Syndrome of psychomotor agitation. Psychomotor agitation: types, symptoms, treatment. Definition of consciousness. syndromes of impaired consciousness

catatonic symptoms. They are manifested by unmotivated actions and movements (sometimes close to neurological hyperkinesis), as well as states of motor numbness and motor (psychomotor) excitation.

1. Negativism- the patient's unmotivated and senseless resistance to both internal urges ("internal negativism") and to external attempts to initiate some kind of action or movement in him ("external negativism"). This opposition can simultaneously be expressed to both internal and external stimuli to the same or different degrees.

With active negativism, patients perform actions and deeds that are opposite to internal and external urges. From such patients, writes E. Bleuler, you can get any kind of action, if you demand to do the opposite. Active negativism in relation to internal urges is manifested by the fact that the patient is silent, clenching his teeth, turning to the side if he has a desire to say something to the interlocutor, strips naked, if it is cold and it would be necessary to get dressed, turns away or moves away from the doctor, when he approaches the patient, does not go to bed, but is awake, walks around the ward, does not go to the dining table and resists if they try to bring him into the dining room, on the contrary, he tries to go far away, etc. Active negativism sometimes, as it were, illustrates I. Newton's third law, when action is equal to counteraction.

This is ambitency - the coexistence of two opposing urges of approximately equal intensity. For example, the patient walks from the ward to the toilet and back until forced urination or defecation occurs; he cannot eat, as the hand with the spoon or the bread moves from the table to the mouth and back. The patient cannot sit up, alternately lowering and rising above the chair, etc.

For example, the symptom of Osipov's pseudo-ptyalism is known: the patient can neither swallow saliva nor spit it out, so that it is in in large numbers accumulates in the mouth and already itself follows from it. It is probably appropriate to note here the Ivanov-Smolensky symptom: the patient does not answer loudly asked questions, but gives answers to questions if they are asked in a whisper. At the request of the doctor to come closer, the patient generally leaves the office - a symptom of Bleicher. With passive negativism, the patient does not fulfill the demands and requests addressed to him, the latter, as it were, do not give rise to appropriate impulses in him. It looks as if the patient is completely detached from reality and does not react to it. In passive internal negativism, the patient simply does not do what he needs, while his own impulses seem to be blocked.

With total negativism, the opposition or inhibition of motives concerns any of them, both external and internal, regardless of what these motives are or from whom they come. With elective negativism, there is a certain selectivity in reactions to stimuli. For example, a patient does not come into contact with a doctor, but communicates normally with a nurse or with a roommate. He eats porridge, but does not touch the soup, dresses, but only halfway, answers questions about his life, but falls silent when asked about his well-being, etc.

A manifestation of catatonia is the refusal to talk - mutism. It is typical of catatonic mutism that the patient does not show any signs of being ready to communicate. He may not look at the interlocutor at all or only turns his head towards him with an indifferent face and an expressionless look. Whatever he is asked, the patient will not flinch: not a single gesture, not a movement on his face, not the slightest impulse to ask something or report something is visible. There are, however, patients who do not speak, but write their answers or who have passed over to contact in writing. At the same time, the patient perfectly understands the speech addressed to him, and later he himself can confirm this. Mutism sometimes manifests itself as a symptom of refusal to last moment Yoncheva: the patient insistently asks the doctor to listen to something, but when he notices that they are ready to listen attentively, he falls silent.

2. Automatic subordination (command automatism, automatism on command, K. Leonhard's proskinesia)- the willingness of the patient to comply with any requests and orders, including unpleasant or even unacceptable for himself. As E. Bleiler writes, “patients carry out all sorts of orders even against their will, for example, they stick out their tongue when they know that they will prick it with a needle.” This is very similar to how patients behave in deep stage hypnotic state: any command of the hypnotist immediately causes a corresponding response impulse. Such behavior is also characteristic of patients with "autism inside out" - they appropriate someone else's will, as if turning it into their own.

3. Echopraxia- involuntary and having neither meaning nor motivation, the patient repeats movements, actions, or even more complex forms of activity of someone around him. For example, a patient follows the doctor into the office. The doctor removes the dressing gown from the hanger and puts it on. The patient does the same. The doctor sits down at the table, takes a pen and paper, preparing to record the conversation. The patient repeats the same. The doctor begins to write something, the patient also writes something. Sometimes you can see such pictures. The doctor makes a round, enters the wards, approaches the patients, asks them. A catatonic walks next to him and copies all the doctor's actions. Or it happens that the patient, excited in mania, quickly walks or even runs while walking. Behind him, an expressionless catatonic does the same. The revival of the instinct of imitation to such a degree indicates a deep regression in the sphere of the will.

4.Echomimy- involuntary and, as it were, mechanical reproduction by the patient of the expressive actions of someone around him. For example, the patient cries inconsolably, it suddenly occurred to her that all her loved ones had died. A patient with catatonia in the next bed begins to sob, as if she had grief. Or someone begins to sing; if there are catatonics nearby, then something like choral singing is obtained.

5. Echolalia- involuntary copying by the patient of the speech of someone around. A conversation with a doctor might look like this. The doctor asks the patient: "How do you feel today?" Patient response: “How are you feeling today?” etc. Not only the words are repeated, but also the intonations of the voice. Sometimes the patient repeats what he said himself. This is what the symptom of the completion of Stengel's phrase looks like: the patient first says part of the phrase, copying the doctor, then repeats it, and only then adds its ending. This symptom can also be manifested in the patient's spontaneous speech.

6. Catatonic echo symptoms, as can be seen, can be combined with one another. When they meet all together, they are designated by the term echopathy. Now mentioned and other manifestations of catatonia are quite rare, in the form of separate inclusions in other symptoms. More often one can meet, for example, such violations when the “voice” repeats what the patient or someone else from those present said, the patient himself involuntarily repeats what was said by the “voice”, or one “voice” copies everything that the other says. There are other options for echo symptoms. For example, the patient does not respond in writing to a question or does not fulfill a request to describe an event, but literally writes down the question or request itself, etc.

7. Stereotypes of posture, location, actions, statements. For example, the patient prefers to be in only one place in the room, perhaps feeling safe there; to the attempts of the staff to "relocate" him, he puts up a desperate resistance. Or the patient's favorite posture is squatting, legs tucked under him, knees pulled up to his chin, lowering or raising his head high.

