The Management of Psychomotor Agitation Associated with Schizophrenia or Bipolar Disorder: A Brief Review

Pompili, Maurizio; Ducci, Giuseppe; Galluzzo, Alessandro; Rosso, Gianluca; Palumbo, Claudia; Berardis, Domenico De

doi:10.3390/ijerph18084368

Cited by 20 publications

(16 citation statements)

References 65 publications

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“…Psychomotor agitation is common and is a real test of effort for cardiac activity. The cardiovascular risks associated with the symptoms of schizophrenia, but also the cardiotoxicity of some antipsychotics, require careful monitoring of these patients to avoid a negative prognosis and even the risk of mortality [ 59 , 60 ]. In clinical psychopharmacology, the effectiveness of antipsychotics on delirium and hallucinations is associated with the ability to bind rapidly and effectively to DRD2.…”

Section: ⧉ Discussionmentioning

confidence: 99%

Impairment of the cardiac ejection fraction by blocking dopamine D2 receptors induced by long-acting injectable antipsychotic treatment

Dehelean¹,

Marinescu²,

Stovicek³

et al. 2022

Rom J Morphol Embryol

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Introduction: Atypical antipsychotics have numerous benefits compared to conventional ones in respect to the possible adverse effects. However, like the other ones, they may induce direct cardiovascular alterations, probably through the apoptotic effect of dopamine receptor D2 (DRD2) blockade. The main objective of the study was to assess the cardiac ejection fraction (EF) using transthoracic speckle tracking echocardiography (TSTE) in patients treated with long-acting injectable (LAI) atypical antipsychotics. Patients, Materials and Methods: This cross-sectional study was conducted on 123 patients with schizophrenia or schizoaffective disorder divided in four samples according to their treatment: Aripiprazole, Olanzapine, Paliperidone and Risperidone. We analyzed socio-demographic data, the intensity of psychiatric symptoms, the duration of psychosis and of LAI treatment, and the cardiac EF measured with TSTE. Results: We found no statistically significant differences between the four antipsychotics regarding the values of the EF. Nevertheless, we observed a trend indicating that patients treated with an antipsychotic associated with a lower affinity for the DRD2, such as Olanzapine, have higher EF values than patients treated with antipsychotics with a stronger binding to the DRD2, such as Paliperidone and Risperidone. Patients receiving Aripiprazole, which has the strongest affinity for the DRD2 from all four antipsychotics but is also a partial DRD2 agonist, display higher EF values than those on Paliperidone and Risperidone. Conclusions: Antipsychotics with a lower affinity for the DRD2 or a partial agonism for it may be associated with higher EF. Cardiac monitoring should be performed periodically in patients on LAI antipsychotic therapy.

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Section: ⧉ Discussionmentioning

confidence: 99%

Impairment of the cardiac ejection fraction by blocking dopamine D2 receptors induced by long-acting injectable antipsychotic treatment

Dehelean¹,

Marinescu²,

Stovicek³

et al. 2022

Rom J Morphol Embryol

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“…Multiple guidelines for the behavioral and pharmacological treatment of acute agitation were thoroughly reviewed by the research team and used to develop the study’s agitation treatment protocol (Table 2 ) [ 1 , 11 – 13 , 20 , 21 ]. A list of recommended non-pharmacologic interventions was formulated based on these guidelines and with the help of nursing staff.…”

Section: Methodsmentioning

confidence: 99%

“…This study also correlated the MASS scale with another evidence-based agitation assessment, the Clinical Global Impressions-Aggression Scale (CGI-A), which has been used in emergency psychiatric settings [ 21 ]. The CGI-A consists of one item, “level of agitation,” and is rated as none, slight, moderate, severe, and aggressive.…”

Section: Implementing the Modified Agitation Severity Scale (Mass) Pr...mentioning

confidence: 99%

“…While several evidence-based assessment scales for agitation exist, many do not have strong enough clinical utility to guide rapid treatment decisions. A recent review summarized rating scales of psychomotor agitation for use in various treatment settings [ 21 ]. In this review, the scales that best fit inpatient psychiatric settings and had strong psychometric properties took too long to administer to be used practically.…”

Section: Introductionmentioning

confidence: 99%

“…In this review, the scales that best fit inpatient psychiatric settings and had strong psychometric properties took too long to administer to be used practically. The shorter scales with strong psychometric properties were either not intended for or not appropriate for in-the-moment assessment of an inpatient psychiatric population, especially because they generally did not describe specific problematic behaviors [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

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The Utilization of a Rapid Agitation Scale and Treatment Protocol for Patient and Staff Safety in an Inpatient Psychiatric Setting

