypoosmolality is metabolic encephalopathy, with agitation, convulsions and coma as its most common symptoms. Profuse diuresis, enuresis and urinary retention, gastric dilatation, watery vomiting and watery diarrhea are diagnostically helpful symptoms of polydipsia typically denied by the patients. Hypoosmolality/hyponatremia are the hallmarks of water intoxication. However, fewer than 50% of all patients present with the expected maximal urinary dilution. Inadequate ADH activity and increased sensitivity of the renal tubule to antidiuretic hormone are the pathogenetic factors in this inappropriate urinary dilution, while psychosis, psychotropic drugs, diuretics, nicotine and alcohol withdrawal are possible causes and cofactors of polydipsia and inadequate urinary dilution. New aspects of treatment are discussed.
 ...
PMID:[Psychogenic water intoxication]. 264 58

Many of the drugs used in anesthesia and intensive care may cause blockade of the central cholinergic neurotransmission. Acetylcholine is of significance in modulation of the interaction among most other central transmitters. The clinical picture of the central cholinergic blockade, known as the central anticholinergic syndrome (CAS), is identical with the central symptoms of atropine intoxication. This behaviour consists of agitation including seizures, restlessness, hallucinations, disorientation or signs of depression such as stupor, coma and respiratory depression. Such disturbances may be induced by opiates, benzodiazepines, phenothiazines, butyrophenones, ketamine, etomidate, propofol, nitrous oxide, and halogenated inhalation anesthetics as well as by H2-blocking agents such as cimetidine. There is an individual predisposition for CAS--but unpredictable from laboratory findings or other signs. Reports of postanesthetic occurrence of the CAS requiring treatment are not unanimous, varying between 1 and 40%. Differential diagnosis of the CAS includes disorders of glucose and electrolyte metabolism, severe hormonal imbalance, respiratory disorders (hypoxia, hypercarbia), hypothermia, hyperthermia and neuropsychiatric diseases (cerebral hypoxia, stroke, catatony, acute psychosis). The CAS may considerably impair the postanesthetic period especially when agitation is prevalent, which may endanger the patient or the surgical results. The diagnosis is confirmed ex iuvantibus by the sudden increase in the acetylcholine level in the brain. This is achieved with physostigmine, a cholinesterase inhibitor able to easily cross the blood-brain barrier. Its peripheral muscarinic effects are minimal. Postanesthetic CAS can be prevented by administration of physostigmine during the anesthesia procedure. During intensive care (IC), agitated forms of CAS may occur in patients undergoing mechanical ventilation, particularly during prolonged high-dose sedation. Artificial ventilation of such patients becomes very difficult and muscle relaxation may be necessary. In these cases of IC-CAS, physostigmine is of value and has proven beneficial during weaning from mechanical ventilation. Dealing with the CAS for more than a decade has improved knowledge of the central cholinergic transmission. For example, it can be said that CAS occurs alongside general anesthesia, being no more than a frequent side-effect. Furthermore, acetylcholine is involved in nociception through the endorphinergic and the serotoninergic systems. There is a close relation between the central cholinergic transmission and actions of nitrous oxide. Moreover, cholinergic transmission is involved in withdrawal from (among others) alcohol, opiates, hallucinogens and nitrous oxide. In some intoxications with psychoactive agents, physostigmine is useful for reversal of the central nervous symptoms of the acute intoxication itself. In addition it can be used for prevention of some withdrawal states. In
 ...
PMID:Central anticholinergic syndrome (CAS) in anesthesia and intensive care. 268 49

The author reviews the literature reporting the untoward effects of withdrawing monoamine oxidase inhibitors (MAOIs). The withdrawal of these agents can result in severe anxiety, agitation, pressured speech, sleeplessness or drowsiness, hallucinations, delirium and paranoid psychosis. MAOI withdrawal phenomena resemble the symptoms produced by the discontinuation of chronically administered psychostimulants. The capacity of MAOI to exert amphetamine-like effects presynaptically, and the propensity of somatic treatments for depression to subsensitize presynaptic receptors regulating the release of catecholamines, can provide a basis for the development of psychotic syndromes upon the withdrawal of MAOIs. Evidence for this hypothesis is reviewed.
 ...
PMID:Monoamine oxidase inhibitor withdrawal phenomena: symptoms and pathophysiology. 284 11

In an open clinical study on the effect of Depamide in acute psychosis, 59 schizophrenic and 23 manic hospitalized patients were tested. They were divided in two groups: in group A, Depamide was administered only after an initial period of treatment with haloperidol or chlorpromazine; in group B instead, Depamide was added from the beginning of the neuroleptic treatment. The results show that the association of Depamide with neuroleptics leads to a reduction of agitation and of the hospitalization period, whereas it ameliorates the adaptation of the patients to the therapeutic milieu.
 ...
PMID:[Valpromide (Depamide) in the treatment of acute psychotic states. Open clinical study]. 287 6

Clonazepam is a high-potency benzodiazepine labeled for use as an anticonvulsant. Increasingly, clonazepam has been used in the treatment of a variety of psychiatric disorders. The authors discuss its potential clinical applications, including (1) use as an adjunct to neuroleptics for treating psychosis, (2) management of specific psychotropic side effects, (3) alternative treatment for certain pain syndromes, and (4) a primary treatment for severe agitation, atypical psychosis, and anxiety disorders. Apparent treatment-emergent side effects including depression, disinhibition, and sexual dysfunction are also discussed.
 ...
PMID:Clonazepam: new uses and potential problems. 288 24

Behavioral problems, and even psychotic symptoms, are universally acknowledged as among the most distressing consequences of dementia. A majority of patients experience either or both at some time during the course of dementia. Agitation is so common that accurate prevalence rates are difficult to ascertain; the available data suggest approximately 70 to 80 per cent of patients manifest this behavior in some form. Psychotic symptoms in some form occur less frequently, but perhaps affect up to half of demented patients at some time. Neuroleptic medications are among the psychoactive drugs most frequently prescribed for the demented elderly, yet they carry the risk of considerable morbidity from side effects, both acute (extrapyramidal syndromes, cardiovascular toxicity, anticholinergic effects) and chronic (tardive dyskinesia). They are most widely used for behavioral and psychotic symptoms; however, their efficacy for these problems is far from unequivocally established. The multiple medical problems of the elderly add to the complexity of diagnosing and managing these symptoms. Systematic delineation of the etiology, course, and prognosis of behavioral and psychotic symptoms may clarify the indications for such treatment. Further research on effective adjuncts and alternatives to neuroleptic treatment in the demented elderly may facilitate patient management, maximizing efficacy and reducing potential adverse consequences.
 ...
PMID:Neuroleptics and alternative treatments. Management of behavioral symptoms and psychosis in Alzheimer's disease and related conditions. 289 33

The authors review the literature discribing non-dyskinetic antipsychotic withdrawal phenomena. Withdrawal of these agents can cause nausea, emesis, anorexia, diarrhea, rhinorrhea, diaphoresis, myalgia, paresthesia, anxiety, agitation, restlessness, and insomnia. Psychotic relapse is often presaged by increased anxiety, agitation, restlessness and insomnia, but the temporal relationship of these prodromal symptoms to reduction in the dosage or discontinuation of neuroleptics distinguishes them from the effects of abrupt withdrawal.
 ...
PMID:Antipsychotic withdrawal symptoms: phenomenology and pathophysiology. 289 77


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>