Or the patient prefers to stand in a corner, facing away from those present, with arms folded or crossed. Such poses rather express the patient's isolation, his autism. There is no stupor at the same time, patients can make some movements, respond to external urges, go to the toilet, go to bed at night. The stereotyping of actions is manifested by the fact that in a certain situation the patient does the same thing. For example, while in the ward, he walks back and forth or along one path, while walking, he only walks counterclockwise along the fence.

Speech stereotypes consist in the fact that every day, when meeting with a doctor, the patient utters one phrase, submits notes with the same content; one of the patients regularly sent letters to newspaper editors containing the same curse words. Motor stereotypes are found not only in catatonic patients, they occur in Pick's disease, post-stroke conditions, and twilight stupefaction.

8.Motor iterations- continuous repetition of the same action, often for a long time. E. Bleiler cites as an example patients who have been rubbing right hand o left thumb, rubbed right hand chest, fingered all the planks and partitions, etc. Motor iterations or palynergy are also observed in patients with atrophic and other organic brain lesions.

9. Speech iterations- repeated repetition by the patient of a word, phrase, said by himself or someone from those around him. The number of repetitions can reach 10-15 times. Autoecholalia or cataphasia is not always iterative. Verbigeration or perseverative logorrhea is the repetition of meaningless sounds, words, phrases or "stringing" them on top of each other according to phonetic similarity.

10. Parakinesia (parapraxia)- involuntary and meaningless distortion of natural motor formulas: postures, actions, expressive acts, articulation. This gives the impression of pretentiousness, mannerisms, foolishness, grimacing. For example, the patient speaks too loudly or in a whisper for some reason, draws out the sounds of speech, distorts them, moves on his heels, sideways or backwards, offers his hand for a palm-down shake, adopts strange postures, bares his teeth, goggles, draws his eyebrows, marches step, smiles with one half of the face, takes something in hand, pushing it through the other or under the knee, etc. Many movements are similar to tics, hyperkinesis.

Some authors consider parapraxia as a manifestation of obliterated catatonic hebephrenic symptoms (Bleicher, 1995). In a broader interpretation, parakinesias are understood as various inadequate motor, speech, expressive and phonatory acts of patients with schizophrenia (Perelman, 1963). The term parakinesis refers to a variant of hyperkinesis, characterized by complex involuntary, coordinated, outwardly resembling purposeful movements. Such actions are beyond the control of the patient. Parakinesis is observed with damage to the cortex of the frontal parts of the brain, more often its right hemisphere.

For other catatonic symptoms, see also the section "Catatonic syndromes", for speech iterations - "Speech disorders".

11. Reactive, absurd, impulsive, and prosectic actions patients with catatonia are described in the section on thinking disorders.

You can also find information of interest in the scientific search engine Otvety.Online. Use the search form:

More on Psychomotor Disorders. Definition. Psychomotor agitation (manic, depressive raptus, catatonic, hysterical, impulsive, hebephrenic-catatonic):

1. 31. Movement disorders. Catatonic syndrome, clinical variants of its manifestation: stupor, agitation.
2. 30. Movement disorders. Catatonic syndrome, clinical variants of its manifestation: stupor, agitation
3. 88. Emergency therapy in psychiatry: relief of epistatus, various types of arousal (manic, catatonic, hebephrenic)

Psychomotor arousal is pathological condition, at which there is an increase and acceleration of the rate of manifestations various parties mental activity: speech, thinking, emotions, movements that come at the same time, in isolation or with a predominance of any of them.

In other words, excitement is expressed by motor restlessness of varying degrees, from fussiness to destructive impulsive actions; often accompanied by speech amplification with verbosity, often almost continuous speaking with cries of phrases, words, individual sounds, etc .; anxiety, malice, tension, aggressiveness or fun, etc. are also pronounced.

The meaning of the syndrome. Psychomotor agitation develops for many reasons: mental illness, acute stages infectious diseases, with intoxication, brain hypoxia, traumatic brain injury, after childbirth, with many organic and toxic brain lesions, in pre-coma and post-coma states, and can also occur in mentally healthy people in extreme situations. Psychomotor agitation develops suddenly, proceeds acutely, and due to the special danger of the excited patient for himself and for those around him, it requires emergency medical care.

The main nosological diseases that cause this syndrome.

Endogenous mental illness (schizophrenia, manic depressive psychosis);

twilight disorder of consciousness and dystrophy in patients with epilepsy;

Symptomatic and organic diseases of the brain (craniocerebral injury, progressive paralysis, pre-coma and post-coma state, excitation in infectious diseases, and others);

· hysteria;

psychopathy and psycho-like disorders.

Syndrome pathogenesis.

In the development of the syndrome great importance given to the features of the nervous system:

The central nervous system is predisposed to a psychopathic type of response;

Or the psychological characteristics of the personality play a role (for example, the emotionally labile type of personality);

Or play the role of psychogenic influences (excessive mental experiences);

Or the effect on the central nervous system of endogenous factors of metabolic disorders, intoxications, toxins in infectious diseases, brain hypoxia, neuroreflex reactions plays a role.

Under the influence of these factors, the processes of excitation begin to prevail over the processes of inhibition, and then characteristic signs of psychomotor arousal appear.

Clinical manifestations of the syndrome.

Common features: increased mental and motor activity.

Features of excitation in various states.

At schizophrenia hallucinatory-delusional arousal may occur. Excited state due to delusions and hallucinations. Patients experience fear, anxiety, confusion; at other times they are vicious, tense, unavailable. They talk with hallucinatory voices. They can attack imaginary pursuers, escaping from them, running without looking at the road, jumping out of a window, from a moving train. There may be persecution mania, megalomania and others.

Schizophrenia is characterized not only by auditory hallucinations, but also by catatonic arousal. At the same time, movements and actions are chaotic, meaningless, sudden, with aggressive actions. Speech discontinuity is observed (either an unfinished phrase, or there is no beginning, jumps from one thought to another). Characterized by foolishness, mannerisms, grimacing, absurd behavior. Excitation can go to stupor (freezing in some position).

For alcohol intoxication excitation similar to hallucinatory-delusional excitation in schizophrenia is characteristic. Excitement occurs when withdrawal syndrome. A feature of this excitement is the frightening nature of hallucinations. The patient is depressed, can hide from his imaginary pursuers, run away, commit any destruction, etc.

