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[PMID]:29308601
[Au] Autor:Ostinelli EG; Jajawi S; Spyridi S; Sayal K; Jayaram MB
[Ad] Endereço:Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì 8, Milan, Italy, 20142.
[Ti] Título:Aripiprazole (intramuscular) for psychosis-induced aggression or agitation (rapid tranquillisation).
[So] Source:Cochrane Database Syst Rev;1:CD008074, 2018 01 08.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: People experiencing psychosis may become aggressive. Antipsychotics, such as aripiprazole in intramuscular form, can be used in such situations. OBJECTIVES: To evaluate the effects of intramuscular aripiprazole in the treatment of psychosis-induced aggression or agitation (rapid tranquillisation). SEARCH METHODS: On 11 December 2014 and 11 April 2017, we searched the Cochrane Schizophrenia Group's Study-based Register of Trials which is based on regular searches of CINAHL, BIOSIS, AMED, Embase, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. SELECTION CRITERIA: All randomised controlled trials (RCTs) that randomised people with psychosis-induced aggression or agitation to receive either intramuscular aripiprazole or another intramuscular intervention. DATA COLLECTION AND ANALYSIS: We independently inspected citations and, where possible, abstracts, ordered papers and re-inspected and quality assessed these. We included studies that met our selection criteria. At least two review authors independently extracted data from the included studies. We chose a fixed-effect model. We analysed dichotomous data using risk ratio (RR) and the 95% confidence intervals (CI). We analysed continuous data using mean differences (MD) and their CIs. We assessed risk of bias for included studies and used GRADE to create 'Summary of findings' tables. MAIN RESULTS: Searching found 63 records referring to 21 possible trials. We could only include three studies, all completed over the last decade, with 885 participants, of which 707 were included for quantitative analyses in this systematic review. Due to limited comparisons, small size of trials and a paucity of investigated and reported 'pragmatic' outcomes, evidence was mostly graded as low or very low quality. No trials reported useful data for one of our primary outcomes of tranquil or asleep by 30 minutes. Economic outcomes were also not reported in the trials.When compared with placebo, fewer people in the aripiprazole group needed additional injections compared to the placebo group (2 RCTs, n = 382, RR 0.69, 95% CI 0.56 to 0.85, very low-quality evidence). Clinically important improvement in agitation at two hours favoured the aripiprazole group (2 RCTs, n = 382, RR 1.50, 95% CI 1.17 to 1.92, very low-quality evidence). The numbers of non-responders after the first injection also favoured aripiprazole (1 RCT, n = 263, RR 0.49, 95% CI 0.34 to 0.71, low-quality evidence). Although no effect was found, more people in the aripiprazole compared to the placebo group experienced adverse effects (1 RCT, n = 117, RR 1.51, 95% CI 0.93 to 2.46, very low-quality evidence).Aripiprazole required more injections compared to haloperidol (2 RCTs, n = 477, RR 1.28, 95% CI 1.00 to 1.63, very low-quality evidence), with no significant difference in agitation (2 RCTs, n = 477, RR 0.94, 95% CI 0.80 to 1.11, very low-quality evidence), and similar non-responders after first injection (1 RCT, n = 360, RR 1.18, 95% CI 0.78 to 1.79, low-quality evidence). Aripiprazole and haloperidol did not differ when taking into account the overall number of people that experienced at least one adverse effect (1 RCT, n = 113, RR 0.91, 95% CI 0.61 to 1.35, very low-quality evidence).Compared to aripiprazole, olanzapine was better at reducing agitation (1 RCT, n = 80, RR 0.77, 95% CI 0.60 to 0.99, low-quality evidence) and had a more favourable effect on global state change scores (1 RCT, n = 80, MD 0.58, 95% CI 0.01 to 1.15, low-quality evidence), both at two hours. No differences were found in terms of experiencing at least one adverse effect during the 24 hours after treatment (1 RCT, n = 80, RR 0.75, 95% CI 0.45 to 1.24, very low-quality evidence). However, participants allocated to aripiprazole experienced less somnolence (1 RCT, n = 80, RR 0.25, 95% CI 0.08 to 0.82, low-quality evidence). AUTHORS' CONCLUSIONS: The available evidence is of poor quality but there is some evidence aripiprazole is effective compared to placebo and haloperidol, but not when compared to olanzapine. However, considering that evidence comes from only three studies, caution is required in generalising these results to real-world practice. This review firmly highlights the need for more high-quality trials on intramuscular aripiprazole in the management of people with acute aggression or agitation.
