Ajite Hastaya Yaklaşım
Özet
Aşırı bir uyarılma hâli olan ajitasyona; yoğun bakımlar, acil servisler, yataklı klinikler, poliklinikler ve günlük hayat dâhil olmak üzere birçok alanda rastlanılabilir.Etiyolojisinde tıbbi durumlar, psikiyatrik rahatsızlıklar ve madde kullanım bozuklukları ön plandadır. Ajite bir hastaya müdahale ederken önce sözel gerginliği azaltma teknikleri uygulanmalı, hastanın kooperasyonu sağlanamaz ise farmakolojik teknikler denenmeli, zorlayıcı durumlarda fiziksel tespit yöntemleri değerlendirilmelidir. Farmakolojik tedavilerde; temel olarak bilinmesi gereken üç grup ilaç vardır: Birinci-kuşak (tipik)antipsikotikler, ikinci-kuşak (atipik) antipsikotikler ve benzodiyazepinlerdir. Eğer hasta kısmi de olsa hekim ile işbirliği içerinegirebiliyorsa öncelikle oral formu olan ilaçlar tercih edilmelidir. Oral form tercih edilemediği durumlarda öncelik IM formu uygulanması şeklinde olmalıdır.
Referanslar
Schnapp BH, Slovis BH, Shah AD, Fant AL, Gisondi MA, Shah KH, et al. Workplace Violence and Harassment Against Emergency Medicine Residents. West J Emerg Med. 2016;17(5):567-73.
F. O. Sims’ symptoms in the mind: Textbook of Descriptive Psychopathology Elsevier Health sciences; 2018.
Association AP. Diagnostic and statistical manual of men- tal Disorders, 5th edition (Dsm-5). Arlington: vA: American Psychiatric Asso- ciation; 2013.
Cummings J, Mintzer J, Brodaty H, Sano M, Banerjee S, Devanand DP, et al. Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition. Int Psychogeriatr. 2015;27(1):7-17.
Poyurovsky M. Acute antipsychotic-induced akathisia revisited. Br J Psychiatry. 2010;196(2):89-91.
Amore M, Menchetti M, Tonti C, Scarlatti F, Lundgren E, Esposito W, et al. Predictors of violent behavior among acute psychiatric patients: clinical study. Psychiatry Clin Neurosci. 2008;62(3):247-55.
Chang PY, Chen JH, Cheng HW, Wang YC. Effects of Psychiatric Disease Severity and Clinical Characteristics on Duration of High Violence Risk: A Perspective on Violence Prevention in the Psychiatric Ward. Neuropsychiatr Dis Treat. 2023;19:663-71.
Sacchetti E, Valsecchi P, Tamussi E, Paulli L, Morigi R, Vita A. Psychomotor agitation in subjects hospitalized for an acute exacerbation of Schizophrenia. Psychiatry Res. 2018;270:357-64.
Dack C, Ross J, Papadopoulos C, Stewart D, Bowers L. A review and meta-analysis of the patient factors associated with psychiatric in-patient aggression. Acta Psychiatr Scand. 2013;127(4):255-68.
Lindenmayer JP. The pathophysiology of agitation. J Clin Psychiatry. 2000;61 Suppl 14:5-10.
San L, Marksteiner J, Zwanzger P, Figuero MA, Romero FT, Kyropoulos G, et al. State of Acute Agitation at Psychiatric Emergencies in Europe: The STAGE Study. Clin Pract Epidemiol Ment Health. 2016;12:75-86.
Boudreaux ED, Allen MH, Claassen C, Currier GW, Bertman L, Glick R, et al. The Psychiatric Emergency Research Collaboration-01: methods and results. Gen Hosp Psychiatry. 2009;31(6):515-22.
Roppolo LP, Morris DW, Khan F, Downs R, Metzger J, Carder T, et al. Improving the management of acutely agitated patients in the emergency department through implementation of Project BETA (Best Practices in the Evaluation and Treatment of Agitation). J Am Coll Emerg Physicians Open. 2020;1(5):898-907.
Wilson MP, Pepper D, Currier GW, Holloman GH, Jr., Feifel D. The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med. 2012;13(1):26-34.