Drinking alcohol causes alcohol intoxication, which is also accompanied by the development of arousal. Alcohol intoxication is characterized by 3 stages. Stage 1 is characterized by increased mood. A person laughs, becomes talkative, communicates more boldly with others. Stage 2 a person becomes more aggressive, irritable, various kinds of conflicts arise. The stage number for it is characterized, on the contrary, by inhibition, this is the stage of sleep.

Affective insanity. There are two phases of the disease. 1 phase depressive arousal. It occurs with a sharp increase in depressive experiences. The patient feels hopelessness, despair, unbearable melancholy worries. Patients rush about, do not find a place for themselves, scream, groan, howl, sob, stubbornly injure themselves, actively seek suicide. 2 phase- manic excitement. Expressed increased mood, motor speech excitation. Patients are sometimes cheerful, sometimes angry, vicious, irritable. They do not sit still, dance, sing, talk continuously, speech is fast, they do not finish phrases, they jump to another topic. They express delusional ideas of greatness, and when objected, they become angry and aggressive.

epileptic excitement. Patients tense, angry, it is difficult or completely impossible to establish contact. This condition comes on suddenly and goes away suddenly. There may be hallucinations, delusions. Such patients are dangerous to others, as they can pounce on others, inflicting severe damage on them, destroying everything that is on the way.

Psychogenic (reactive) excitation occurs in acute mental trauma or situations. Characterized by chaotic agitation with stampede, self-harm, or suicide. In case of mass disasters, this is dangerous because it can be transmitted to large groups people and panic.

psychopathic arousal- occurs in individuals with psychopathic personality traits. In this case, the response does not correspond to the strength of the stimulus. There is malice, aggressiveness towards specific persons who have offended the patient, accompanied by cries, threats, cynical curses. There is some theatricality in the actions.

Infectious diseases include typhus that occur with the development of delusional states. Typhoid fever is characterized by an increase in temperature up to 39 degrees, severe headaches, and dyspepsia. Against this background, delirium and disorder of consciousness arise. The skin of the face is hyperemic. The liver and spleen may enlarge. The drop in temperature proceeds critically, with the development of collapse. Such bouts of fever can be repeated several times, that is, the period of fever is long. Sometimes a roseolous rash may appear during bouts of fever.

Excitation is characteristic of rabies. Repeat the clinic of this disease.

Arousal can also occur when following states: hypoglycemic coma, hepatic coma, 3rd period of peritonitis development, drug intoxication, stroke. Repeat on your own clinical manifestations these states.

Diagnostic search with psychomotor agitation syndrome.

1. Find out from relatives or others changes in behavior, that is, increased mental and motor activity.

2. When taking an anamnesis, find out exogenous and endogenous hazards. Were there before epileptic seizures. It is necessary to find out the predisposition to the psychopathic type of response, the psychological characteristics of the personality, the psychogenic impact.

Help with psychomotor agitation syndrome.

In connection with the special danger of an excited patient for himself and for others, immediate use is required. emergency care, in which, from the very beginning, simultaneous combined use of measures for care and supervision (including methods of fixing patients) and drug therapy is carried out.

First of all, first aid should be aimed at immediately keeping the excited patient from committing dangerous actions.

The paramedic called to the patient must establish the nature of the disease and, without wasting time, begin to provide assistance:

It is necessary to ensure the safety of the patient and those around him. To do this, remove piercing and cutting objects, remove the curious, so as not to irritate the patient.

It is necessary to arrange assistants so that there is continuous monitoring of the patient, to exclude the possibility of escape and suicide. For example, two are near the patient, one watches the window, the other behind the door. It is impossible to demonstrate to the patient that he is being watched intensely and that he is dangerous. This can increase anger, fear, aggressiveness. For observation in this case, it is better to involve the relatives of the patient.

If it is not possible to persuade the patient to calm down and take medicines, the patient is fixed, if necessary, involving others for this, 3-4 people.

Many neuropsychiatric pathologies can be accompanied by a condition characterized by hypermobility and abnormal behavior that does not correspond to the situation. It manifests itself in different ways - from fussy obsessive agitation to uncontrollable aggression. The actions of the patient are often accompanied by a violation of objective perception, hallucinations, delusions and other symptoms, depending on the type of disease, against which psychomotor agitation develops. A patient of any age in such a state, especially one who is inaccessible to contact, can be dangerous for others and himself, moreover, he will not seek help on his own, because he is unable to control his behavior. Psychomotor agitation suggests the development of acute psychosis, and therefore requires the provision of emergency psychiatric care.

Causes of psychomotor agitation

In order to survive this state, it is not at all necessary to be a mentally ill person. It can arise as one of the types of reactive psychosis (psychogenic shock), which a person experiences as a result of very strong emotional upheavals. This may be an event that threatens the life of a person or people very close to him - an accident, a message about incurable disease, any significant loss and so on. At risk are people with psychopathic traits character, paranoid inclinations, emotionally labile, prone to hysteria, accentuated personalities, whose deviations from the norm are sufficiently compensated and do not reach a pathological level.

In some periods - age crises, pregnancy, a person becomes more vulnerable to the development of psychomotor agitation as a result of psychogenic shock. Such cases are usually temporary, sometimes isolated, and completely reversible.

The development of psychomotor agitation occurs as a result of brain injuries, infections complicated by inflammatory diseases of the meninges, intoxications and hypoxia, ischemic processes, hemorrhages and tumors. Psychomotor agitation after a stroke is more likely to develop with hemorrhagic form vascular catastrophe, with ischemia - also not excluded, but less pronounced.

Psychomotor agitation often develops in people with mental (schizophrenia, manic-depressive psychosis, personality disorders), severe mental retardation or neurological (epilepsy, neuroses) diseases.

Risk factors

Risk factors for the development of such a condition are metabolic disorders in the brain tissues as a result of chronic or acute direct intoxication with alcohol, drugs, medicines and others chemicals, precomatous and comatose conditions; autoimmune and immune processes.

Pathogenesis

The pathogenesis of psychomotor agitation may be different depending on the cause that caused its development. The psychological characteristics of the individual, circumstances, neuroreflex mechanisms, immune disorders, ischemic, hemorrhagic, metabolic disorders in the brain substance, direct toxic effects of toxic substances that caused an imbalance of excitation and inhibition are considered as pathogenetic links.

