When psychomotor agitation increases mental and physical activity, there is inadequate behavior, there may be impaired consciousness with delusions and hallucinations.
Psychomotor agitation can occur in healthy people with acute mental trauma (severe stress). More often it is associated with car accidents and other emergencies. The causes of psychomotor excitement are toxic lesions of the central nervous system against the background of acute infectious diseases, craniocerebral injuries, epilepsy, acute poisoning, including alcoholic ones. General excitement is possible with oxygen starvation and toxic brain damage in pre-comatose states on the background of various diseases. It can be a sign of hysteria when a person’s reaction to an external stimulus is excessive. Psychomotor agitation is also noted in mental disorders (manic-depressive psychosis, schizophrenia, bipolar affective disorders).
Psychomotor agitation can manifest itself in various forms.
In the case of a catatonic form, the patient behaves pretentiously, performs impulsive actions, manages, his movements can be coordinated or rhythmic and monotonous. This variant of psychomotor agitation is characteristic of schizophrenia and schizophren-like syndromes.
Hebephrenic arousal is accompanied in a patient by foolishness, senseless impulsive actions, which are often aggressive. It is also found in schizophrenia.
With hallucinations, psychomotor agitation is accompanied by tension and concentration of the patient. His mimicry is changeable, speech consists of phrases unrelated to each other. The movements are characterized by impetuousness, there may be defensive or threatening gestures and actions, intonation in the voice. Such arousal occurs when alcoholism, brain damage, amid organic changes or intoxication. When delirium patients are malicious, suspicious, aggressive. May unexpectedly harm themselves and those around them. This happens more often in schizophrenia.
The manic form of arousal is accompanied by an elevated mood, inconsistent thinking and actions, and a desire for action. Patients in this state are distinguished by associative thinking. There may be delirium with hallucinations. It is more common in schizophrenia.
Psychomotor agitation in an alarming form accompanies depressive states. It is manifested by the patient’s restless behavior — by moving around the room, swinging the body in a sitting position, turning over the fingers, or pulling clothes. The patient sometimes moans or speaks short phrases. Suddenly, the excitement can increase – he begins to rush, scream, show aggression towards the environment or himself.
When dysphoria psychomotor agitation manifests itself with negative emotions – the patient is tense, gloomy, gloomy. He can be malicious and distrustful, commit aggressive actions. This type of arousal is characteristic of epilepsy.
Epileptiform arousal is accompanied by a pronounced motor manifestation with aggression. The patient rushes about in fear, seeks to escape. He has delirium and hallucinations, loss of orientation in time and environment. Characterized by organic brain damage and epilepsy.
Psychomotor agitation associated with mental trauma, accompanied by a contraction of consciousness. A person is marked with fear, panic, he is senselessly torn.
Erotic arousal during oligophrenia is manifested by actions of a destructive nature, with a cry.
Psychopathic arousal is usually targeted, the behavior of patients depends on their interest and any attitudes. So, patients can seek vacation or any other benefits. Patients not only show anxiety, fuss, scream, but also incite others to this, creating a tense atmosphere around them. Patients cynically scold, can be aggressive, but always against certain individuals with whom they come into conflict. Psychopathic arousal along with sedative medical therapy also requires psychotherapy, especially with the explanation and resolution of the traumatic situation.
Treatment and care. The state of excitement in the mentally ill always requires special attention from the medical staff. Excited patients should be under strict supervision: it is necessary to ensure that they can not cause damage to themselves or others, to be fed, because in a state of excitement, patients can not chew food, but swallow it in large chunks, or refuse to eat.
Before the patient is given sedative medication, he should be put to bed. If the patient is very agitated, does not allow him to approach himself, threatening with any object, then he needs to approach him, holding in front of him a blanket unfolded or raised up, which is quickly thrown over the patient and the patient is put into bed. You can not cause pain, pressure on the neck, chest and abdomen, as this violates breathing and can lead to a fracture of cartilage and bones. The patient is kept in bed 2-3 nurses. He is laid on his back with his arms and legs straightened. The orderlies are at the sides of the bed and at the head; one holds the shoulders and forearms of the patient, the other holds the thighs and legs, fixing the knee joints, the third holds the patient’s head, pressing it to the pillow with a towel thrown over the forehead.
Due to the fact that patients in a state of arousal are capable of causing bodily injuries to themselves and others, they need to be given emergency help. The patient at the same time, as a rule, resists.
It is necessary to reduce the manifestations of aggression on the part of the patient by persuasion, to divert attention (by talking or by his behavior), to keep him from escaping or dangerous actions. And it is necessary to show the patient confidence and show composure, while sympathizing with him and showing a desire to help. You must persuade him to take a sedative or to inject him. To keep a patient who is armed or very aggressive, before the arrival of the psychiatric brigade of the “emergency medical care” you can bring in police officers who are obliged to provide assistance.
Patients with psychomotor agitation are treated in psychiatric clinics. Before transport, they are given intramuscular or intravenous neuroleptics (50–75 mg of chlorpromazine, 50–75 mg levomepromazina, 50 mg clozapida). If the patient has previously received antipsychotics, the dose of drugs increased by 2 times. 0.25 can be used to eliminate the excitation % – solution was droperidol (2 ml intramuscularly) or 20 % – s hydroxybutyrate sodium chloride (20 ml of 20 ml 40 % – Foot glucose solution intravenously).
Controlling the level of blood pressure after drug administration is required. For elderly people or debilitated patients, it is preferable to use intravenous, intramuscular diazepam (up to 30 mg), midazolam (up to 15 mg).
Before the effect of the introduction of sedatives, the patient can be fixed in a gentle way (sheets, belts of cloth). Hands, and sometimes legs fixed separately. Moreover, it is impossible to prevent circulatory disorders – do not pinch the blood vessels and large nerves with tight straps. The patient, even in a fixed state, needs constant observation. These actions are noted in the accompanying documentation.
Patients are subject to urgent hospitalization in a psychiatric supervisory department.
With unfinished suicide medical help is based from available to the patient damage . With fractures due to the fall patient from a height – splinting, anti-shock events, hospitalization at corresponding transport (see. “Surgical Section diseases”).
With drowning ( after extraction the sick of water ) and when hanging ( cut a rope supporting patient ) need to clear mouth and pull out language, after what produce artificial breath , maintain hearty activities as well conduct dehydrating therapy (see. Reanimation).
Required urgenthospitalization; at transportation the sick on stretcher rendering medical help not is terminated.
In case of poisoning with psychotropic drugs (amitriptyline), To remove the remaining drugs, stomach is fed through a tube, saline laxative, adsorbing (activated carbon, burnt magnesia) and enveloping agents are prescribed . Urgent hospitalization is required; during transportation to support cardiovascular activity.