What Are the Treatment Options for Psychomotor Agitation?

The typical symptoms of mania are high moods, increased thoughtfulness and increased activity. The state of mind rises as relaxed and happy, feel good about yourself, feel that everything around is very beautiful, feel that its life is colorful, and that you are extremely happy and happy. The thoughts and thoughts are expressed as quotations from the classics, eloquence, and endless, giving a superficial and superficial feeling. Increasing activities are manifested in vigorous energy, markedly increased activities and unbearable, busy all day, and there is no end to work. Xiguan is lively, has a lot of communication, and is enthusiastic about people.

Mania

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(1) High mood: full of happiness and elation all day. Its pleasant mood is quite vivid and vivid, it is in harmony with the inner experience, has a certain contagious power, and can often resonate with people around it. Emotions can be unstable and have

1. Create a good atmosphere

The color of the room of patients with mental mania should be cold, such as green and blue, and the room layout should be simple and elegant. When listening to music, you should try to put on some slow serenade or light music. It should not be too intense. Music, so as not to excite the patient.

2. Contact attention method

When contacting and talking with patients with mental mania, pay attention to methods and methods. Be attentive, kind, and patient. Patients with a lot of dialogue should try not to talk or argue with them too much, let alone satirize patients with exaggerated words. Laugh at him.

3. Pay attention to diet regulation

Excited, restless patients often "sleep and forget" because of "busy", and will appear again when starvation is excessive

(1) Injection medication

Haloperidol rapid treatment, haloperidol 5mg, intramuscular injection every half an hour, until the patient falls asleep, the maximum daily amount does not exceed 50mg.

Intravenous bolus injection of chlorpromazine, 50-100mg of chlorpromazine, dissolved in 100ml of 50% glucose, slowly intravenous injection until the patient falls asleep.

Intramuscular injection of clonazepam, 1 to 2 mg of clonazepam, intramuscular injection 3 to 4 times a day. This method can also make patients quiet as soon as possible, more safe and effective.

(2) oral medication

Lithium carbonate should generally be used under the monitoring of blood lithium concentration, otherwise lithium poisoning is prone to occur. The dosage generally does not exceed 3.0g, preferably between 2.0 and 2.5g / day. The blood lithium concentration should be controlled between 0.8 and 1.5mmol / L, and the therapeutic effect is about 80%. Pay attention to the symptoms of poisoning and adverse reactions. If poisoning occurs, the drug should be stopped immediately to accelerate the excretion of lithium.

Clozapine, dose from 25mg, orally, 3 times a day, gradually increasing to 450 ~ 600mg / day, so far. The curative effect is fast and reliable, but it is easy to cause leukopenia. Blood tests should be performed once a week.

Clonazepam has a strong control of psychomotor excitement, anti-manic effect is significantly better than other nerve blockers with small side effects, and is widely used. The oral dose is 2-6 mg each time, 3 times daily.

Sodium phenytoin has a certain anti-manic effect, and its effective dose is 0.12 0.2, which is taken orally 3 times a day.

Sodium valproate has a good anti-manic effect, the dosage is 0.2 to 0.6, orally 3 times a day.

Carbamazepine has a certain anti-manic effect, especially suitable for those who cannot tolerate lithium salt.

(3) Electric shock treatment

It is one of the effective methods for treating mania. It has the characteristics of safety, effectiveness and speed. It is once every other day and 8 to 12 times is a course of treatment. Usually 3 to 5 times can control symptoms.

(4) Maintenance treatment

Although the symptoms of mania are easy to control and relapse, it needs a certain period of maintenance treatment. For first-time patients, lithium therapy should be maintained for at least 6 months after recovery from mania. For every year, the author should be maintained with lithium salt for a long time, and a sustained release agent can be used at this time.

(5) Anti-relapse therapy

Mania is characterized by recurrent episodes and often requires anti-relapse treatment.

In patients with first-onset mania, treatment can be stopped for a period of time, and anti-relapse treatment is not required. However, if any recurring symptoms are found, such as reduced sleep, more talking, and more activity, treatment should be resumed immediately.

