Psychomotor agitation: types, symptoms, treatment

Psychomotor agitation occurs in acute disorders of the psyche and is manifested by increased motor activity, which can be accompanied by confusion, anxiety, aggression, fun, hallucinations, confusion of consciousness, delusional state, etc. More about what this state represents, why It can happen and how it is treated, will be discussed later in the article.

The main signs of psychomotor agitation

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

His movements acquire a chaotic, inadequate character, they can be accompanied by verbal excitement - mul- tiple, sometimes in the form of a continuous stream of words, shouting out individual sounds or phrases. The patient may be hallucinated, his consciousness is clouded, his thinking becomes accelerated and torn (dissociative). There is an aggression directed both to others and to oneself (suicidal attempts). By the way, the patient does not have a criticism for his condition.

As is clear from the listed symptoms, the patient's health is a danger and requires urgent medical attention. But what can lead to such a state of affairs?

The causes of psychomotor agitation

Acute psychomotor agitation can be triggered by a variety of causes, such as severe stress, and organic brain damage (eg, epilepsy).

Most often it occurs:

• With the long 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 crash, a so-called reactive psychosis may develop ) ;
• With acute or chronic alcohol intoxication, as well as poisoning with caffeine, acrichine, atropine, etc.;
• After exiting from a coma or after traumatic brain injuries that provoked pathological lesions of brain areas;
• May be a consequence of CNS damage by toxins, as a result of a serious infectious disease;
• With hysteria;
• Often occurs in mental illness: schizophrenia, depressive psychosis, manic agitation or bipolar affective disorder.

Degrees of expression of psychomotor agitation

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

1. Easy degree. Patients in this case look only as unusually lively.
2. The average degree is expressed in manifestations of the non-purposefulness of their speech and actions. Actions become unexpected, there are pronounced affective disorders (gaiety, anger, anguish, spite, etc.).
3. A sharp degree of excitement is manifested by extreme chaos of speech and movements, as well as by the confusion of consciousness.

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

Children - it's monotonous crying, screaming, laughing or repeating the same questions, shaking, grimacing or smacking is possible. And in elderly patients, excitement is manifested by fussiness, with a kind of businesslike preoccupation and complacent talkableness. But in such situations, there are frequent displays of irritability or anxiety, accompanied by grumbling.

Types of psychomotor agitation

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

• Hallucinatory-delirious arousal - characterized by a sense of fear, anxiety, confusion, or malice 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 exploring the road and obvious obstacles.
• Catatonic psychomotor agitation - its symptoms are manifested in the chaotic and inappropriate direction of the patient's movements - they are sudden, senseless and impulsive, with transitions from excitement to stupor. The patient is foolish, grimaces, behaves absurdly and mannerally.
• Manic excitement is expressed by the transitions from gaiety to anger, irritability and malice. The patient can not sit still - he sings, dances, interferes in everything, takes everything for everything and does not finish anything. He speaks quickly, continuously, now and then changing the subject and not finishing the phrases. Explicitly overestimates his capabilities, can express ideas of greatness, and when objecting to manifest aggression.

A few more types of psychomotor agitation

In addition to the above, there are several more types of psychomotor agitation that can develop in a healthy person and in those with organic brain lesions.

• Thus, epileptic excitation is characteristic of the twilight state of consciousness in patients with epilepsy. He is accompanied by an angry-aggressive affect, a complete disorientation, the 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, as the patient can pounce on them and inflict heavy damage, as well as destroy everything that they find on the way.
• Psychogenic psychomotor agitation occurs immediately after acute stressful situations (catastrophe, wreck, etc.). It is expressed by varying degrees of motor anxiety. It can be a 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, in case of mass disasters such a state can include large groups of people, becoming common.
• Psychopathic exhilaration looks similarly 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 related to the psychopathic characteristics of the patient's character.

How to provide first aid in acute psychomotor agitation

If a person has psychomotor agitation, emergency care is needed immediately, since the patient can cause injuries to himself and others. For this purpose, all the outsiders are asked to leave the room where it is located.

With the patient communicate calmly and confidently. It should be isolated in a separate room, which is pre-examined: they close windows and doors, remove sharp objects and everything that can be hit. Urgently call a psychiatric team.

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

Assisting with immobilization of the patient

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

If the patient is resisting, swinging an object, the helpers are advised to keep blankets, pillows or mattresses in front of them. One of them must throw a blanket over the face of the patient, this will help put him on the bed. Sometimes you have to hold your head, for which a towel (preferably wet) is put on the forehead and pulled to the ends to the bed.

It is important to be careful while holding, so as not to cause damage.

Features of assistance with psychomotor agitation

Medication for psychomotor agitation Should be provided in a hospital. For a period until the patient is transported there, and for a time before the beginning of the action of the medicines, the temporary application of fixation is allowed (which is recorded in medical records). At the same time, compulsory rules are observed:

• During the application of measures of restraint use only soft materials (towels, sheets, cloth belts, etc.);
• Securely fix each limb and shoulder girdle, as otherwise the patient can easily be released;
• Do not squeeze nerve trunks and blood vessels, because this can lead to dangerous conditions;
• Fixed patient is not left unattended.

After the action of neuroleptics, it is released from fixation, but the observation should be continued, as the condition remains unstable and a new attack of excitement may occur.

Treatment of psychomotor agitation

For relief of the severity of the attack, a patient with any psychosis is given sedatives: "Seduxen" - intravenously, "Barbital-sodium" - intramuscularly, "Aminazine" (IV or IM). If the patient can take the drugs inside, then he is prescribed tablets "Phenobarbital", "Seduxen" or "Aminazin".

Neuroleptics "Clozapine", "Zuk-lopentixol" and "Levomepromazin" are no less effective. It is very important at the same time to monitor the patient's blood pressure, as these drugs can cause it to fall.

In a somatic hospital, psychomotor excitation is treated with drugs used for anesthesia ("Droperidol" and sodium oxybutyrate solution with glucose) with mandatory respiratory control 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, the newly admitted patient is prescribed generalized drugs, but after clarifying the diagnosis, further suppression of psychomotor agitation will be Directly depend on its kind. So, with hallucinatory-delirious excitement, preparations "Haloperidol", "Stelazine" are prescribed, and when manic the drugs "Clopixol" and "Lithium oxybutyrate" are effective. The reactive state is removed with the drugs "Aminazine", "Tizercin" or "Phenazepam", and the cathotonic excitation is cured with the drug "Mazepril".

Specialized medicines are combined, if necessary, with generalized, correcting the dose.

A few words in conclusion

Psychomotor agitation can occur in a domestic situation or occur against a backdrop 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 the first aid is to be collected and calm. Do not try to apply physical influence on the patient yourself 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 the symptoms of his difficult condition.