Symptoms of psychomotor agitation

This state of abnormal hyperactivity is characterized by age-related features. Psychomotor arousal in young children is expressed in monotonous repetitions of cries, one phrase or question, movements - head nodding, swaying from side to side, jumping. Children cry mournfully and monotonously, laugh hysterically, grimace, bark or howl, bite their nails.

Older children are constantly moving, crushing and tearing everything, sometimes manifestations of aggression are frankly sadistic. They can pretend to be babies - suck their thumb for a long time, babble excitedly like a child.

Psychomotor agitation in the elderly is also characterized by motor and speech monotony. Manifested by fussiness, anxiety or irritability and grouchiness.

And although the clinical picture of different types of this condition has symptomatic differences (described below), the first signs always appear unexpectedly and acutely. The patient's behavior attracts attention - inadequate movements, violent emotions, defensive reactions, aggressive actions, attempts to injure oneself.

AT mild stage psychomotor agitation, the patient is unusually mobile, talkative, he clearly has a hyperthymic mood, however, the abnormal behavior is not yet too noticeable. The middle stage is characterized by already noticeable anomalies, dissociative thinking, unexpected and inadequate actions, the purpose of which is unclear, visible affects (rage, anger, longing, unbridled fun) and the lack of a critical attitude towards one's behavior. Acute psychomotor agitation in the third stage is very dangerous state requiring emergency medical attention. Affects go off scale: consciousness is clouded, speech and movements are chaotic, there may be delirium, hallucinations. In this state, the patient is inaccessible to contact and is very dangerous for others and himself.

Forms

Types of psychomotor agitation largely depend on the causes that caused it, and differ in clinical course.

For depressive syndromes characterized by anxiety. Motor reactions in this case are endless monotonous repetitions of simple movements, accompanied by speech repetitions of the same phrase, words, sometimes just groans. Raptuses are periodically observed - sudden impulsive attacks, frantic screams, self-damaging actions.

Psychogenic arousal occurs against the background of a strong mental shock or under life-threatening circumstances. Accompanied by symptoms of an affective-shock disorder: mental and motor overexcitation, autonomic disorders- increased heart rate and respiration, dry mouth, hyperhidrosis, dizziness, tremor of the limbs, fear of death. There are various variants of symptoms - from catatonic or anxious to senseless panic acts. There may be suicide attempts, escape from the scene. In global cataclysms and catastrophes, psychogenic arousal has a group character.

Psychopathic arousal occurs in people with personality disorders, more often in excitable psychopaths, under the influence of exogenous irritation. In this case, the patient reacts with a force that is absolutely inadequate to the irritating factor. The use of psychoactive substances (alcohol, drugs) increases the likelihood of psychomotor agitation in a person with psychopathic or neurasthenic features. Aggression, anger, anger is directed at individuals who have offended the patient, who have not appreciated his achievements. Most often it is expressed in threats, abuse, physical actions, suicide attempts, the demonstrative nature of which is designed to provide a wide audience, which is especially characteristic of the hysterical subspecies of psychopathic arousal, when playing at the viewer is accompanied by violent affects. The facial expressions and gestures of the patient are emphatically expressive and often even pretentious. It is noticeable that the "actor" appeals to the audience in order to achieve empathy. Unlike "real" patients (epileptics, people with organic brain diseases), psychopaths are well oriented in the environment and, in most cases, control the situation and can refrain from breaking the law, because they realize that they will be held responsible for their actions. However, there is no guarantee of safety, especially if the psychopath is under the influence of psychoactive substances.

With organic lesions of the brain and in epileptics, dysphoric psychomotor agitation often develops. The patient is tense, gloomy and gloomy, very suspicious. He often takes a defensive position, reacts to attempts to establish contact with sharp irritation and unexpected strong aggression, suicidal intentions are possible.

Manic excitement is accompanied by a euphoric mood, all movements and thoughts are focused on performing some purposeful action, while accelerated thinking is characterized by a lack of logic, attempts to prevent an individual in this state can cause violent aggression. Patients often miss words in sentences, it seems that their actions do not keep up with their thoughts. The voice of the patients becomes hoarse and not one of their actions is brought to its logical conclusion.

Catatonic excitement - impulsive rhythmic repetitions of monotonous indistinct muttering, singing, abuse, grimaces, jumps, shouts, pretentious unnatural movements and poses. Some patients are characterized by mannerisms - they greet everyone in a row and several times, they try to make small talk, asking the same questions.

In schizophrenics, hebephrenic arousal is often observed, a specific sign of which is foolish behavior, however, it, obeying a sudden impulse, can turn into aggression with elements of delirium, illusory visions, and mental automatism.

Epileptiform psychomotor agitation, to which epileptics with the temporal form of the lesion are most susceptible, is accompanied by clouding of consciousness, spatial and temporal disorientation, contact with the patient is impossible. It occurs suddenly - it is expressed by motor hyperactivity, aggressive actions. The patient is defending himself from imaginary enemies, trying to escape from them. There is a viciously intense affect, often such attacks of excitement are accompanied by the commission of violent acts. The excited state lasts about one or two minutes, then just as suddenly passes. After that, the patient does not remember his actions and for some time (at least 10 minutes) remains unavailable for contact.

Eretic psychomotor agitation is observed in oligophrenics and in other forms of mental retardation. It manifests itself in non-purposeful destructive activity, devoid of any meaning, which is accompanied by abuse or loud meaningless sounds.

Delirious psychomotor agitation occurs under the influence of psychoactive substances or in chronic alcoholics, drug addicts with experience - as a withdrawal syndrome, as well as - with injuries, neuroinfections, tumors. It is expressed by chaotic meaningless movements, intense concentration, incoherent speeches, changeable facial expressions, aggressive gestures. This type of psychomotor agitation is almost always accompanied by delusions and hallucinations, under the influence of which patients are prone to unmotivated attacks on imaginary enemies and / or self-damaging actions.

There are also delusional and hallucinatory excitation. Delusional is characterized by the presence of overvalued ideas for the patient. Patients in a state of delirium are aggressive, they see the surrounding enemies that impede the implementation of delusional ideas. It is typical for schizophrenics and people with organic pathologies of the central nervous system.