In patients with recurrent mania, anti-relapse treatment after treatment should be performed according to the law of relapse.

a The author is sent once a year to see which seasons often occur and can be taken before the season arrives. If the onset is irregular within one year, you should take the medicine all year round.

b Those who relapse once more than two years can start taking the medicine sometime in the year of the relapse.

c Anti-relapse treatment is a difficult problem for those who do not have certain seizures, but anti-relapse treatment is not needed, but it should be observed, and if there is a relapse, the drug should be grasped.

d Anti-relapse drugs have been recognized as lithium carbonate, with a dosage of 0.5 to 0.75, orally twice daily. In addition, small and medium doses of antipsychotics are often used as anti-relapse drugs for mania, such as chlorpromazine 200-300 mg per night Once, clozapine 100-150mg, once a night, have obvious effects, it has been reported that carbamazepine or sodium valproate can replace lithium carbonate as an anti-relapse medicine for mania, the dosage is 0.12 0.2 or 0.2 0.4 Orally 2 to 3 times a day.

Antimanic drugs are drugs that have better treatment and prevention of mania, have strong specificity and are often ineffective against schizophrenia. The earliest clinical use of lithium salts, certain anti-epileptic drugs such as carbamazepine, sodium valproate, etc., have achieved positive results in the treatment of mania. Other psychiatric drugs have been reported to have anti-manic effects, such as clonazepam. Due to the uncertain effect, lack of strict experimental research and academic debate, they will not be introduced. Now we mainly introduce lithium salts, carbamazepine, and sodium valproate. .

(1) lithium salt

Pharmacological effect: mainly related to lithium ion.

a Sleep and electrophysiology: It can prolong the slow wave sleep time, prolong the rapid eye movement latency, and shorten the rapid eye movement sleep period.

b Cardiovascular department: often cause non-specific changes in ECG, T wave flattened or inverted.

c Endocrinology and metabolism: It can inhibit the production, release and utilization of thyroxine.

d Urinary system: With a therapeutic dose of lithium, the glomerular filtration function is mostly within the normal range, but the renal tubular reabsorption function is often affected. The clinical manifestations are polyuria, thirst, and a few symptoms of diabetes insipidus.

Mechanism of action: The mechanism of anti-manic action of lithium has not been elucidated. The research mainly focuses on electrolytes, cAMP and central neurotransmitters.

a Electrolyte: The balance of lithium and sodium inside and outside the cell membrane plays an important role in the permeability of the membrane and the excitability of the cell. Lithium enters the cell through ion channels, displaces the sodium in the cell, and reduces the excitability of the cell.

b Cyclic adenosine monophosphate (cAMP): The therapeutic dose of lithium affects many enzyme systems such as Na + -K-ATPase, but the most studied is adenylate cyclase.

c Neurotransmitters: Noradrenaline (NE) found that lithium can promote the reuptake of NE by the presynaptic membrane through isolated brain slices and synaptosome preparations, increase the storage of NE in neurons, and enhance the activity of MAD. Promote NE degradation in neurons and inhibit NE release, so NE at synaptic sites is reduced, which is conducive to correcting catecholamine hyperactivity in mania.

clinical application

a Preparation before treatment: detailed examination of the body, nervous system, blood, urine routine, heart, EEG examination. Those who are older or suspected of having thyroid or kidney disease should be checked for T3, T4, TSH, creatinine, or lithium clearance rates. Patients' families should be introduced to the possible side effects of lithium, early symptoms of poisoning, and encourage patients to drink more water.

b. Prediction of curative effect: Prediction of curative effect is mainly based on clinical, that is, from typical manic depression, bipolar course, or bipolar family history, and the effect of previous lithium treatment.

c Inhibitors and doses: Lithium carbonate is most commonly used. The therapeutic dose for the acute phase of mania is generally 600-2000 mg / day, and the maintenance amount is 500-1000 mg / day, which can be divided into 2 or 3 oral administrations.