[Mh] Termos MeSH primário: Agressão/efeitos dos fármacos
Antipsicóticos/administração & dosagem
Aripiprazol/administração & dosagem
Agitação Psicomotora/tratamento farmacológico
[Mh] Termos MeSH secundário: Agressão/psicologia
Antipsicóticos/efeitos adversos
Aripiprazol/efeitos adversos
Benzodiazepinas/administração & dosagem
Haloperidol/administração & dosagem
Seres Humanos
Injeções Intramusculares
Agitação Psicomotora/psicologia
Ensaios Clínicos Controlados Aleatórios como Assunto
Tranquilizantes/administração & dosagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Antipsychotic Agents); 0 (Tranquilizing Agents); 12794-10-4 (Benzodiazepines); 82VFR53I78 (Aripiprazole); J6292F8L3D (Haloperidol); N7U69T4SZR (olanzapine)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180109
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD008074.pub2


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[PMID]:27775164
[Au] Autor:Wilson HJ; Dasgupta K; Michael K
[Ti] Título:Implementation of the Agitated Behavior Scale in the Electronic Health Record.
[So] Source:Rehabil Nurs;43(1):21-25, 2018 Jan/Feb.
[Is] ISSN:2048-7940
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The purpose of the study was to implement an Agitated Behavior Scale through an electronic health record and to evaluate the usability of the scale in a brain injury unit at a rehabilitation hospital. DESIGN: A quality improvement project was conducted in the brain injury unit at a large rehabilitation hospital with registered nurses as participants using convenience sampling. METHODS: The project consisted of three phases and included education, implementation of the scale in the electronic health record, and administration of the survey questionnaire, which utilized the system usability scale. FINDINGS: The Agitated Behavior Scale was found to be usable, and there was 92.2% compliance with the use of the electronic Electronic Agitated Behavior Scale. CONCLUSION: The Agitated Behavior Scale was effectively implemented in the electronic health record and was found to be usable in the assessment of agitation. CLINICAL RELEVANCE: Utilization of the scale through the electronic health record on a daily basis will allow for an early identification of agitation in patients with traumatic brain injury and enable prompt interventions to manage agitation.
[Mh] Termos MeSH primário: Escala de Avaliação Comportamental
Registros Eletrônicos de Saúde/tendências
Agitação Psicomotora/psicologia
[Mh] Termos MeSH secundário: Adulto
Lesões Encefálicas/complicações
Feminino
Seres Humanos
Masculino
Estudos Prospectivos
Melhoria de Qualidade
Enfermagem em Reabilitação/métodos
Enfermagem em Reabilitação/tendências
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.1002/rnj.297


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[PMID]:28463343
[Au] Autor:Correll CU; Yu X; Xiang Y; Kane JM; Masand P
[Ti] Título:Biological treatment of acute agitation or aggression with schizophrenia or bipolar disorder in the inpatient setting.
[So] Source:Ann Clin Psychiatry;29(2):92-107, 2017 05.
[Is] ISSN:1547-3325
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Schizophrenia and bipolar disorders are chronic illnesses that commonly present with symptoms of acute agitation and aggression. These symptoms must be managed rapidly to prevent potential harm to the patient and others, including their caregivers, peers, and health care workers. A number of treatment options are available to clinicians to manage acute agitation and aggression, including non-pharmacologic behavioral and environmental de-escalation strategies, as well as biological treatment options such as pharmacologic agents and electroconvulsive therapy. We summarize the available biological treatment options for patients with schizophrenia or bipolar disorder presenting with acute agitation or aggression in the inpatient setting, focusing on antipsychotics. METHODS: The following searches were used in PubMed to obtain the most relevant advances in treating schizophrenia or bipolar disorder with acute agitation and aggression: (agitation, agitated, aggression, aggressive, hostile, hostility, violent, or violence) and (schizophr*, psychosis, psychot*, psychos*, mania, manic, or bipolar) and (*pharmacologic, antipsychotic*, neuroleptic*, antiepileptic*, anti-seizure*, mood stabilizer*, lithium, benzodiazepine*, beta blocker, beta-blocker, alpha2, alpha-2, *histamine*, electroconvulsive, ECT, shock, or transcranial). Individual searches were performed for each drug class. The studies were limited to peer-reviewed, English-language, and human studies. Most were placebo-controlled randomized controlled trials (RCTs) or meta-analyses. RESULTS: Among pharmacologic agents, antipsychotics, benzodiazepines, anticonvulsants, and lithium have been studied in randomized trials. Some typical and, more recently, atypical antipsychotics are available as both oral and short-acting intramuscular (IM) formulations, with 1 typical antipsychotic also available as an inhalable formulation. CONCLUSIONS: Among the pharmacologic agents studied in RCTs, atypical antipsychotics have the best evidence to support efficacy both in oral and short-acting IM formulations, as well as in one instance in an inhalable formulation.
