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Management of agitated

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https://www.readbyqxmd.com/read/29026329/pharmacogenomic-testing-aiding-in-the-management-of-psychotropic-therapy-for-adolescents-with-autism-spectrum-disorders
#1
Seuli Bose-Brill, Jinming Xing, Debra J Barnette, Christopher Hanks
Adolescents with autism have higher rates of anxiety than the general adolescent population. They often struggle to express psychological symptoms verbally where their symptoms may manifest as withdrawal and agitation. Adolescent patients with autism have higher rates of polypharmacy and high-risk psychiatric medication use (eg, atypical antipsychotics) than other patients with psychiatric illness. Primary care pediatricians are at the front lines of psychiatric management for patients with autism. Yet, they have inadequate access to pediatric psychiatry for complex medication management...
2017: Pharmacogenomics and Personalized Medicine
https://www.readbyqxmd.com/read/29023898/impact-of-ketamine-use-on-adjunctive-analgesic-and-sedative-medications-in-critically-ill-trauma-patients
#2
Kaitlin A Pruskowski, Kelly Harbourt, Mehrnaz Pajoumand, Sai-Ho Jason Chui, H Neal Reynolds
BACKGROUND: Ketamine may be used to manage pain and agitation that is refractory to "traditional" agents such as fentanyl, propofol, benzodiazepines, and dexmedetomidine; however, literature describing the use of ketamine continuous infusions for this purpose in critically ill trauma patients is limited. OBJECTIVES: The primary objective of this study was to determine the impact of the initiation of a ketamine continuous infusion on sedative and analgesic use in critically ill trauma patients...
October 10, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29021727/analgesia-sedation-and-arousal-status-in-burn-patients-the-gap-between-recommendations-and-current-practices
#3
A Lavrentieva, N Depetris, I Rodini
Assessment and treatment of pain, agitation and delirium are integral parts of the management of critically ill patients. The purpose of this review is to describe how pain, delirium and agitation are managed in general intensive care units and in burn units, and to address whether management of these issues is compatible with internationally accepted recommendations. A substantial gap exists between the conception of the guidelines, clinical practice and physicians' statements regarding pain, sedation and delirium management...
June 30, 2017: Annals of Burns and Fire Disasters
https://www.readbyqxmd.com/read/28987298/palliative-care-symptom-management-in-the-emergency-department-the-abc-s-of-symptom-management-for-the-emergency-physician
#4
Mari Siegel, Suzanne Bigelow
BACKGROUND: Palliative care is a rapidly evolving area of emergency medicine. With an estimated 5,000 to 10,000 baby boomers per day reaching retirement age, emergency departments (EDs) are treating more patients with chronic and serious disease. Palliative care offers comprehensive care for patients with advanced medical illness, aims to alleviate suffering and improve quality of life, and plays an important role in caring for these patients in the ED. OBJECTIVES: We sought to increase the emergency physician's knowledge of and comfort with symptom control in palliative and hospice patients...
October 5, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28986942/management-of-behavioral-and-psychological-symptoms-of-dementia-bpsd-by-an-aroma-massage-with-acupressure-treatment-protocol-a-randomized-clinical-trial
#5
Jo Kamen Ka-Man Fung, Hector Wing-Hong Tsang
AIMS AND OBJECTIVES: This study evaluates the clinical effectiveness of a multi-component aroma-massage with an acupressure treatment protocol and compared it to cognitive training for the management of BPSD. BACKGROUND: Pharmacological interventions have been unsatisfactory in managing BPSD; thus, complementary and alternative medicine has been extensively researched to identify an adjunct safe and cost-effective intervention. DESIGN: This RCT utilized a three-arm parallel group design...