Gottlieb M, Long B, Koyfman A. Approach to the Agitated Emergency Department Patient. The Journal of Emergency Medicine. 2018;54(4):447-57.
KUTLU L, Nesrin A. Açık Agresyon Ölçeği’nin Türk Psikiyatrik Hasta Grubunda Geçerlik ve Güvenirlik Çalışması. Sağlık Bilimleri ve Meslekleri Dergisi. 2019;6(3):513-26.
MADRAN PHAD. The reliability and validity of the Buss-Perry Aggression Questionnaire
(BAQ)-Turkish version. Turk Psikiyatri Dergisi. 2013;24(2):124.
Özel-Kizil Et, Baştug G, Erdogan S, Sakarya D, Durmaz N. Demans Hastalarinda Cohen-Mansfield Ajitasyon Envanteri’nin Türkçe Uyarlamasinin Psikometrik Özellikleri. Turkish Journal of Geriatrics/Türk Geriatri Dergisi. 2012;15(1).
Du M, Wang X, Yin S, Shu W, Hao R, Zhao S, et al. De-escalation techniques for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2017;4(4):Cd009922.
Richmond JS, Berlin JS, Fishkind AB, Holloman GH, Jr., Zeller SL, Wilson MP, et al. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. West J Emerg Med. 2012;13(1):17-25.
Gault TI, Gray SM, Vilke GM, Wilson MP. Are oral medications effective in the management
of acute agitation? J Emerg Med. 2012;43(5):854-9.
Baldaçara L, Diaz AP, Leite V, Pereira LA, Dos Santos RM, Gomes Júnior VP, et al. Brazilian guidelines for the management of psychomotor agitation. Part 2. Pharmacological approach. Braz J Psychiatry. 2019;41(4):324-35.
Zhang H, Wang G, Zhao J, Xie S, Xu X, Shi J, et al. Intramuscular ziprasidone versus haloperi-
dol for managing agitation in Chinese patients with schizophrenia. J Clin Psychopharmacol. 2013;33(2):178-85.
Walther S, Moggi F, Horn H, Moskvitin K, Abderhalden C, Maier N, et al. Rapid tranquilization of severely agitated patients with schizophrenia spectrum disorders: a naturalistic, ra-
ter-blinded, randomized, controlled study with oral haloperidol, risperidone, and olanzapine. J Clin Psychopharmacol. 2014;34(1):124-8.
Barak Y, Mazeh D, Plopski I, Baruch Y. Intramuscular ziprasidone treatment of acute psychotic agitation in elderly patients with schizophrenia. Am J Geriatr Psychiatry. 2006;14(7):629-33.
Nobay F, Simon BC, Levitt MA, Dresden GM. A prospective, double-blind, randomized trial of midazolam versus haloperidol versus lorazepam in the chemical restraint of violent and severely agitated patients. Acad Emerg Med. 2004;11(7):744-9.
Patel MX, Sethi FN, Barnes TR, Dix R, Dratcu L, Fox B, et al. Joint BAP NAPICU eviden-
ce-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation. J Psychopharmacol. 2018;32(6):601-40.
Hopper AB, Vilke GM, Castillo EM, Campillo A, Davie T, Wilson MP. Ketamine use for acute agitation in the emergency department. J Emerg Med. 2015;48(6):712-9.
Huf G, Alexander J, Gandhi P, Allen MH. Haloperidol plus promethazine for psychosis-induced aggression. Cochrane Database Syst Rev. 2016;11(11):Cd005146.
Jayakody K, Gibson RC, Kumar A, Gunadasa S. Zuclopenthixol acetate for acute schizophrenia and similar serious mental illnesses. Cochrane Database Syst Rev. 2012;2012(4):Cd000525.
KALOĞLU HA. Ajite hastaların yönetiminde farmakolojik ajanlar ve bu alanda yapılan güncel araştırmalar. . In: Ç. H, editor. Psikiyatri Pratiğinde Ajite Hastaların Yönetimi. 1 ed. Ankara: türkiye klinikleri; 2023.
Guerrero P, Mycyk MB. Physical and chemical restraints (an update). Emergency Medicine Clinics. 2020;38(2):437-51.
