Current Understanding of the Neurobiology of Agitation

Miller, Christopher; Hodzic, Vedrana; Weintraub, Eric

doi:10.5811/westjem.2020.4.45779

Cited by 14 publications

(13 citation statements)

References 56 publications

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“…32 Interestingly, aggression and agitation are associated with reduced levels of serotonin in these regions. 31 Sleep, attention, and sensory perception is consistent with the known functioning of the locus coeruleus and norepinephrine (LC/NE). In ASD, altered sensory perception is implicated, in which multiple faulty perceptions are distributed in all sensory modalities.…”

Section: Introductionmentioning

confidence: 57%

“…, 30 Serotonin, which is involved in top-down control of limbic areas and neurocircuitry involved in fear, 31 facilitates OFC and anterior cingulate cortex that are involved in modulating serotonin 5-HT2 receptors in these regions 32 . Interestingly, aggression and agitation are associated with reduced levels of serotonin in these regions 31 . Sleep, attention, and sensory perception is consistent with the known functioning of the locus coeruleus and norepinephrine (LC/NE).…”

Section: Neurobiological Rationale For the Use Of An Snri In Asd Asd-...mentioning

confidence: 77%

“…28 In ASD, concurrent hyperactivity in the amygdala and OFC are indicative of a poor regulatory system, whereby the OFC activates, but then fails to sufficiently downregulate, the amygdala. 29,30 Serotonin, which is involved in top-down control of limbic areas and neurocircuitry involved in fear, 31 facilitates OFC and anterior cingulate cortex that are involved in modulating serotonin 5-HT2 receptors in these regions. 32 Interestingly, aggression and agitation are associated with reduced levels of serotonin in these regions.…”

Section: Introductionmentioning

confidence: 99%

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Use of selective serotonin and norepinephrine reuptake inhibitors (SNRIs) in the treatment of autism spectrum disorder (ASD), comorbid psychiatric disorders and ASD-associated symptoms: a clinical review

et al. 2020

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It is challenging to treat symptoms of autism spectrum disorder (ASD), comorbid psychiatric disorders and ASD-associated symptoms. Some of the commonly used medications to treat these can, and frequently do have serious adverse side effects. Therefore, it is important to identify medications that are effective and with fewer side effects and negative outcomes. In this review, we looked at current evidence available for using the serotonin and norepinephrine reuptake inhibitors (SNRIs) class of medications in treating some of these often difficult to treat symptoms and behaviors. An extensive literature search was conducted using EBSCO.host. Our search algorithm identified 130 articles, 6 of which were deemed to meet criteria for the purpose of this review. Each of these six articles was independently reviewed and critically appraised. As a prototype of the SNRIs family, venlafaxine was found to be a useful adjuvant in children and adults with ASD for the treatment of self-injurious behaviors, aggression, and ADHD symptoms when used in doses lower than its antidepressant dosage. However, duloxetine was not found to show any added benefit in treatment of any of the comorbid symptoms and behaviors in ASD when compared to other antidepressants. On the other hand, milnacipran was reported to produce improvements in impulsivity, hyperactivity symptoms, and social functioning through reduction of inattention of ADHD when comorbid with ASD. Overall, SNRIs were shown variable effectiveness in treatment of these comorbid symptoms and behaviors in ASD.

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Section: Introductionmentioning

confidence: 57%

Section: Neurobiological Rationale For the Use Of An Snri In Asd Asd-...mentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Use of selective serotonin and norepinephrine reuptake inhibitors (SNRIs) in the treatment of autism spectrum disorder (ASD), comorbid psychiatric disorders and ASD-associated symptoms: a clinical review

et al. 2020

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“…29,30 Damage to the frontal lobe, corpus collosum, parietal lobe, or hippocampus may affect the patients' behavior, emotions, or decision-making processes and the ability to think through consequences of actions. 29,30 The limbic system involves a collection of structures such as the hippocampus, amygdala and hypothalamus; the limbic system regulates emotions and functions such as sleep, appetite, fear, and sex drive, so damage to these structures can cause dysregulation of these functions. 29,30 If there is overstimulation from the environment, this activates the hypothalamic-pituitary axis, which causes a chain reaction involving the hypothalamus, the anterior pituitary, and the adrenal cortex, leading to an excessive release of catecholamines (noradrenaline and dopamine) and glutamate and acetylcolamine.…”