Manning

Bell

Dawson³

et al. 2022

Psychiatr Q

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Agitation is a common and potentially dangerous condition requiring rapid recognition and treatment in acute psychiatric units. Prompt intervention can prevent a patient with agitation from harming themselves, harming others, or needing restraints or seclusion. After the review of numerous guidelines, the Modified Agitation Severity Scale (MASS) agitation treatment protocol was developed to identify and manage agitation in an inpatient adult psychiatric setting. This protocol involved modifying an existing agitation scale and pairing scores with a treatment algorithm to indicate which behavioral and medication interventions would be most appropriate. All scoring and interventions were recorded in the electronic medical record (EMR). Three months of data were collected before and after the protocol was implemented. The new, modified scale had high reliability and correlated well with another validated agitation scale. Perceived patient safety was high during both study phases. Nurses’ perceptions of safety trended upward after the protocol was implemented, though these differences were not significant, likely due to insufficient power. Although there was no decrease in seclusion events after implementation of the treatment protocol, there was a 44% decrease in restraint events and average restraint minutes per incident. Despite a potential increase in workload for nursing staff, implementation of the protocol did not increase burnout scores. Physicians continued to order the protocol for 55% of patients after the study period ended. These findings suggest that including a rapid agitation assessment and protocol within the EMR potentially improves nurses’ perceptions of unit safety, helps assess treatment response, reduces time patients spend restrained, and supports decision making for nurses. Supplementary Information The online version contains supplementary material available at 10.1007/s11126-022-10001-y.

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Effect of Sublingual Dexmedetomidine vs Placebo on Acute Agitation Associated With Bipolar Disorder

Preskorn

Zeller

Citrome

et al. 2022

JAMA

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IMPORTANCEAcute agitation is common in patients with bipolar disorder and requires urgent management to relieve distress and to prevent escalation to aggressive behavior.OBJECTIVE To evaluate the effect of orally absorbed, sublingual dexmedetomidine, a selective α 2A -adrenergic receptor agonist on symptoms of acute agitation in patients with bipolar disorder.DESIGN, SETTING, AND PARTICIPANTS Phase 3, randomized, double-blind, placebo-controlled trial conducted in 15 sites in the US with enrollment between February 24, 2020, and April 27, 2020, and final follow-up on May 21, 2020. A total of 380 adults with bipolar I or II disorder were randomized and 362 completed the study. INTERVENTIONS Participants were randomized to 3 groups: sublingual dexmedetomidine 180 μg (n = 127), sublingual dexmedetomidine 120 μg (n = 127), or placebo (n = 126). MAIN OUTCOMES AND MEASURESThe primary efficacy end point was the mean change from baseline at 2 hours for the Positive and Negative Syndrome Scale-Excited Component (PEC) total score. The range of possible total scores is 5 (absence of agitation) to 35 (extremely severe). The secondary end point was the earliest time of a statistically significant change in PEC total score from baseline for the drug vs placebo. On the primary efficacy end point, to account for multiplicity associated with comparing 2 sublingual dexmedetomidine doses with placebo, the 2-sided significance level for each dose vs placebo was set at .025. RESULTSOf 380 patients randomized (mean age, 45.6 years; 54.8% women; and 56.1% Black individuals), 378 (99.5%) self-administered the study medication and completed the study. Baseline agitation was mild to moderate, with an overall mean PEC total score of 18.0. Two hours after taking the medication, the mean changes from baseline in PEC total score were −10.4 for sublingual dexmedetomidine 180 μg, −9.0 for sublingual dexmedetomidine 120 μg, and −4.9 for placebo. Least-square mean differences from placebo in the sublingual dexmedetomidine groups at 2 hours were −5.4 (97.5% CI, −6.6 to −4.2) for 180 μg and −4.1 (97.5% CI, −5.3 to −2.9) for 120 μg (both doses P < .001 vs placebo). Treatment effects began 20 minutes after taking the medication among patients in the sublingual dexmedetomidine groups (least-square mean difference for 180 μg, −1.1 [97.5% CI, −2.0 to −0.2]; P = .007; for 120 μg, −1.0 [97.5% CI, −1.9 to −0.1]; P = .009). Adverse events occurred in 35.7% of patients taking 180 μg of dexmedetomidine, 34.9% taking 120 μg, and 17.5% taking placebo. The most common adverse events (Ն5%) in the respective 180 μg, 120 μg, and placebo groups were somnolence (21.4% and 20.6% vs 4.8%); dry mouth (4.8% and 7.1% vs 0.8%); hypotension (6.3% and 4.8% vs 0%); and dizziness (5.6% and 5.6% vs 0.8%).CONCLUSIONS AND RELEVANCE Among patients with mild to moderate agitation associated with bipolar disorder, treatment with a sublingual film formulation of dexmedetomidine 120 μg or 180 μg, compared with placebo, resulted in significantly greater reduction in the agitation score...

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The Management of Psychomotor Agitation Associated with Schizophrenia or Bipolar Disorder: A Brief Review

Cited by 20 publications

References 65 publications

Impairment of the cardiac ejection fraction by blocking dopamine D2 receptors induced by long-acting injectable antipsychotic treatment

Impairment of the cardiac ejection fraction by blocking dopamine D2 receptors induced by long-acting injectable antipsychotic treatment

The Utilization of a Rapid Agitation Scale and Treatment Protocol for Patient and Staff Safety in an Inpatient Psychiatric Setting

Effect of Sublingual Dexmedetomidine vs Placebo on Acute Agitation Associated With Bipolar Disorder

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