Agitation

Expressed anxiety that occurs in response to various irritating factors is agitation. Let's consider its main causes and symptoms, treatment methods.

Many specialists consider agitation as a pre-pathological condition within the boundaries of psychological norm. It manifests itself in the form of strong motor excitation, accompanied by anxiety, fear, poorly understood speech and other symptoms.

The disease occurs in the presence of severe stress and mental illnesses: Alzheimer's disease, depression, catatonic schizophrenia, neuroses. The disease also manifests itself in drug and alcohol intoxication, some infectious pathologies, and brain diseases.

The main types of psychomotor agitation and their signs:

• Catatonic – manifested by impulsiveness, lack of coordination, rhythmicity and monotony of movements, talkativeness.
• Hebephrenic – senseless actions, aggression. Occurs in schizophrenic disorder.
• Hallucinatory - concentration and tension, incoherent speech, defensive aggressive movements and gestures, changeable facial expressions. This type of agitation refers to the syndrome of clouding and is typical for people with alcoholism.
• Delusional state – ideas of persecution, increased aggressiveness, threats, use of force. Occurs in hallucinatory-delusional states, brain pathologies, symptomatic psychoses, schizophrenia.
• Manic excitement - elevated mood, accelerated thought processes and inconsistency of actions, fussiness.
• Anxiety – restlessness, desire to do something and move, pronounced motor reactions.
• Dystrophic - tension, mistrust, gloominess, anger.
• Eretic - destructive senseless actions with screams. Occurs in people with oligophrenia.
• Epileptiform - sudden movements, fear, delirium, hallucinations. After the end of the affective state, amnesia, disorientation in space and time are possible.
• Psychogenic - panic mood, fear, lack of understanding of what is happening. Manifested in mental trauma.

All types of agitation are characterized by uniform, conscious movements, excessive fussiness. In most cases, emotional instability can be corrected. For this, medications, psychotherapy and other treatment methods are used.

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Epidemiology

As medical statistics show, in healthy people, severe anxiety is in most cases associated with extreme situations when a person experiences increased stress and is unable to cope with it.

The painful condition also develops against the background of mental illnesses, most often schizophrenia, Alzheimer's disease, depression, various metabolic disorders. In some cases, the disorder manifests itself against the background of chronic alcohol and other intoxication of the body.

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Causes agitation

In most cases, emotional agitation is associated with severe stress and psychological trauma. The causes of agitation include changes in the usual environment, severe fear. This condition manifests itself in people whose professional activities are associated with a risk to life. It is also characteristic of such infectious and psychological diseases:

• Alzheimer's disease.
• Agitated or involutional depression.
• Senile decline.
• Endocrine pathologies.
• Hyperthyroidism.
• Bipolar mental disorder.
• Catatonic schizophrenia.
• Anxiety neurosis.
• Taking medications.
• Alcohol or drug intoxication.
• Withdrawal syndrome.
• Avitaminosis.
• Too much caffeine.

Overexcitement arising from emergency situations and other stress factors is very often perceived as confusion. In this case, the painful condition can proceed not only with emotional, but also motor anxiety.

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Agitation in Alzheimer's

One of the most common forms of dementia is Alzheimer's disease. The neurodegenerative disease is most often diagnosed in people over 50, but it can also occur at an earlier age. The main cause of senile dementia is the deposition of amyloid in brain tissue, which leads to disruption of neural connections and cell death, i.e. degeneration of the brain matter.

Patients with Alzheimer's disease experience various behavioral disorders: agitation, depression, paranoia, hallucinations, irritability, atypical behavior, clouding of consciousness. Such disorders interfere with normal life, increase the risk of various injuries, and cause problems with falling asleep and waking up.

Very often, agitation occurs due to fatigue, fear, or changes in the patient's usual environment or things. The diseased state occurs with unconscious motor and speech anxiety. The person becomes fussy and performs repetitive actions. Against this background, vegetative disorders may develop: sweating, catatonia, neuroses. Symptomatic therapy is performed to normalize the patient's condition.