Section: Discussionmentioning

confidence: 99%

A Literature Review: Violence and Aggression in Neuroscience Nursing

Woon¹

2023

Journal of Neuroscience Nursing

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BACKGROUND: Violence and aggression is commonly encountered in nursing worldwide and is an increasing concern, although it is largely underreported by staff. Violence and aggression can take many forms, from verbal and physical abuse to sexual assault. This study aims to define agitation, violence, and aggression and to explore the prevalence of violence and aggression among neuroscience patients. This review also examines why violence and aggression occurs for neuroscience patients and to determine the effects on the patients, the environment, and the nursing staff. METHODS: A review of articles was conducted using CINAHL, PubMed, the Cochrane Database, and Google Scholar between 2012 and 2022. DISCUSSION: Agitation can escalate to violence and aggression. The reasons a neuroscience patient may become agitated are multifactorial. An injury to the brain may not cause agitation; however, the effect on the frontal lobe, hypothalamus, and hippocampus may cause a lack of self-control, impulsivity, an inability to control emotions, and an uncontrolled release of hormones, leading to a heightened sympathetic response. The effects of violence and aggression can be detrimental to the patient and include isolation, increased sedation, reduced observations, and even death. The effects on the nurse are profound including a decline in productivity at work, an increased risk of drug errors, and posttraumatic stress disorder or burnout as longer-term consequences. CONCLUSION: Violence and aggression is commonly experienced within neuroscience nursing, and the contributing factors are multifactorial. The effects for the patients and staff can be profound, and this is why prevention of agitation is fundamental to ensure the safety and retention of nursing staff.

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“…However, some advances in that matter have been reported. The amygdala and its innervation attached to other areas (for example the hypo thalamus) is said to regulate stress hormone release and that may play a substantial role in the occurrence of acute agitation [11]. Bilateral thalamic stroke is a rare cause of stroke that occurs in less than 0.5% of all cerebral infarctions [12].…”

Section: Commentsmentioning

confidence: 99%

Acute psychomotor agitation – challenges for psychiatrists and neurologists: a case study

Luchowski¹,

Sojka²,

Oleksak³

et al. 2022

ppn

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Purpose: Bilateral thalamic ischemia can, paradoxically, manifest itself with various non-sensory clinical symptoms, thereby complicating diagnosis. Case description: A 59-year-old woman was admitted to an Emergency Department about and hour and a half after she was found with altered mental status. Her initial symptoms were psychomotor agitation and slight confusion. No evident focal neurological deficit was observed at that time and computed tomography was negative. After acute drug intoxication was excluded, a transfer to a psychiatric unit was considered. Simultaneously, short stenosis of the left posterior cerebral artery was diagnosed with the use of computed tomography angiography. Magnetic resonance imaging revealed bilateral acute ischemia of the medial parts of the thalamus, and immediate thrombolysis and thrombectomy treatment was initiated. Both procedures were successful and the patient was discharged in good general condition. Comment: Psychomotor agitation may be an atypical manifestation of a bilateral thalamic ischemia. This may lead to misdiagnosis and reduce the likelihood of proper treatment.

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Current Understanding of the Neurobiology of Agitation

Cited by 14 publications

References 56 publications

Use of selective serotonin and norepinephrine reuptake inhibitors (SNRIs) in the treatment of autism spectrum disorder (ASD), comorbid psychiatric disorders and ASD-associated symptoms: a clinical review

Use of selective serotonin and norepinephrine reuptake inhibitors (SNRIs) in the treatment of autism spectrum disorder (ASD), comorbid psychiatric disorders and ASD-associated symptoms: a clinical review

A Literature Review: Violence and Aggression in Neuroscience Nursing

Acute psychomotor agitation – challenges for psychiatrists and neurologists: a case study

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