[Mh] Termos MeSH primário: Transtorno Bipolar
Agitação Psicomotora/terapia
Psicotrópicos/farmacologia
Esquizofrenia/terapia
[Mh] Termos MeSH secundário: Agressão/efeitos dos fármacos
Agressão/psicologia
Transtorno Bipolar/psicologia
Transtorno Bipolar/terapia
Eletroconvulsoterapia/métodos
Serviços de Emergência Psiquiátrica/métodos
Seres Humanos
Agitação Psicomotora/psicologia
Ensaios Clínicos Controlados Aleatórios como Assunto
Psicologia do Esquizofrênico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Psychotropic Drugs)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:28463820
[Au] Autor:Mi W; Zhang S; Liu Q; Yang F; Wang Y; Li T; Mei Q; He H; Chen Z; Su Z; Liu T; Xie S; Tan Q; Zhang J; Zhang C; Sang H; Chen W; Shi L; Li L; Shi Y; Guo L; Zhang H; Lu L
[Ad] Endereço:Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51, Huayuan Bei Road, Beijing 100191, China.
[Ti] Título:Prevalence and risk factors of agitation in newly hospitalized schizophrenia patients in China: An observational survey.
[So] Source:Psychiatry Res;253:401-406, 2017 Jul.
[Is] ISSN:1872-7123
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:This multi-center observational study investigated the prevalence of agitation in newly hospitalized schizophrenia patients in China and its potential risk factors. It was performed in 2014 and covered 14 hospitals. Newly hospitalized patients with schizophrenia or suspected schizophrenia who met the diagnostic criteria of the International Statistical Classification of Diseases and Related Health Problems, 10th revision, were recruited. Agitation and related risk factors were evaluated by a questionnaire designed for the survey. General demographic data, disease characteristics, scores on schizophrenia rating scales and agitation rating scales (e.g., Positive and Negative Syndrome Scale-Excited Component [PANSS-EC] and Behavioral Activity Rating Scale [BARS]) were collected. Among the 1512 patients screened in the study, 1400 (92.59%) were eligible. According to the PANSS-EC and BARS, the prevalence of agitation was 60.92% (853 of 1400) and 59.00% (826 of 1400), respectively. The overall prevalence of agitation was 47.50% (665 of 1400). The most important risk factor of agitation was being aggressive at baseline (Modified Overt Aggression Scale score ≥4, odds ratio=6.54; 95% confidence interval=4.93-8.69). Other risk factors included a history of aggressive behavior, northern region of residence, involuntary hospitalization, disease severity, low level of education, living alone, being unemployed or retired.
[Mh] Termos MeSH primário: Pacientes Internados/psicologia
Agitação Psicomotora/epidemiologia
Agitação Psicomotora/psicologia
Esquizofrenia/complicações
Psicologia do Esquizofrênico
[Mh] Termos MeSH secundário: Adulto
Agressão
China/epidemiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Prevalência
Escalas de Graduação Psiquiátrica
Fatores de Risco
Inquéritos e Questionários
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180119
[Lr] Data última revisão:
180119
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:29287876
[Au] Autor:Zhong Q; Qu X; Xu C
[Ad] Endereço:Department of Anesthesiology, Xiamen Changgung Hospital, Xiamen, Fujian 361028, PR China.
[Ti] Título:Effect of preoperative visiting operation room on emergence agitation in preschool children under sevoflurane anesthesia.
[So] Source:Int J Pediatr Otorhinolaryngol;104:32-35, 2018 Jan.