October 6, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28982303/possible-garcinia-cambogia-induced-mania-with-psychosis-a-case-report
#6
David C Nguyen, Tysen K Timmer, Blair C Davison, Ian R McGrane
Garcinia cambogia is a Southeast Asian fruit becoming increasingly popular as a weight management supplement. Hydroxycitric acid (HCA) is the primary active ingredient which demonstrates serotonergic- and muscarinic-enhancing properties via inhibition of selective serotonin reuptake and acetylcholinesterase. We report a young adult female with no history of bipolar disorder who developed mania and psychosis approximately 1 week following initiation of G cambogia and the Cleanse and Detox™ dietary supplement manufactured by Apex Vitality Health...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28979829/hypertensive-encephalopathy-a-case-of-a-male-who-bit-off-his-fingers
#7
Carole H Kim, Saba Syed
Although altered consciousness and other neurologic manifestations are frequently seen in hypertensive encephalopathy, behavioral and psychotic symptoms are rarely seen. We describe a patient with no previous psychiatric history who was admitted for hypertensive crisis. A few days after admission, his blood pressure remained uncontrolled and he started to exhibit episodes of confusion, agitation, and psychosis. During one particular episode, he overcame multiple staff members and physical restraints to bite off two of his fingers without any signs of pain...
June 11, 2017: Curēus
https://www.readbyqxmd.com/read/28978587/persistent-oromandibular-dystonia-and-angioedema-secondary-to-haloperidol
#8
Ruziana Masiran
We report a case in a young man who developed acute, persistent and painful tongue protrusion followed by swelling for more than 24 hours. He had relapse symptoms of schizophrenia and had recently received a single dose of parenteral haloperidol to manage his agitation. His record showed history of similar event and he has been taking atypical antipsychotic for maintenance. Mental state examination on admission revealed an agitated man with disorganised speech, restricted affect, auditory hallucination and persecutory delusion...
October 4, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28972633/undergraduate-placements-in-geriatric-care-facilities-students-gaining-experience-with-challenging-responsive-behaviors
#9
Beverly O'Connell, Lorna Guse, Loreley Greenslade, Angela Osterreicher, Fiona Jensen
BACKGROUND: Undergraduate nursing students may experience challenging behaviors in residents during their clinical placement in geriatric long-term care (GLTC) facilities. METHOD: Bachelor of Nursing students participated in an anonymous online questionnaire (n = 116). RESULTS: The students witnessed a wide range of challenging behaviors, also referred to as responsive behaviors, in GLTC residents. The most frequent behaviors included agitation/restlessness, repetitive talk, and wandering...
October 1, 2017: Journal of Nursing Education
https://www.readbyqxmd.com/read/28971511/relationship-between-speaking-english-as-a-second-language-and-agitation-in-people-with-dementia-living-in-care-homes-results-from-the-marque-managing-agitation-and-raising-quality-of-life-english-national-care-home-survey
#10
C Cooper, P Rapaport, S Robertson, L Marston, J Barber, M Manela, G Livingston
OBJECTIVE: As not speaking English as a first language may lead to increased difficulties in communication with staff and other residents, we (1) tested our primary hypotheses that care home residents with dementia speaking English as a second language experience more agitation and overall neuropsychiatric symptoms, and (2) explored qualitatively how staff consider that residents' language, ethnicity, and culture might impact on how they manage agitation. METHODS: We interviewed staff, residents with dementia, and their family carers from 86 care homes (2014-2015) about resident's neuropsychiatric symptoms, agitation, life quality, and dementia severity...
October 3, 2017: International Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/28922625/living-and-dying-with-advanced-dementia-a-prospective-cohort-study-of-symptoms-service-use-and-care-at-the-end-of-life
#11
Elizabeth L Sampson, Bridget Candy, Sarah Davis, Anna Buylova Gola, Jane Harrington, Michael King, Nuriye Kupeli, Gerry Leavey, Kirsten Moore, Irwin Nazareth, Rumana Z Omar, Victoria Vickerstaff, Louise Jones
BACKGROUND: Increasing number of people are dying with advanced dementia. Comfort and quality of life are key goals of care. AIMS: To describe (1) physical and psychological symptoms, (2) health and social care service utilisation and (3) care at end of life in people with advanced dementia. DESIGN: 9-month prospective cohort study. SETTING AND PARTICIPANTS: Greater London, England, people with advanced dementia (Functional Assessment Staging Scale 6e and above) from 14 nursing homes or their own homes...