Göktaş A, Buldukoğlu K. Determination of psychiatric clinic nurses’ knowledge, attitudes, and practices regarding the use of physical restraints. Journal of Psychiatric Nursing/Psikiyatri Hemsireleri Dernegi. 2018;9(1).
Mohr WK, Petti TA, Mohr BD. Adverse effects associated with physical restraint. The Canadian Journal of Psychiatry. 2003;48(5):330-7.
Rice MM, Moore GP. Management of the violent patient: therapeutic and legal considerations. Emergency medicine clinics of North America. 1991;9(1):13-30.
Referanslar
Schnapp BH, Slovis BH, Shah AD, Fant AL, Gisondi MA, Shah KH, et al. Workplace Violence and Harassment Against Emergency Medicine Residents. West J Emerg Med. 2016;17(5):567-73.
F. O. Sims’ symptoms in the mind: Textbook of Descriptive Psychopathology Elsevier Health sciences; 2018.
Association AP. Diagnostic and statistical manual of men- tal Disorders, 5th edition (Dsm-5). Arlington: vA: American Psychiatric Asso- ciation; 2013.
Cummings J, Mintzer J, Brodaty H, Sano M, Banerjee S, Devanand DP, et al. Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition. Int Psychogeriatr. 2015;27(1):7-17.
Poyurovsky M. Acute antipsychotic-induced akathisia revisited. Br J Psychiatry. 2010;196(2):89-91.
Amore M, Menchetti M, Tonti C, Scarlatti F, Lundgren E, Esposito W, et al. Predictors of violent behavior among acute psychiatric patients: clinical study. Psychiatry Clin Neurosci. 2008;62(3):247-55.
Chang PY, Chen JH, Cheng HW, Wang YC. Effects of Psychiatric Disease Severity and Clinical Characteristics on Duration of High Violence Risk: A Perspective on Violence Prevention in the Psychiatric Ward. Neuropsychiatr Dis Treat. 2023;19:663-71.
Sacchetti E, Valsecchi P, Tamussi E, Paulli L, Morigi R, Vita A. Psychomotor agitation in subjects hospitalized for an acute exacerbation of Schizophrenia. Psychiatry Res. 2018;270:357-64.
Dack C, Ross J, Papadopoulos C, Stewart D, Bowers L. A review and meta-analysis of the patient factors associated with psychiatric in-patient aggression. Acta Psychiatr Scand. 2013;127(4):255-68.
Lindenmayer JP. The pathophysiology of agitation. J Clin Psychiatry. 2000;61 Suppl 14:5-10.
San L, Marksteiner J, Zwanzger P, Figuero MA, Romero FT, Kyropoulos G, et al. State of Acute Agitation at Psychiatric Emergencies in Europe: The STAGE Study. Clin Pract Epidemiol Ment Health. 2016;12:75-86.
Boudreaux ED, Allen MH, Claassen C, Currier GW, Bertman L, Glick R, et al. The Psychiatric Emergency Research Collaboration-01: methods and results. Gen Hosp Psychiatry. 2009;31(6):515-22.
Roppolo LP, Morris DW, Khan F, Downs R, Metzger J, Carder T, et al. Improving the management of acutely agitated patients in the emergency department through implementation of Project BETA (Best Practices in the Evaluation and Treatment of Agitation). J Am Coll Emerg Physicians Open. 2020;1(5):898-907.
Wilson MP, Pepper D, Currier GW, Holloman GH, Jr., Feifel D. The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med. 2012;13(1):26-34.
Gottlieb M, Long B, Koyfman A. Approach to the Agitated Emergency Department Patient. The Journal of Emergency Medicine. 2018;54(4):447-57.
KUTLU L, Nesrin A. Açık Agresyon Ölçeği’nin Türk Psikiyatrik Hasta Grubunda Geçerlik ve Güvenirlik Çalışması. Sağlık Bilimleri ve Meslekleri Dergisi. 2019;6(3):513-26.
MADRAN PHAD. The reliability and validity of the Buss-Perry Aggression Questionnaire
(BAQ)-Turkish version. Turk Psikiyatri Dergisi. 2013;24(2):124.