Patients with hallucinatory arousal, first of all, have very rich facial expressions, they are focused on their illusions, they are hostile to others, their speech is usually incoherent.

The diametrically opposite state is psychomotor inhibition or stupor. This condition is characterized by hypo- and akinesia, reduced muscle tone, laconic or just stupid silence. Sometimes the patient is available for contact, sometimes not. The causes and types that caused psychomotor inhibition are similar to arousal, in addition, one state can be replaced by another, sometimes quickly and unexpectedly.

Complications and consequences

by the most significant result psychomotor agitation is the infliction of bodily harm incompatible with life, to oneself or to others. Less significant - minor injuries and damage to property. Patients with catatonic and hallucinatory delusional types of excitation are especially dangerous, since their impulsive action cannot be predicted.

In addition, the occurrence of such a condition may indicate that the individual has serious illnesses psyche or nervous system requiring urgent action.

Diagnostics of psychomotor agitation

Prehospital diagnosis is carried out visually. It is desirable for the doctor to assess the degree of aggressiveness of the patient and the hypothetical cause of the state of psychomotor agitation. In addition, it is necessary to avoid aggression directed directly at health workers.

Often asking questions to the patient does not make sense, because he does not want to contact.

However, some questions that will help to conduct a differential diagnosis should be clarified, if not from the patient himself, then from his close people: did the patient have such conditions before, which preceded the attack of excitement, whether the patient has a psychiatric or neurological diagnosis, did he take psychoactive substances the day before whether he was injured, whether he suffers from alcoholism, whether there have been suicide attempts before, and others.

On examination, the physician should focus on identifying specific symptoms the patient's condition, whether they are getting worse, whether there are delusions, hallucinations. To pay attention to the severity of affect, the presence of demonstrativeness, to try to determine the severity of psychomotor agitation - how the patient speaks and moves (especially loud, non-stop, meaningless speech and hyperkinetism, combined with a lack of response to requests, comments, orders of others) are the basis for hospitalization.

Differential Diagnosis

Differential Diagnosis carried out between psychomotor excitations without psychotic symptoms and with them. Psychogenic and psychopathic excitations should be distinguished from manic, epileptiform, schizophrenia, and delirium.

Delirious disorders caused by the use of psychoactive substances and requiring the neutralization of their action from delirium caused by other causes - neuroinfections, epilepsy, tumors. Affective disorders - from each other, in particular, a large depressive disorder (clinical depression), which is characterized by long-term preservation of mood in one state, is differentiated from intermittent manic and depressive episodes (bipolar disorder). Stress also needs to be differentiated from mental illness, and the severity of the stress response indicates what action needs to be taken.

Treatment of psychomotor agitation

In the vast majority of cases, patients in a state of psychomotor agitation pose a danger, to a greater extent - to others, but sometimes they also show auto-aggression. Can prevent unwanted consequences urgent care with psychomotor agitation. They try to isolate the patient and not leave him alone, watching him, if possible, not too noticeably, since demonstrative observation can cause an attack of aggression on the part of the patient. Be sure to call ambulance. Usually, a psychiatric team is sent to such a call, before the arrival of which, in difficult cases, you can call the police, who are obliged by law to provide psychiatric care.

Help algorithm on prehospital stage– prevention of aggression on the part of the patient with the help of persuasion, distraction and physical strength(retention of the patient). Of course, first of all, if the patient is available for contact, they try to persuade him to take the medicine or allow him to get an injection and voluntarily go to the hospital.

In severe cases (the patient actively resists, behaves threateningly or has a weapon), law enforcement agencies are involved and assistance is provided without the consent of the patient.

Rampant patients for the time needed for transport, while the drugs have not yet taken effect, are temporarily immobilized or immobilized using improvised means or a straitjacket.

The main recommendations for knitting a patient in psychomotor agitation are that soft and wide materials are selected from improvised means - sheets, towels, cloth belts, which should not squeeze the vessels and nerve trunks of the body. It is necessary to securely fix each arm of the patient separately, as well as the shoulder girdle. Basically, this is enough. In particularly violent and mobile patients, the lower limbs are also immobilized. In this case, it is necessary to make sure that it is impossible to get rid of the fixing bandages on your own. The state of the immobilized patient must be constantly monitored.

The relief of psychomotor agitation is drug-induced, except in cases of emergency surgery, when hyperactivity is a sign of progressive brain compression.

The most widely used drugs for psychomotor agitation are neuroleptics with a pronounced sedative effect. Most commonly used parenteral administration- intramuscular or intravenous. If the patient is persuasive, parenteral forms of drugs can be used. Patients who have never been treated with antipsychotics are prescribed minimal effective dose. For those who have previously been treated with psychotropic drugs, the dose is doubled. The patient is constantly monitored for blood pressure, respiratory function and the absence of signs of orthostatic phenomena. In milder cases, as well as in debilitated and elderly patients, tranquilizers are prescribed. Naturally, these drugs are not combined with alcohol.

The drugs are dosed individually, depending on the patient's response to the treatment.

In cases of anxiety in mild and moderate stages, a medicine is prescribed. Atarax. Active substance the drug hydroxyzine dihydrochloride is a blocker of H1-histamine, as well as choline receptors, exhibits a moderate anxiolytic effect, in addition, it provides a hypnotic and antiemetic effect. It is a mild tranquilizer. With anxiety in patients, the process of falling asleep is accelerated, the quality of sleep and its duration improve. The relaxing effect of the drug on the muscles and the sympathetic nervous system contributes to this effect.

In addition, Atarax generally has a beneficial effect on memory, concentration and memorization, but this is a long-term effect. And during the reception, you should refuse to drive a car, work at height, with electrical wiring, etc.

The active ingredient is absorbed at a good rate in the gastrointestinal tract. The effect of taking the tablets occurs in half an hour, and with intramuscular injection- almost instantly. As a result of taking the drug, there is no withdrawal syndrome, however, in elderly patients suffering from hepatic and renal insufficiency, dose adjustment is required.

Atarax crosses the placental barrier, accumulates in the tissues of the unborn child, penetrates into breast milk, so the drug is contraindicated for pregnant and lactating women.