August 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28911339/emerging-treatments-for-the-behavioral-and-psychological-symptoms-of-dementia
#12
Abhinav Anand, Puneet Khurana, Jasneet Chawla, Neha Sharma, Navneet Khurana
Dementia is referred to a loss of memory and decline in other mental abilities at levels critical enough to hinder performance of daily activities. It can be of several types, depending on the underlying pathophysiology. The behavioral and psychological symptoms of dementia (BPSD) are various, but the most clinically significant are depression, apathy, and anxiety. Other BPSD include agitation, aberrant motor behavior, elation, hallucinations, and alterations in sleep and appetite. About 90% of sufferers of dementia are affected by BPSD during the course of the illness...
September 15, 2017: CNS Spectrums
https://www.readbyqxmd.com/read/28886752/protocol-for-the-management-of-psychiatric-patients-with-psychomotor-agitation
#13
Eduard Vieta, Marina Garriga, Laura Cardete, Miquel Bernardo, María Lombraña, Jordi Blanch, Rosa Catalán, Mireia Vázquez, Victòria Soler, Noélia Ortuño, Anabel Martínez-Arán
BACKGROUND: Psychomotor agitation (PMA) is a state of motor restlessness and mental tension that requires prompt recognition, appropriate assessment and management to minimize anxiety for the patient and reduce the risk for escalation to aggression and violence. Standardized and applicable protocols and algorithms can assist healthcare providers to identify patients at risk of PMA, achieve timely diagnosis and implement minimally invasive management strategies to ensure patient and staff safety and resolution of the episode...
September 8, 2017: BMC Psychiatry
https://www.readbyqxmd.com/read/28882192/satisfaction-with-quality-of-icu-care-for-patients-and-families-the-euroq2-project
#14
Hanne Irene Jensen, Rik T Gerritsen, Matty Koopmans, Lois Downey, Ruth A Engelberg, J Randall Curtis, Peter E Spronk, Jan G Zijlstra, Helle Ørding
BACKGROUND: Families' perspectives are of great importance in evaluating quality of care in the intensive care unit (ICU). This Danish-Dutch study tested a European adaptation of the "Family Satisfaction in the ICU" (euroFS-ICU). The aim of the study was to examine assessments of satisfaction with care in a large cohort of Danish and Dutch family members and to examine the measurement characteristics of the euroFS-ICU. METHODS: Data were from 11 Danish and 10 Dutch ICUs and included family members of patients admitted to the ICU for 48 hours or more...
September 7, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28876970/responding-to-ten-common-delirium-misconceptions-with-best-evidence-an-educational-review-for-clinicians
#15
Mark A Oldham, Nina M Flanagan, Ariba Khan, Olga Boukrina, Edward R Marcantonio
Delirium (acute confusion) is a serious, common health condition, and it predicts poor outcomes, including greater rates of mortality, institutionalization, prolonged hospitalization, and cognitive impairment. Expedient diagnosis and management are critical to address modifiable delirium causes and improve both quality of care and outcomes. Moreover, more than a third of delirium is preventable. Despite the clear significance of delirium and our increasingly sophisticated understanding of the condition, the gap between evidence and practice persists...
