Psychomotor agitation occurs in acute mental disorders and is manifested by increased motor activity, which can be accompanied by confusion, anxiety, aggression, fun, hallucinations, confusion, delusional state, etc. More about what this condition is, which is why it can occur and how it is treated will be described later in the article.
The main signs of psychomotor agitation
The state of psychomotor agitation is characterized by an acute onset, pronounced impaired consciousness and motor anxiety (this can be either fussiness or destructive impulsive actions). The patient may experience euphoria or, conversely, anxiety, fear.
His movements acquire a chaotic, inadequate character, they can be accompanied by verbal arousal - eloquence, sometimes in the form of a continuous stream of words with shouting of individual sounds or phrases. The patient may be chased by hallucinations, he has confusion, thinking becomes accelerated and torn (dissociative). There is aggression directed both at others and at oneself (suicidal attempts). By the way, the patient is not critical of his condition.
As is clear from the above symptoms, the patient's well-being is a danger and requires urgent medical attention. But what could lead to this state of affairs?
Causes of psychomotor agitation
Acute psychomotor agitation can be triggered by a variety of reasons, both severe stress and organic brain damage (for example, epilepsy).
Most often it occurs:
- with a prolonged stay of a mentally healthy person in a state of panic fear or as a result of a life-threatening situation (for example, after a car accident, the so-called reactive psychosis may develop);
- in acute or chronic alcohol intoxication, as well as in case of poisoning with caffeine, acrychin, atropine, etc.
- after exiting a coma or after traumatic brain injury, which provoked a pathological damage to parts of the brain;
- may be a consequence of the central nervous system damage by toxins, as a result of a serious infectious disease
- with hysteria;
- often found in mental illnesses: schizophrenia, depressive psychosis, manic arousal or bipolar affective disorder.
The severity of psychomotor agitation
In medicine, psychomotor agitation is divided into three degrees of severity.
- Easy degree. Patients in this case look only as unusually lively.
- The average degree is expressed in the manifestations of the lack of focus of their speech and actions. Actions become unexpected, expressed affective disorders appear (gaiety, anger, longing, viciousness, etc.).
- A sharp degree of excitement is manifested by the extreme randomness of speech and movements, as well as confusion.
By the way, how this excitement manifests itself, to a large extent, depends on the age of the patient. So, in childhood or senility, it is accompanied by monotonous speech or motor acts.
In children, this is monotonous crying, screaming, laughing or repeating the same questions, swaying, grimacing, or smacking are possible. And in elderly patients, excitement is manifested by fussiness, with a look of business concern and complacent talkativeness. But frequent in such situations are manifestations of irritability or anxiety, accompanied by grouchy.
Types of psychomotor agitation
Different types of this condition are differentiated depending on the nature of the patient’s excitement.
- Hallucinatory-delusional arousal - characterized by a feeling of fear, anxiety, confusion or spite and tension. 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 taking apart roads and obvious obstacles.
- Catatonic psychomotor agitation - its symptoms are manifested in the randomness and lack of focus of the patient's movements - they are sudden, meaningless and impulsive, with transitions from agitation to stupor. The patient is foolish, grimaces, behaves absurdly and manneredly.
- Manic arousal is expressed by transitions from gaiety to anger, irritability and spite. The patient cannot sit still - he sings, dances, intervenes in everything, takes on everything and brings nothing to the end. He speaks quickly, continuously, constantly changing the subject and not ending phrases. Explicitly overestimates his abilities, can express ideas of greatness, and when objected, show aggression.
A few more types of psychomotor agitation
In addition to the above, there are several types of psychomotor agitation that can develop in a healthy person and in those who have organic brain lesions.
- So, epileptic agitation is characteristic of the twilight state of consciousness in patients with epilepsy. He is accompanied by maliciously aggressive affect, complete disorientation, impossibility of contact. The beginning and end of it, as a rule, are sudden, and the condition can reach a high degree of danger for others, since the patient can attack them and inflict severe damage, as well as destroy everything that he encounters on the way.