It is not prescribed for patients with porphyria and an established allergy to the active substance or an auxiliary contained in the drug, in particular lactose, as well as to cetirizine, aminophylline, piperazine, ethylenediamine and their derivatives.

The drug can cause an allergic reaction, although it has the ability to eliminate it, rare side effects are increased arousal, hallucinations and delusions.

Basically, it causes drowsiness, weakness, low-grade fever, blurred vision, dyspepsia, hypotension.

With moderate psychomotor agitation, elderly and debilitated patients, as well as for the purpose of stopping predilirious arousal or symptoms of psychoactive substance withdrawal syndrome, the drug can be used Grandaxin. The active substance tofisopam belongs to the group of benzodiazepines. This drug reduces mental stress, reduces anxiety, has a light sedative action. However, it is believed that it does not cause drowsiness, muscle relaxation and anticonvulsant effect, therefore, with severe psychomotor agitation, its use is inappropriate. The drug can provoke increased excitation, dyspeptic symptoms and allergic reactions. In the first three months of pregnancy is prohibited, then - only vital indications. Breastfeeding women can be taken subject to the cessation of lactation. Side effects are more common in people with hepatic and renal dysfunction, the mentally retarded and the elderly.

In epilepsy, this drug can cause convulsions, in states of depressive anxiety, the risk of attempts to commit suicide increases, special care should be taken with patients with organic brain disorders, as well as those suffering from personality disorders.

Other benzodiazepine anxiolytic Relanium(the active ingredient is diazepam) is often used in emergency cases acute psychomotor anxiety. It is used both orally and parenterally - intramuscularly and intravenously. The drug, unlike the previous one, has a pronounced hypnotic, anticonvulsant and muscle-relaxing effect.

Interacts with benzodiazepine receptors located in the center of regulation of the activity of structures of the brain and spinal cord, enhances the action of the inhibitory neurotransmitter - γ-aminobutyric acid, both presynaptic and postsynaptic, and also inhibits polysynaptic spinal reflexes.

The sedative and hypnotic effect is realized mainly through the influence on the neurons of the reticular formation of the brain stem.

Convulsions are stopped by suppressing the spread of epileptogenic activity, however, excitation in the epileptic focus remains intact.

Relanium weakens the delirious excitation of alcoholic etiology, however, it has practically no effect on the productive manifestations of psychotic disorders (delusions, hallucinations).

Contraindicated in severe respiratory failure, tendency to stop breathing during sleep and muscle weakness patient. Also not used in coma, for the treatment of patients with phobic disorders and chronic psychoses. Contraindicated in patients with glaucoma, especially angle-closure glaucoma, with severe dysfunction of the liver and kidneys. Chronic alcoholics and drug addicts are prescribed exclusively for the relief of arousal caused by the withdrawal syndrome.

In bipolar and other types of mixed disorders with a predominance of an anxiety component, the drug can be used to stop an attack of psychomotor agitation. Amitriptyline. Belongs to the class of tricyclic antidepressants, available in both tablet and injectable form. Increases the concentration of catecholamines and serotonin in the synaptic cleft, inhibiting the process of their reuptake. Blocks choline and histamine receptors. Improving mood when taking the drug is simultaneously supported by sedation - a decrease in anxiety.

It is believed that it does not affect the activity of monoamine oxidase. At the same time, it is not prescribed in combination with other antidepressants that inhibit monoamine oxidase. If necessary, replace Amitriptyline with a monoamine oxidase inhibitor, the interval between doses of drugs should be at least two weeks.

Paradoxical side effects, and also - increased drowsiness, headache, coordination disorder, dyspepsia. The drug is not recommended for use in manic phase bipolar disorder, epileptics and suicidal patients. Contraindicated in children under the age of twelve, with extreme caution is prescribed to men suffering from prostate adenoma, persons of both sexes with dysfunction thyroid gland, heart and blood vessels, glaucoma, patients with myocardial infarction, pregnant and lactating women.

Sleeping pill with antipsychotic action Tiapride blocks adrenergic receptors in the brainstem. At the same time, it has an antiemetic effect by blocking dopamine neurotransmitter receptors in the chemoreceptor trigger zone of the brain, as well as in the hypothalamic center of thermoregulation.

The drug is indicated for the treatment of patients older than six years of age in a state of psychomotor agitation of various origins, including alcohol, drug and senile aggression. The drug is taken orally with minimum doses, bringing to effective.

Non-contact patients are given injections every four or six hours. The dose is prescribed by the doctor, but per day you can get no more than 0.3 g of the drug for a child and 1.8 g for an adult. The injection form is used to treat patients from seven years of age.

Contraindicated in the first four months of pregnancy, nursing mothers, patients with prolactin-dependent tumors, pheochromocytoma, decompensated and severe cardiovascular and renal pathologies.

Epileptics and elderly patients are prescribed with caution.

Adverse effects from taking the drug can be expressed in increased hypnotic action or paradoxical effects, hyperprolactinemia, allergic reactions.

The most versatile and widely used at the present time in the relief of the state of psychomotor agitation in different stages are antipsychotics, the most popular of which is Aminazine. This neuroblocker has proven to be an effective means of combating hyperexcitation and is used in many countries of the world under different names: Chlorpromazine (English version), Megafen (Germany), Largactyl (France).

This drug has a diverse and complex dose-dependent effect on the work of the central and peripheral nervous system. An increase in the dose causes an increase in sedation, the muscles of the patient's body relax and motor activity decreases - the patient's condition approaches the normal physiological state of sleep, which differs from narcotic sleep in that it is deprived of side effects anesthesia - stupor, characterized by ease of awakening. That's why this medicine is the drug of choice for stopping the states of motor and speech arousal, anger, rage, unmotivated aggression combined with hallucinations and delusions.

In addition, the drug, acting on the center of thermoregulation, is able to lower body temperature, which is valuable when excited due to acute brain injuries, hemorrhagic strokes (when hyperthermia is often observed). This action is potentiated by the creation of artificial cooling.

In addition, Aminazine has antiemetic properties, soothes hiccups, which is also important in the above cases. Potentiates the action of anticonvulsants, painkillers, narcotic, sedatives. Able to stop attacks of hypertension caused by the release of adrenaline, and other interoceptive reflexes. The drug has a moderate anti-inflammatory and angioprotective activity.