d Serum lithium concentration: Because the amount of lithium salt treated and poisoned are close, the serum lithium concentration should be monitored. It not only helps to adjust the amount of treatment and maintenance, but also provides the doctor whether the patient has taken the drug as prescribed by the doctor. Aggravation is the objective basis for renal dysfunction and acute poisoning. The minimum blood lithium concentration in the acute phase treatment is 0.6 to 1.2mmol / L, and the blood lithium concentration in maintenance treatment is 0.4 to 0.8mmol / L. 1.4mnmol / L should be regarded as the upper limit of the effective concentration, and poisoning is easy to exceed this value. However, the blood lithium concentration is not directly related to clinical manifestations, so the dose adjustment cannot be based on laboratory data alone, and clinical observation should be emphasized.

Adverse reactions

a Gastrointestinal symptoms: upper abdominal discomfort, nausea, vomiting, diarrhea, and anorexia.

b Nervous system: fatigue, weakness, drowsiness, a small amount of memory and comprehension, tremor, and consciousness disorders in rare cases.

c. Cardiovascular system: T wave is common.

d Hematopoietic system: Leukocytosis may occur.

e Metabolism and endocrine: weight gain, occasionally facial, lower extremity and anterior tibia edema.

f Urinary system: polyuria, trouble symptoms.

Lithium poisoning: The typical clinical sign of lithium poisoning is acute organic brain syndrome, which is characterized by different degrees of consciousness disturbance, which may be accompanied by dysphonia, ataxia, hyperreflexia, pyramidal tract signs and other neurological symptoms. The man was unconscious and died. The treatment is to stop the lithium preparation, accelerate the excretion of lithium, intravenous drip of normal saline, theophylline, mannitol, sodium bicarbonate, etc. are all conducive to the excretion of lithium. In severe cases, hemodialysis is feasible.

(2) Carbamazepine

Mechanism of action: It acts on the mesencephalic and marginal regions, and the mesencephalic limbic system is the localized area of many mental illnesses and is the basis of CBZ's treatment of affective mental disorders.

Clinical application: It is effective in treating various types of mania, and its efficacy is not inferior to lithium salt, especially it has a unique effect on accelerating circulation. It is also effective for those who are ineffective in lithium salt treatment, and it can be used as the drug of choice for this type of emotional disorder.

Because clinical effects and adverse reactions are dose-dependent and vary widely from individual to individual, the dosage should be individualized. 600 to 1200 mg daily, divided into two or three times orally, the maximum is not more than 1600 mg / day, which should be gradually increased from a low dose, and the maximum therapeutic dose should be maintained for two to three weeks. Before the treatment, check the body carefully, and check the blood and urine. Routine, liver function, EEG, etc., are reviewed once a week during treatment. Pay attention to the occurrence of adverse reactions. Discontinue treatment when severe toxic side effects occur.

Adverse reactions

a Nervous system: dizziness, drowsiness, ataxia, blurred vision, diplopia, tinnitus, peripheral neuritis.

b Digestive system: nausea, vomiting, abdominal pain, constipation, abnormal liver function, gastritis, dry mouth, etc.

c Hematopoietic system: Leukopenia, thrombocytopenia, aplastic anemia, etc.

d Cardiovascular system: congestive heart failure, hypertension, hypotension, edema, thrombophlebitis, arrhythmia, and atrioventricular block.

e Urogenital system: frequent urination, urinary retention, renal failure, diabetes, impotence, etc.

f Others: rash, exfoliative dermatitis, sweating, fever, hypothyroidism, etc.

(3) Sodium valproate

Mechanism of action: It is not very clear, it may be related to increasing GABA content in the brain.

Adverse reactions: Gastrointestinal symptoms are common, such as anorexia, nausea, vomiting, and indigestion. Transient aminotransferase elevations, mild tremors, etc. have occurred in some cases, hair loss, severe cases of fatal liver necrosis, and acute pancreatitis.

Clinical application: It is used for the treatment of fast-circulating affective disorder, which is equivalent to CBZ, and also suitable for the treatment of acute mania and senile mania.

The therapeutic dose is 800-1800mg / day, and it is taken orally in 2 to 3 times. Check liver function before and during treatment.