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Query: UMLS:C0085631 (agitation)
 12,064 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Psychiatric disorders in the elderly are common and often overlap with multiple medical problems. If used inappropriately, psychotropic drugs can further compromise a difficult clinical situation. Management of elderly patients with agitation, psychosis, anxiety, and insomnia are reviewed with a discussion of the optimal use of antipsychotic, anxiolytic, and sedating drugs. Initial attempts to control symptoms should involve nonpharmacologic techniques, but, when absolutely required, psychotropic drugs will often relieve symptoms with a minimum of side effects. Dangers in the chronic use of neuroleptics are stressed.
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PMID:Psychoactive drugs in the elderly: antipsychotics and anxiolytics. 290 Jul 97

The literature describing nondyskinetic antipsychotic withdrawal symptoms is reviewed. The withdrawal of antipsychotic agents can result in nausea, emesis, anorexia, diarrhea, rhinorrhea, diaphoresis, myalgias, paresthesias, anxiety, agitation, restlessness, and insomnia. Psychotic relapse is often presaged by increased anxiety, agitation, restlessness, and insomnia. However, the temporal relationship of these prodromal symptoms to reduction in the dosage or discontinuation of neuroleptics distinguishes them from the effects of abrupt withdrawal.
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PMID:Antipsychotic withdrawal phenomena in the medical-surgical setting. 290 18

The prevalence of neuropsychiatric disorders and other medical illnesses was investigated in 65 nursing home residents. The authors found neuropsychiatric disorders to be present in 94% of the sample. The neuropathologic causes of these syndromes were found to be more diverse than in previous studies. The most frequent causes were degenerative, vascular, and toxic. The most common psychiatric syndromes that resulted from these neuropathologic disorders were dementia syndrome (72%), organic personality syndrome (14%), and organic psychotic disorders (12%). The most common behavioral problems, agitation and aggression, most likely reflected the high prevalence of frontal lobe damage and affected 48% of the sample. Other non-neuropsychiatric medical problems were significantly less common. While only 4% of the sample had no neuropsychiatric diagnosis, 39% had no other non-neuropsychiatric diagnosis. These results suggest that the nursing home is not used as a referral source for chronic medical conditions in general but almost exclusively for the care of chronic neuropsychiatric disorders.
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PMID:The prevalence of neuropsychiatric disorders in a nursing home population. 326 98

Nonresponsive psychosis encompasses heterogeneous psychotics who are symptomatic despite adequate trials of neuroleptic medication. A proportion of those patients are schizophrenic. A second subgroup are symptomatic in that they have specific target features. The use of carbamazepine is discussed in the context of searching for active target symptoms and features that may imply its appropriate application as adjunctive medication in nonaffective, nonepileptic psychotics. Despite a dearth of studies in the literature, two studies, those of Neppe and of Klein, appear to be of theoretical relevance and are used as starting points to compare the other blind and nonblind literature available. It appears that carbamazepine is worthwhile in patients with some aggression and interpersonal difficulties who are refractory to neuroleptics alone and who exhibit instability and agitation. The role of temporal-lobe symptomatology and temporal-lobe foci is unclear, and the mechanism of action of carbamazepine is apparently not directly antipsychotic and may relate to an antikindling-like mechanism. The role of psychodynamics should not, however, be ignored. A great deal more research is required.
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PMID:Carbamazepine in nonresponsive psychosis. 328 May 58

Epidemiologic data have identified risk factors, such as major depressive illness and sedative/alcohol addiction, that can help the clinician detect potentially suicidal persons. Evidence of subtle differences in the pattern of suicidality in bipolar and unipolar depressive illnesses has emerged. Suicide occurs early in unipolar episodes and intensifies along with increasing agitation and worsening melancholic symptoms. In bipolar depressive episodes, suicidality becomes an issue late in the course of a single episode, and illness severity and lethality are progressively aggravated by each affective relapse. Safe, effective treatment for suicide patients is the responsibility of the individual clinician and depends on neuropsychiatric variables, proper therapy, and direct and honest communication between patient and clinician. Adamant avoidance of division of primary clinical responsibility among cooperating specialists and clinician obstinancy when dealing with third parties can help prevent suicides. Early identification of psychosis, sedativism and subtle organicity are imperative. Pharmacotherapy usually equates to the fastest acting, most effective antidepressant drug, but some patients require electroconvulsive therapy to reduce suicidality. Involvement is the essence of psychotherapy in suicide management.
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PMID:Lest treatment abet suicide. 332 37