[Is] ISSN:1872-8464
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Emergence agitation (EA) is a common complication in children during recovery from sevoflurane anesthesia with an high incidence. The main objective of this study was to compare the effects of preoperative visiting operation room (PVOR) to administration of propofol at the end of anesthesia on EA in preschool children under sevoflurane anesthesia. METHODS: Sixty-nine preschool children aged from 3 to 6 years scheduled for tonsillectomy under sevoflurane anesthesia were randomly allocated to one of the three groups to receive either PVOR (Group PV), routine preoperative visit (Group RV) or routine preoperative visit plus propofol (Group RP), 23 patients were included in each group. General anesthesia was induced and maintained with sevoflurane. Parental separation status score, mask acceptance score, Aono's four point score and pediatric anesthesia emergence delirium (PAED) score and incidence of EA were recorded. PAED score >10 were regarded as EA. Recovery profile and adverse events were also recorded. RESULT: Parental separation status score and mask acceptance score in group PV was significantly lower than that in group RV and group RP (P < 0.05); Aono's four point score, PAED score and incidence of EA in group PV and group RP was significantly lower than that in group RV (P < 0.05); Time to extubation and time to interaction in group PV and group RV was significantly shorter than that in group RP (P < 0.05); POV and rescue by fentanyl in group PV and group RP was significantly lower than that in group RV(P < 0.05). CONCLUSION: PVOR can effectively reduce the incidence of EA as well as administration of propofol without additional medical expenses and other adverse effects.
[Mh] Termos MeSH primário: Anestésicos Inalatórios/efeitos adversos
Éteres Metílicos/efeitos adversos
Salas Cirúrgicas/estatística & dados numéricos
Cuidados Pré-Operatórios/métodos
Propofol/efeitos adversos
Agitação Psicomotora/etiologia
[Mh] Termos MeSH secundário: Período de Recuperação da Anestesia
Anestesia Geral/efeitos adversos
Anestésicos Inalatórios/uso terapêutico
Criança
Pré-Escolar
Delírio do Despertar
Feminino
Fentanila/uso terapêutico
Seres Humanos
Masculino
Éteres Metílicos/uso terapêutico
Propofol/uso terapêutico
Tonsilectomia/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anesthetics, Inhalation); 0 (Methyl Ethers); 38LVP0K73A (sevoflurane); UF599785JZ (Fentanyl); YI7VU623SF (Propofol)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171231
[St] Status:MEDLINE


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[PMID]:28975291
[Au] Autor:Yohanna D; Cifu AS
[Ad] Endereço:University of Chicago, Chicago, Illinois.
[Ti] Título:Antipsychotics to Treat Agitation or Psychosis in Patients With Dementia.
[So] Source:JAMA;318(11):1057-1058, 2017 Sep 19.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Antipsicóticos/uso terapêutico
Demência/psicologia
Agitação Psicomotora/tratamento farmacológico
Transtornos Psicóticos/tratamento farmacológico
[Mh] Termos MeSH secundário: Antipsicóticos/efeitos adversos
Seres Humanos
Guias de Prática Clínica como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antipsychotic Agents)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171005
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.11112


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[PMID]:28975287
[Au] Autor:Pandharipande PP; Ely EW
[Ad] Endereço:Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
[Ti] Título:Humanizing the Treatment of Hyperactive Delirium in the Last Days of Life.
[So] Source:JAMA;318(11):1014-1015, 2017 09 19.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Delírio
Agitação Psicomotora
Assistência Terminal
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171005
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.11466


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[PMID]:28834857
[Au] Autor:Yeo QM; Wiley TL; Smith MN; Hammond DA
[Ad] Endereço:Department of Pharmacy, Changi General Hospital, Singapore (Dr Yeo); Department of Pharmacy, The University of Mississippi Medical Center, Jackson (Dr Wiley); Department of Pharmacy, Medical University of South Carolina, Charleston (Dr Smith); and Department of Pharmacy, Rush University Medical Center, Chicago, Illinois (Dr Hammond).
[Ti] Título:Oral Agents for the Management of Agitation and Agitated Delirium in Critically Ill Patients.
[So] Source:Crit Care Nurs Q;40(4):344-362, 2017 Oct/Dec.
[Is] ISSN:1550-5111
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo: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. Despite inconclusive findings from different studies, antipsychotics, clonidine, and valproic acid may provide benefit for specific patient populations. As more evidence emerges, these agents may start playing a greater role in the management of agitation, which is not amenable to first-line agents. As health care professionals, it is prudent to be familiar with their dosing regimens, common adverse effects, and the monitoring required to maximize patient benefits and minimize harms.