September 6, 2017: Journal of Neuropsychiatry and Clinical Neurosciences
https://www.readbyqxmd.com/read/28876969/noncognitive-behavioral-changes-associated-with-alzheimer-s-disease-implications-of-neuroimaging-findings
#16
Jeff Victoroff, Feng V Lin, Kerry L Coburn, Samuel D Shillcutt, Valerie Voon, Simon Ducharme
Alzheimer's disease (AD) is commonly associated with noncognitive behavioral changes (NCBCs). The authors systematically reviewed whether neuroimaging has helped with understanding the pathophysiology, diagnosis, or management of NCBCs associated with AD, including depression, aggression or agitation, anxiety, apathy, psychosis, and sleep disorder. The authors identified dissociable neural substrates with multimodal imaging: depression implicates the lateral and superior prefrontal cortex; apathy and agitation implicate the dorsal anterior cingulate; psychosis implicates right lateralized frontal and medial temporal areas; and anxiety implicates mesial temporal regions...
September 6, 2017: Journal of Neuropsychiatry and Clinical Neurosciences
https://www.readbyqxmd.com/read/28872734/xenon-as-an-adjuvant-to-sevoflurane-anesthesia-in-children-younger-than-4%C3%A2-years-of-age-undergoing-interventional-or-diagnostic-cardiac-catheterization-a-randomized-controlled-clinical-trial
#17
Sarah Devroe, Roselien Meeusen, Marc Gewillig, Bjorn Cools, Koen Poesen, Robert Sanders, Steffen Rex
BACKGROUND: Xenon has repeatedly been demonstrated to have only minimal hemodynamic side effects when compared to other anesthetics. Moreover, in experimental models, xenon was found to be neuroprotective and devoid of developmental neurotoxicity. These properties could render xenon attractive for the anesthesia in neonates and infants with congenital heart disease. However, experience with xenon anesthesia in children is scarce. AIMS: We hypothesized that in children undergoing cardiac catheterization, general anesthesia with a combination of sevoflurane with xenon results in superior hemodynamic stability, compared to sevoflurane alone...
September 5, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28869145/the-early-diagnosis-and-management-of-mixed-delirium-in-a-patient-placed-on-ecmo-and-with-difficult-sedation-a-case-report
#18
María Acevedo-Nuevo, Maria Teresa González-Gil, Miguel Ángel Romera-Ortega, Ignacio Latorre-Marco, Maria Dolores Rodríguez-Huerta
Delirium represents a serious problem that impacts the physical and cognitive prognosis of patients admitted to intensive care units and requires prompt diagnosis and management. This article describes the case and progress of a patient placed on Extracorporeal Membrane Oxygenation with difficult sedation criteria and an early diagnosis of mixed delirium. During the case report, we reflect on the pharmacological and non-pharmacological strategies employed to cope with delirium paying special attention to the non-use of physical restraint measures in order to preserve vital support devices (endotracheal tube or Extracorporeal Membrane Oxygenation cannula)...
August 28, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/28864877/clinical-assessment-and-management-of-delirium-in-the-palliative-care-setting
#19
Shirley Harvey Bush, Sallyanne Tierney, Peter Gerard Lawlor
Delirium is a neurocognitive syndrome arising from acute global brain dysfunction, and is prevalent in up to 42% of patients admitted to palliative care inpatient units. The symptoms of delirium and its associated communicative impediment invariably generate high levels of patient and family distress. Furthermore, delirium is associated with significant patient morbidity and increased mortality in many patient populations, especially palliative care where refractory delirium is common in the dying phase. As the clinical diagnosis of delirium is frequently missed by the healthcare team, the case for regular screening is arguably very compelling...
September 1, 2017: Drugs
https://www.readbyqxmd.com/read/28834857/oral-agents-for-the-management-of-agitation-and-agitated-delirium-in-critically-ill-patients
#20
Qiu Min Yeo, Tessa L Wiley, Melanie N Smith, Drayton A Hammond
Agitation is one of the most common issues that critically ill patients experience. Medications used to manage agitation are often administered intravenously or intramuscularly in the acutely agitated, critically ill patient. However, a multimodal approach that utilizes multiple routes of administration may be appropriate. This review summarizes the available literature on oral antipsychotics, clonidine, and valproic acid to manage agitation in critically ill patients while also focusing on their pharmacology and appropriate monitoring...
October 2017: Critical Care Nursing Quarterly
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