The mechanisms of its action are still not fully understood, but its effectiveness is not in doubt. Research data in different countries indicate that the active substance (phenothiazine derivative) has a direct effect on the occurrence and conduction of nerve impulses that transmit excitation in different parts of both the central and autonomic nervous systems. Under the influence of the drug slow down metabolic processes in the tissues of the brain, especially in the neurons of its cortex. Therefore, the neuroplegic effects of the drug are associated with cortical activities. In addition, Aminazin also acts on the subcortex, reticular formation and peripheral nerve receptors, extinguishes almost all types of psychomotor agitation, relieves hallucinatory and delusional symptoms, however, is not hypnotic. A patient under the influence of this drug is able to respond adequately and answer questions.

It is used both alone and in combination with anxiolytics and other psychotropic drugs. Absolute contraindications medications are difficult to use systemic pathologies brain and spinal cord, dysfunction of the liver and kidneys, hematopoietic organs, myxedema, a tendency to thromboembolism, decompensated heart disease.

Apply at any age, dosed individually, according to age norms and severity of the condition. Oral administration is possible, as well as parenteral (intramuscular and intravenous). To avoid post-injection complications and pain, the contents of the ampoule are diluted with novocaine or lidocaine, saline, glucose solution (intravenous administration).

After using the drug, especially injections, a drop in blood pressure is possible, so the patient is advised to lie down for several hours and take an upright position without sudden movements.

In addition, other side effects are possible - allergies, dyspepsia, neuroleptic syndrome.

A drug Phenotropil- a new word in improving the work of the central and peripheral nervous system. A nootropic that came to a wide consumer from space medicine. pharmachologic effect the drug is close to natural - its manufacturers claim that the drug can activate a more rational use of its own resource, and not lead to its depletion.

The drug has a beneficial effect on metabolic processes in brain neurons and stimulates blood circulation in cerebral vessels. It activates the course of redox processes, increases the efficiency of glucogenesis, thus increasing the energy potential of the body. The active substance of the drug phenylpiracetam increases the content of mediators of cheerfulness, pleasure and good mood - norepinephrine, dopamine and serotonin. It is not necessary to list all of its wonderful qualities, but we note that it is directly related to the relief of psychomotor arousal. The drug has a psychostimulating effect - it accelerates the transmission of nerve impulses, improves performance, cognitive qualities, has a moderate anti-anxiety activity. True, in the features of the application, it is noted that people who are prone to panic attacks and psychotic arousal attacks should be treated with caution. The drug is rather suitable for the prevention of psychomotor agitation and increasing the body's resistance to stress. He has no direct indications for stopping the state of motor and mental hyperactivity. On the contrary, it is indicated in cases of decreased mobility, lethargy, memory impairment and manifestations of anxious inhibition.

Used to treat psychomotor agitation different means with sedative properties: barbiturates - veronal, medinal, luminal, chloral hydrate and others. They have a pronounced hypnotic effect. They are sometimes given rectally (in an enema). The effectiveness of such funds increases with the simultaneous intravenous administration magnesium sulphate.

In severe cases, they resort to fast-acting, often narcotic, drugs (thiopental-sodium, Hexenal) and their intravenous administration. Sleep apnea and acute disorder activity of the heart muscle.

Effect reserpine in cases of psychomotor agitation, it resembles the action of Aminazine. It is not a sleeping pill, but potentiates natural sleep and relieves arousal, providing central action. Patients feel calm, muscle relaxation, fall asleep calm and deep sleep. This process is accompanied by a decrease in blood pressure. Hypotension remains after the abolition of Reserpine. Normalization of pressure after discontinuation of the drug occurs as gradually as its decrease under the influence of the drug. This drug is indicated for hypertensive patients with acute psychomotor agitation. Contraindicated in epileptics and other patients prone to seizures.

After placing a patient with psychomotor agitation in an inpatient department and providing first aid (stopping arousal), he is continued to be monitored in a special ward, since the stability of his condition is questionable and there is a possibility of resuming an attack.

Prevention

It is almost impossible to prevent an accident or catastrophe, other serious stress factors. However, it is necessary to try to increase your stress resistance.

First, it concerns the general state of health. Proper nutrition, absence bad habits, physical activity provides the highest possible immunity and reduces the likelihood of developing acute psychogenic reactions.

Secondly, a positive outlook on the world, an adequate and objective self-assessment of the individual also reduces the risk of pathology.

Thirdly, in the presence of diseases of any etiology, one should not run them and take courses of the necessary treatment.

People who are prone to stress and react sharply to them should engage in psychocorrection - use any relaxation factors (yoga, meditation, music, nature, pets, various types of training under the guidance of specialists). You can take pharmacocorrection courses under the guidance of a phytotherapist, homeopath, neurologist.

Forecast

Timely assistance can prevent the danger of this condition both for others and for the patient himself. Psychomotor agitation of mild and sometimes moderate severity can be eliminated without hospitalization by a psychiatric emergency team. Severe cases with non-contact patients require special care, use special measures and mandatory hospitalization. After stopping the attack of excitation further development events is determined by the nature of the underlying disease.

Psychic and manifested by increased motor activity, which may be accompanied by confusion, anxiety, aggressiveness, fun, hallucinations, clouding of consciousness, delusional state, etc. More details about what this condition is, why it can occur and how it is treated will be described later in article.

The main signs of psychomotor agitation

The state of psychomotor agitation is characterized by an acute onset, pronounced and motor restlessness (this can be both fussiness and destructive impulsive actions). The patient may experience euphoria or, conversely, anxiety, fear.

His movements acquire a chaotic, inadequate character, they may be accompanied by verbal excitement - verbosity, sometimes in the form of a continuous stream of words with the shouting of individual sounds or phrases. The patient may be haunted by hallucinations, he has a clouding of consciousness, thinking becomes accelerated and broken (dissociative). There is aggression directed both at others and at oneself (suicidal attempts). By the way, the patient has no criticism of his condition.

As is clear from the listed symptoms, the patient's well-being is a danger and requires urgent medical attention. But what can lead to such a state of affairs?

Causes of psychomotor agitation

Acute psychomotor agitation can be provoked by the most different reasons both severe stress and organic brain damage (for example, epilepsy).