Özel-Kizil Et, Baştug G, Erdogan S, Sakarya D, Durmaz N. Demans Hastalarinda Cohen-Mansfield Ajitasyon Envanteri’nin Türkçe Uyarlamasinin Psikometrik Özellikleri. Turkish Journal of Geriatrics/Türk Geriatri Dergisi. 2012;15(1).
Du M, Wang X, Yin S, Shu W, Hao R, Zhao S, et al. De-escalation techniques for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2017;4(4):Cd009922.
Richmond JS, Berlin JS, Fishkind AB, Holloman GH, Jr., Zeller SL, Wilson MP, et al. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. West J Emerg Med. 2012;13(1):17-25.
Gault TI, Gray SM, Vilke GM, Wilson MP. Are oral medications effective in the management
of acute agitation? J Emerg Med. 2012;43(5):854-9.
Baldaçara L, Diaz AP, Leite V, Pereira LA, Dos Santos RM, Gomes Júnior VP, et al. Brazilian guidelines for the management of psychomotor agitation. Part 2. Pharmacological approach. Braz J Psychiatry. 2019;41(4):324-35.
Zhang H, Wang G, Zhao J, Xie S, Xu X, Shi J, et al. Intramuscular ziprasidone versus haloperi-
dol for managing agitation in Chinese patients with schizophrenia. J Clin Psychopharmacol. 2013;33(2):178-85.
Walther S, Moggi F, Horn H, Moskvitin K, Abderhalden C, Maier N, et al. Rapid tranquilization of severely agitated patients with schizophrenia spectrum disorders: a naturalistic, ra-
ter-blinded, randomized, controlled study with oral haloperidol, risperidone, and olanzapine. J Clin Psychopharmacol. 2014;34(1):124-8.
Barak Y, Mazeh D, Plopski I, Baruch Y. Intramuscular ziprasidone treatment of acute psychotic agitation in elderly patients with schizophrenia. Am J Geriatr Psychiatry. 2006;14(7):629-33.
Nobay F, Simon BC, Levitt MA, Dresden GM. A prospective, double-blind, randomized trial of midazolam versus haloperidol versus lorazepam in the chemical restraint of violent and severely agitated patients. Acad Emerg Med. 2004;11(7):744-9.
Patel MX, Sethi FN, Barnes TR, Dix R, Dratcu L, Fox B, et al. Joint BAP NAPICU eviden-
ce-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation. J Psychopharmacol. 2018;32(6):601-40.
Hopper AB, Vilke GM, Castillo EM, Campillo A, Davie T, Wilson MP. Ketamine use for acute agitation in the emergency department. J Emerg Med. 2015;48(6):712-9.
Huf G, Alexander J, Gandhi P, Allen MH. Haloperidol plus promethazine for psychosis-induced aggression. Cochrane Database Syst Rev. 2016;11(11):Cd005146.
Jayakody K, Gibson RC, Kumar A, Gunadasa S. Zuclopenthixol acetate for acute schizophrenia and similar serious mental illnesses. Cochrane Database Syst Rev. 2012;2012(4):Cd000525.
KALOĞLU HA. Ajite hastaların yönetiminde farmakolojik ajanlar ve bu alanda yapılan güncel araştırmalar. . In: Ç. H, editor. Psikiyatri Pratiğinde Ajite Hastaların Yönetimi. 1 ed. Ankara: türkiye klinikleri; 2023.
Guerrero P, Mycyk MB. Physical and chemical restraints (an update). Emergency Medicine Clinics. 2020;38(2):437-51.
Göktaş A, Buldukoğlu K. Determination of psychiatric clinic nurses’ knowledge, attitudes, and practices regarding the use of physical restraints. Journal of Psychiatric Nursing/Psikiyatri Hemsireleri Dernegi. 2018;9(1).
Mohr WK, Petti TA, Mohr BD. Adverse effects associated with physical restraint. The Canadian Journal of Psychiatry. 2003;48(5):330-7.
Rice MM, Moore GP. Management of the violent patient: therapeutic and legal considerations. Emergency medicine clinics of North America. 1991;9(1):13-30.