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Risk factors

There are a number of triggers, that is, risk factors, that provoke the development of agitation. The main ones include:

• Acute stress reaction – occurs in mentally healthy people in extreme situations, after mental trauma.
• Acute forms of infectious diseases with damage to the central nervous system by toxins of pathogenic microorganisms.
• Epileptic disorder.
• Acute and chronic intoxications: alcohol, drugs, medications.
• Brain damage: craniocerebral trauma, postoperative complications, progressive paralysis. Hypoxia, intoxication, pre-comatose and comatose states.
• Mental illnesses: schizophrenia, bipolar affective disorder, manic agitation, depressive psychosis.
• Hallucinatory clouding of consciousness with delirium and visual hallucinations.
• Hysterical state.

Those at risk for developing an affective state include elderly patients and people whose nervous system is unable to effectively cope with stress and emotional experiences.

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Pathogenesis

The mechanism of development of overexcited state is not fully understood. Many experts believe that the pathogenesis of agitation is directly related to the following factors:

• Metabolic disorders.
• Intoxication processes.
• Autoimmune and immune reactions.
• Psychological characteristics of personality.
• Neuroreflex mechanisms.
• Cerebral ischemia.

Regardless of the etiology, an intense emotional impulse occurs with pronounced motor restlessness, automated motor operations, fussiness, and the need to move.

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Symptoms agitation

An intense emotional impulse has pronounced clinical symptoms, while the patient may not notice pathological signs. In most cases, agitation has a collective symptom complex:

• Increased pulse and breathing.
• Tremor of the limbs.
• Paleness of the skin.
• Increased sweating.
• Motor and speech restlessness.
• High blood pressure.
• Panic state.
• Feeling of fear.
• Meaningless active actions.

The above symptoms may be supplemented by visual and auditory hallucinations, sudden mood swings, aggression. Temporary memory impairment, problems with speech and cognitive functions are possible. Impaired coordination of movements. The patient cannot establish the cause-effect relationship of what is happening, walks from side to side, performs stereotypical actions.

Agitation may be accompanied by symptoms of the underlying disease. This condition is dangerous both for the patient and for those around him. The patient needs medical care. Often, therapy is carried out in a specialized medical institution.

At the initial stages, agitation is manifested by pale skin, trembling hands, rapid breathing, pulse and heartbeat. Against this background, increased sweating and blood pressure surges are observed.

During an attack, the ability to reason correctly and make cause-and-effect connections is lost. The person experiences severe anxiety and fear, and cannot calm down on his own. The patient is overcome by a paranoid certainty that something bad is about to happen. Speech changes, the patient monotonously repeats the same phrases. Restlessness and the need for constant movement are accompanied by delusional thoughts and aggression.

Affective state can occur against the background of Alzheimer's disease and other mental illnesses. In this case, the pathology is supplemented by auditory and visual hallucinations.

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Morning agitation

One of the reasons why morning agitation occurs is a disruption of night sleep. An anxious state can be one of the symptoms of neurological or mental illnesses. The influence of physiological and hereditary factors should not be excluded. For example, stress experienced the day before, deep experiences in personal life or at work can also provoke emotional nervous excitement.

Symptoms of the disorder:

• After waking up, a feeling of anxiety appears and quickly increases.
• General weakness and rapid fatigue.
• Trembling of the limbs.
• Sudden change of mood.
• Dizziness and headaches.
• Painful sensations in the heart area.
• Shortness of breath and lack of air.

An anxious state can provoke shallow, intermittent sleep with frequent awakenings, nightmares. Affective disorders are often accompanied by incomplete awakening, due to which a person inadequately perceives what is happening. After such awakening, repeated sleep does not occur for a long time.

The average duration of an agitation attack is about 20 minutes. Treatment is aimed at eliminating the root cause of the disease. If the pathology is associated with neuroses, depression or psychological deviations, the patient is prescribed antidepressants, neuroleptics, antipsychotics and other medications.