This article discusses the diagnostic and therapeutic problems that are unique to psychogeriatric patients in a primary care setting. Practical guidelines for the evaluation and treatment of dementia and depression, psychosis and agitation, and insomnia are presented.
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PMID:Geriatric psychiatry. 332 33

Psychiatric management of elderly patients is a challenging task because of the many age-related physiologic changes and medical problems in this population. Thorough patient evaluation is essential to rule out somatic disorders and determine underlying causes. Somatic complaints must be taken seriously, even if a patient is receiving treatment for a psychiatric disorder. Psychotropic therapy is used mainly for controlling depression, agitation, and psychotic symptoms. If psychiatric symptoms persist or become worse, psychotropics should be discontinued to prevent possible drug toxicity (eg, anticholinergic delirium) and psychiatric consultation should be requested.
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PMID:Psychiatric disorders in the elderly. Psychopharmacologic management. 333 12

The Zung Self-Rating Depression Scale (SDS) was presented to 99 depressed inpatients. The patients were categorized according to DSM-III as suffering from minor depression, major depression without melancholia and major depression with melancholia and/or with psychotic features. Differences in self-reported symptoms between these categories were studied with multivariate statistical techniques including linear discriminant analysis (LDA) and statistical isolinear multiple components analysis (SIMCA). Patients with minor depression rate themselves significantly less depressed than those with major depression. Patients with major depression without melancholia are less depressed than those with melancholia and/or psychotic features. The three DSM-III depressive categories can be regarded as belonging to a clinical continuum in which they form relevant levels with quantitative differences in self-reported symptoms. These differences are not only defined by gradual shiftings in the overall severity of illness, but also by quantitative differences in the severity of some target symptoms, i.e. agitation, retardation, diurnal variation, loss of libido, fatiguability, insomnia, anorexia, sadness and anhedonia.
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PMID:Self rated depression in relation to DSM-III classification: a statistical isolinear multiple components analysis. 334 93

We performed a retrospective chart analysis of 33 patients with an Emergency Department discharge diagnosis of phencyclidine (PCP) intoxication. All 33 cases presented to the Emergency Department between November 1986 and April 1987. Thirty of the 33 patients (91%) were classified as mildly intoxicated (per clinical syndrome as described by Aronow and Done) while the remaining 3 patients (9%) were moderately intoxicated. Two of the patients (6%) required benzodiazepine therapy for agitation while an additional 3 patients (9%) required haloperidol for psychotic symptoms. Twenty-three patients (70%) did not require any medication. Of particular interest was our finding that 11 of the 27 males (41%) required leather restraints for agitation or violent behavior while none of the 6 female patients required leather restraints (Fisher's exact test, p = 0.00078). While nursing perception of physical strength may be a confounder, level of agitation and violent behavior is our primary indication for use of restraints. We believe that there is a sexual disparity in level of agitation and violent behavior induced by PCP. We hypothesize that this may be due to pharmacokinetic factors (such as difference in body fat distribution between the sexes) or biological differences in the central nervous system.
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PMID:Analysis of sexual disparity of violent behavior in PCP intoxication. 335 86

A 34-year-old woman experienced three episodes of an atypical psychosis, characterized by confusion, agitation, delusional thinking, paranoid ideation, and auditory hallucinations, during the 14 months prior to her death. Findings of gross examination of the brain and spinal cord were unremarkable. Histologic examination revealed scattered subpial foci of demyelination throughout the brain stem, with involvement of the hippocampal formation bilaterally. Although occasional active lesions at early stages of development were noted, most lesions were gliotic and therefore quiescent. This case and one similar example of disseminated subpial demyelination found in the literature probably represent an unusual variant of multiple sclerosis.
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PMID:Atypical psychosis with disseminated subpial demyelination. 336 70


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