[Mh] Termos MeSH primário: Administração Oral
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico
Antipsicóticos/uso terapêutico
Clonidina/uso terapêutico
Estado Terminal
Delírio/tratamento farmacológico
GABAérgicos/uso terapêutico
Agitação Psicomotora/tratamento farmacológico
Ácido Valproico/uso terapêutico
[Mh] Termos MeSH secundário: Protocolos Clínicos
Cuidados Críticos
Enfermagem de Cuidados Críticos
Delírio/etiologia
Seres Humanos
Agitação Psicomotora/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Adrenergic alpha-2 Receptor Agonists); 0 (Antipsychotic Agents); 0 (GABA Agents); 614OI1Z5WI (Valproic Acid); MN3L5RMN02 (Clonidine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170824
[St] Status:MEDLINE
[do] DOI:10.1097/CNQ.0000000000000172


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[PMID]:28826872
[Au] Autor:Kolanowski A; Boltz M; Galik E; Gitlin LN; Kales HC; Resnick B; Van Haitsma KS; Knehans A; Sutterlin JE; Sefcik JS; Liu W; Petrovsky DV; Massimo L; Gilmore-Bykovskyi A; MacAndrew M; Brewster G; Nalls V; Jao YL; Duffort N; Scerpella D
[Ad] Endereço:College of Nursing, Penn State, University Park, PA. Electronic address: amk20@psu.edu.
[Ti] Título:Determinants of behavioral and psychological symptoms of dementia: A scoping review of the evidence.
[So] Source:Nurs Outlook;65(5):515-529, 2017 Sep - Oct.
[Is] ISSN:1528-3968
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are prevalent in people with neurodegenerative diseases. PURPOSE: In this scoping review the Kales, Gitlin and Lykestos framework is used to answer the question: What high quality evidence exists for the patient, caregiver and environmental determinants of five specific BPSD: aggression, agitation, apathy, depression and psychosis? METHOD: An a priori review protocol was developed; 692 of 6013 articles retrieved in the search were deemed eligible for review. Gough's Weight of Evidence Framework and the Cochrane Collaboration's tool for assessing risk of bias were used. The findings from 56 high quality/low bias articles are summarized. DISCUSSION: Each symptom had its own set of determinants, but many were common across several symptoms: neurodegeneration, type of dementia, severity of cognitive impairments, and declining functional abilities, and to a lesser extent, caregiver burden and communication. CONCLUSION: Research and policy implications are relevant to the National Plan to Address Alzheimer's Disease.
[Mh] Termos MeSH primário: Agressão
Doença de Alzheimer/fisiopatologia
Apatia
Demência/fisiopatologia
Depressão/fisiopatologia
Agitação Psicomotora/fisiopatologia
Transtornos Psicóticos/fisiopatologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Doença de Alzheimer/complicações
Demência/complicações
Depressão/etiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Agitação Psicomotora/etiologia
Transtornos Psicóticos/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:AIM; IM; N
[Da] Data de entrada para processamento:170823
[St] Status:MEDLINE


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[PMID]:28758203
[Au] Autor:Ostinelli EG; Brooke-Powney MJ; Li X; Adams CE
[Ad] Endereço:Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì 8, Milan, Italy, 20142.
[Ti] Título:Haloperidol for psychosis-induced aggression or agitation (rapid tranquillisation).