- Psychogenic psychomotor agitation occurs immediately after acute stressful situations (catastrophe, crash, etc.). It is expressed by varying degrees of motor anxiety. This can be monotonous agitation with inarticulate sounds, and chaotic agitation with panic, flight, self-mutilation, attempted suicide. Often excitement is replaced by a stupor. By the way, in case of mass disasters, such a state can also cover large groups of people, becoming common.
- Psychopathic agitation looks similar to psychogenic, as it also arises under the influence of external factors, but the strength of the response in this case, as a rule, does not correspond to the cause 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 is found to have psychomotor agitation, emergency care is necessary immediately, since the patient can cause injuries to himself and others. To do this, all outsiders are asked to leave the room where he is located.
They communicate with the patient calmly and confidently. It should be isolated in a separate room, which is pre-inspected: close windows and doors, remove sharp objects and all that can strike. Urgently call a psychiatric team.
Prior to her arrival, one should try to distract the patient (this advice does not apply to the twilight state, because the patient is not in contact), and if necessary, carry out immobilization.
Assisting in patient immobilization
Psychomotor agitation, the symptoms of which were discussed above, often requires the use of constraint measures. This usually requires the help of 3-4 people. They come from behind and from the sides, hold the patient’s hands pressed to his chest and grab it sharply under his knees, thus laying on a bed or couch, previously moved away from the wall so that it can be approached from 2 sides.
If the patient is resisting by waving an object, then the assistants are advised to keep blankets, pillows or mattresses in front of them. One of them should throw a blanket over the patient’s face, this will help to lay him on the bed. Sometimes you have to hold your head, for which they throw a towel (best wet) on their foreheads and pull them towards the bed.
It is important to be careful when holding so as not to cause damage.
Features of assistance with psychomotor agitation
Medication for psychomotor agitation should be in a hospital setting. For the period while the patient is transported there, and for the time before the start of the medication, temporary fixation is allowed (which is recorded in medical documents). In this case, the mandatory rules are observed:
- during the application of constraint measures use only soft materials (towels, sheets, cloth belts, etc.);
- each limb and shoulder girdle are securely fixed, since otherwise the patient can easily be released;
- squeezing of nerve trunks and blood vessels should not be allowed, because this can lead to dangerous conditions;
- a fixed patient is not left unattended.
After the action of antipsychotics, it is released from fixation, but observation should be continued, since the condition remains unstable and a new attack of excitement can occur.
Treatment of psychomotor agitation
To relieve the severity of the attack, a patient with any psychosis is given sedatives: “Seduxen” - intravenously, “Barbital-sodium” - intramuscularly, “Aminazine” (intravenous or intramuscular). If the patient can take the drugs inside, then he is prescribed Phenobarbital, Seduxen, or Aminazin tablets.
Neuroleptics “Clozapine”, “Zuk-lopentixol” and “Levomepromazin” are no less effective. It is very important to control the blood pressure of the patient, since these funds can cause its decrease.
In a somatic hospital, psychomotor agitation is also treated with drugs used for anesthesia (Droperidol and sodium hydroxybutyrate solution with glucose) with mandatory control of respiration and blood pressure. And for weakened or elderly patients, tranquilizers are used: Tiaprid, Diazepam, Midazolam.
The use of drugs depending on the type of psychosis
As a rule, sedative drugs are prescribed to the newly admitted patient, but after clarifying the diagnosis, further stopping the psychomotor agitation will be directly depend on its type. So, with hallucinatory-delusional excitement, Haloperidol and Stelazin are prescribed, and with manic, Clopixol and Lithium Oxybutyrate are effective. The reactive state is relieved by the drugs “Aminazin”, “Tizercin” or “Phenazepam”, and the catotonic agitation is cured by the drug “Majepril”.
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. There is no need to try to apply a physical effect on the patient independently 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 a symptom of his serious condition.