Most often it occurs:

• during a long stay mentally healthy person able panic fear or as a result of a life-threatening situation he has endured (for example, after a car accident, a so-called reactive psychosis may develop);
• in acute or also in case of poisoning with caffeine, quinacrine, atropine, etc .;
• after leaving a coma or after a traumatic brain injury that provoked a pathological lesion of parts of the brain;
• may be a consequence of damage to the central nervous system by toxins, as a result of a severe infectious disease;
• with hysteria;
• often occurs in mental illness: schizophrenia, depressive psychosis, manic arousal or bipolar affective disorder.

Degrees of severity of psychomotor agitation

In medicine, psychomotor agitation is divided into three degrees of severity.

1. Easy degree. Patients in this case look only as unusually lively.
2. The average degree is expressed in manifestations of non-purposefulness of their speech and actions. Actions become unexpected, pronounced ones appear (gaiety, anger, melancholy, malice, etc.).
3. A sharp degree of excitement is manifested by extreme chaotic speech and movements, as well as clouding of consciousness.

By the way, how this excitation manifests itself, to a large extent, depends on the age of the patient. So, in childhood or old age, it is accompanied by monotonous speech or motor acts.

In children, this is monotonous crying, screaming, laughing or repeating the same questions, rocking, grimacing or smacking are possible. And in older patients, excitement is manifested by fussiness, with an air of businesslike concern and complacent talkativeness. But it is not uncommon in such situations and manifestations of irritability or anxiety, accompanied by grouchiness.

Types of psychomotor agitation

Depending on the nature of the excitation of the patient, different types of this condition are differentiated.

A few more types of psychomotor agitation

In addition to those listed above, there are several more types of psychomotor agitation that can develop in both a healthy person and a person with organic lesions brain.

• Thus, epileptic excitation is characteristic of the twilight state of consciousness in patients with epilepsy. It is accompanied by a viciously aggressive affect, complete disorientation, impossibility of contact. The beginning and end of it, as a rule, is sudden, and the condition can reach a high degree of danger to others, as the patient can attack them and cause severe damage, as well as destroy everything that they meet on the way.
• Psychogenic psychomotor agitation occurs immediately after acute stressful situations(catastrophes, crashes, etc.). It is expressed varying degrees motor anxiety. It can be monotonous excitement with inarticulate sounds, and chaotic excitement with panic, flight, self-mutilation, suicide attempt. Quite often excitement is replaced by a stupor. By the way, in case of mass disasters similar condition can cover large groups of people, becoming general.
• Psychopathic arousal is outwardly similar to psychogenic, as it also occurs under the influence of external factors, but the strength of the response in this case, as a rule, does not correspond to the reason that caused it. This condition is associated with psychopathic characteristics of the patient's character.

How to provide emergency care for acute psychomotor agitation

If a person has psychomotor agitation, emergency care is needed immediately, as the patient can injure himself and others. For this, all outsiders are asked to leave the room where he is.

Communicate calmly and confidently with the patient. It should be isolated in a separate room, which is preliminarily inspected: close windows and doors, clean sharp objects and anything that can hit. The psychiatric team is urgently called.

Before her arrival, you should try to distract the patient (to a twilight state this advice not suitable, because the patient is not in contact), and, if necessary, to carry out immobilization.

Assistance in immobilization of the patient

Psychomotor agitation, the symptoms of which have been discussed above, often requires the use of restraints. This usually requires the help of 3-4 people. They come from behind and from the sides, hold the patient's arms pressed to the chest and sharply grab him under his knees, thus laying him on a bed or couch, previously moved away from the wall so that it can be approached from 2 sides.

If the patient resists by waving an object, helpers are advised to hold blankets, pillows, or mattresses in front of them. One of them should throw a blanket over the patient's face, this will help put him on the bed. Sometimes you have to hold your head, for which a towel (preferably wet) is thrown over your forehead and pulled by the ends to the bed.

It is important to be careful when holding so as not to cause damage.

Features of assistance with psychomotor agitation

Medical care for psychomotor agitation should be provided in a hospital setting. For the period while the patient is transported there, and for the time before the onset of the drugs, temporary application of fixation is allowed (which is recorded in medical documents). In this case, the following mandatory rules are observed:

• during the application of restraint measures, only soft materials are used (towels, sheets, fabric belts, etc.);
• securely fix each limb and shoulder girdle, otherwise the patient can easily free himself;
• do not compress the nerve trunks and blood vessels because it can lead to dangerous conditions;
• the fixed patient is not left unattended.

After the action of neuroleptics, he is released from fixation, but observation should be continued, since the state remains unstable and a new attack of excitation may occur.

Treatment of psychomotor agitation

To stop the severity of an attack, a patient with any psychosis is given sedatives: "Seduxen" - intravenously, "Barbital sodium" - intramuscularly, "Aminazin" (in/in or/m). If the patient can take drugs inside, then he is prescribed tablets "Phenobarbital", "Seduxen" or "Aminazin".

No less effective are the neuroleptics Clozapine, Zuklopentiksol and Levomepromazine. It is very important at the same time to control the patient's blood pressure, since these funds can cause it to decrease.

In the conditions of a somatic hospital, the treatment of psychomotor agitation is also carried out with drugs used for anesthesia (Droperidol and a solution with glucose) with mandatory control of respiration and blood pressure. And for weakened or elderly patients, tranquilizers are used: Tiaprid, Diazepam, Midazolam.

The use of drugs depending on the type of psychosis

As a rule, a newly admitted patient is prescribed general sedatives, but after the diagnosis is clarified, further relief of psychomotor agitation will directly depend on its type. So, with hallucinatory-delusional excitation, Haloperidol, Stelazin are prescribed, and with manic, Klopiksol and Lithium oxybutyrate are effective. it is removed with drugs "Aminazine", "Tizercin" or "Phenazepam", and catotonic excitation is cured with the drug "Mazhepril".

Specialized medicines are combined, if necessary, with general sedatives, adjusting the dose.

A few words in conclusion

Psychomotor agitation can occur in a domestic situation or occur against the background of pathological processes associated with neurology, surgery or traumatology. Therefore, it is very important to know how to stop an attack of psychosis without causing damage to the patient.

As is clear from what was said in the article, the main thing during first aid is to be collected and calm. No need to try to apply physical influence on the patient on your own and do not show aggression towards him. Remember, such a person most often does not realize what he is doing, and everything that happens is just symptoms of his serious condition.