[So] Source:Cochrane Database Syst Rev;7:CD009377, 2017 07 31.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Haloperidol used alone is recommended to help calm situations of aggression or agitation for people with psychosis. It is widely accessible and may be the only antipsychotic medication available in limited-resource areas. OBJECTIVES: To examine whether haloperidol alone is an effective treatment for psychosis-induced aggression or agitation, wherein clinicians are required to intervene to prevent harm to self and others. SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (26th May 2016). This register is compiled by systematic searches of major resources (including AMED, BIOSIS CINAHL, Embase, MEDLINE, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings, with no language, date, document type, or publication status limitations for inclusion of records into the register. SELECTION CRITERIA: Randomised controlled trials (RCTs) involving people exhibiting aggression and/or agitation thought to be due to psychosis, allocated rapid use of haloperidol alone (by any route), compared with any other treatment. Outcomes of interest included tranquillisation or asleep by 30 minutes, repeated need for rapid tranquillisation within 24 hours, specific behaviours (threat or injury to others/self), adverse effects. We included trials meeting our selection criteria and providing useable data. DATA COLLECTION AND ANALYSIS: We independently inspected all citations from searches, identified relevant abstracts, and independently extracted data from all included studies. For binary data we calculated risk ratio (RR), for continuous data we calculated mean difference (MD), and for cognitive outcomes we derived standardised mean difference (SMD) effect sizes, all with 95% confidence intervals (CI) and using a fixed-effect model. We assessed risk of bias for the included studies and used the GRADE approach to produce 'Summary of findings' tables which included our pre-specified main outcomes of interest. MAIN RESULTS: We found nine new RCTs from the 2016 update search, giving a total of 41 included studies and 24 comparisons. Few studies were undertaken in circumstances that reflect real-world practice, and, with notable exceptions, most were small and carried considerable risk of bias. Due to the large number of comparisons, we can only present a summary of main results.Compared with placebo, more people in the haloperidol group were asleep at two hours (2 RCTs, n=220, RR 0.88, 95%CI 0.82 to 0.95, very low-quality evidence) and experienced dystonia (2 RCTs, n=207, RR 7.49, 95%CI 0.93 to 60.21, very low-quality evidence).Compared with aripiprazole, people in the haloperidol group required fewer injections than those in the aripiprazole group (2 RCTs, n=473, RR 0.78, 95%CI 0.62 to 0.99, low-quality evidence). More people in the haloperidol group experienced dystonia (2 RCTs, n=477, RR 6.63, 95%CI 1.52 to 28.86, very low-quality evidence).Four trials (n=207) compared haloperidol with lorazepam with no significant differences with regard to number of participants asleep at one hour (1 RCT, n=60, RR 1.05, 95%CI 0.76 to 1.44, very low-quality of evidence) or those requiring additional injections (1 RCT, n=66, RR 1.14, 95%CI 0.91 to 1.43, very low-quality of evidence).Haloperidol's adverse effects were not offset by addition of lorazepam (e.g. dystonia 1 RCT, n=67, RR 8.25, 95%CI 0.46 to 147.45, very low-quality of evidence).Addition of promethazine was investigated in two trials (n=376). More people in the haloperidol group were not tranquil or asleep by 20 minutes (1 RCT, n=316, RR 1.60, 95%CI 1.18 to 2.16, moderate-quality evidence). Acute dystonia was too common in the haloperidol alone group for the trial to continue beyond the interim analysis (1 RCT, n=316, RR 19.48, 95%CI 1.14 to 331.92, low-quality evidence). AUTHORS' CONCLUSIONS: Additional data from new studies does not alter previous conclusions of this review. If no other alternative exists, sole use of intramuscular haloperidol could be life-saving. Where additional drugs are available, sole use of haloperidol for extreme emergency could be considered unethical. Addition of the sedating promethazine has support from better-grade evidence from within randomised trials. Use of an alternative antipsychotic drug is only partially supported by fragmented and poor-grade evidence. Adding a benzodiazepine to haloperidol does not have strong evidence of benefit and carries risk of additional harm.After six decades of use for emergency rapid tranquillisation, this is still an area in need of good independent trials relevant to real-world practice.
[Mh] Termos MeSH primário: Agressão/efeitos dos fármacos
Haloperidol/administração & dosagem
Agitação Psicomotora/tratamento farmacológico
Transtornos Psicóticos/tratamento farmacológico
Tranquilizantes/uso terapêutico
[Mh] Termos MeSH secundário: Agressão/psicologia
Antipsicóticos/administração & dosagem
Antipsicóticos/efeitos adversos
Distonia/induzido quimicamente
Haloperidol/efeitos adversos
Seres Humanos
Hipnóticos e Sedativos/administração & dosagem
Hipnóticos e Sedativos/efeitos adversos
Placebos/uso terapêutico
Transtornos Psicóticos/psicologia
Ensaios Clínicos Controlados Aleatórios como Assunto
Sono
Tranquilizantes/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Antipsychotic Agents); 0 (Hypnotics and Sedatives); 0 (Placebos); 0 (Tranquilizing Agents); J6292F8L3D (Haloperidol)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170801
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD009377.pub3



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