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Sedation Agitation Scale

Emotional nervous excitement requires a structured and consistent assessment. For this, the RASS Sedation Agitation Scale is used. It is one of the most informative methods for assessing anxiety. It consists of several subscales that are divided by a neutral boundary. This allows for a comprehensive assessment of the patient's condition.

Richmond Agitation-Sedation Scale:

Grade	Definition	Description
+4	Aggression	The patient is aggressive and poses a threat to both himself and the medical staff.
+3	Expressed excitement	Aggressive behavior towards others. Pulls or removes tubes and catheters.
+2	Excitation	Frequent non-purposeful movements and/or desynchronization with the ventilator.
+1	Anxiety	Excited, movements are not energetic. No aggression.
0		In adequate condition, calm.
-1	Drowsiness	Loss of attentiveness; does not close eyes for more than 10 seconds during verbal contact.
-2	Light sedation	When verbally contacted, closes eyes in less than 10 seconds.
-3	Moderate sedation	Any movement (but not eye contact) in response to the voice.
-4	Deep sedation	No response to voice. Shows activity to physical stimulation.
-5	No awakening	There is no response to voice or physical stimulation.

To diagnose a mental disorder, the following signs must be present: a sharp change or unstable mental state, attention deficit, disorganized thinking, the patient is not aware of current events. The RASS scale is most often used in intensive care to describe the degree of patient aggression, as well as in anesthesiology and resuscitation to determine the level of sedation depth.

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Complications and consequences

The main danger of agitation is that during an attack the patient can cause harm to himself or others. According to medical statistics, it is the affective state that is one of the causes of injuries and mutilations among medical personnel and people whose profession is directly related to extreme situations.

If the disorder arose against the background of another disease, for example, with damage to the brain and central nervous system, mental syndromes, then the consequences consist in the complication of the main pathology. With timely treatment, anxious sensitivity is easily corrected and does not cause complications.

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Diagnostics agitation

Confirming the diagnosis of agitation presents a number of difficulties. If emotional nervous excitement is suspected, long-term observation of the patient is required to assess his condition. In addition to an external examination, the patient is prescribed a set of such studies:

• Clinical analysis of urine and blood.
• Thyroid hormone test.
• Blood alcohol test.
• Computed tomography.
• Magnetic resonance imaging of the brain.
• Measuring blood pressure and pulse.
• Screening of used drugs.

During the diagnosis, the psychiatrist determines the current symptoms, collects personal and family history, and carefully studies the patient's medical history. Particular attention is paid to differentiating agitation from diseases with similar symptoms.

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Differential diagnosis

This type of research is aimed at distinguishing psychomotor agitation from other pathologies and psychotic symptoms. When differentiating, agitation is distinguished from the following disorders:

• Manic excitement.
• Schizophrenia.
• Delirium.
• Delirium.
• Epileptiform excitation.
• Complications after brain injuries and central nervous system damage.
• Neuroinfections.
• Tumor formations.
• Depressive disorders.
• Bipolar disorder.
• Stress response.
• Akathisia.
• Various intoxications of the body.

If the patient has chronic diseases, they are also taken into account in the differentiation process.

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Akathisia and agitation

Impaired motor function with a constant feeling of internal anxiety and the need to perform the same type of movements is akathisia. Agitation can occur against the background of this disorder.

There are two main factors in the development of akathisia:

1. Pathophysiological – disruption of blood supply or oxygen starvation of the brain, various injuries and postoperative complications.
2. Medicinal – overdose or prolonged use of drugs from the following pharmacological groups: neuroleptics, antidepressants, antiemetics, antipsychotics that affect the regulation of dopamine levels.

Very often, the pathological condition occurs against the background of Parkinson's disease and other pathologies with similar symptoms. Akathisia causes a feeling of anxiety, which varies in intensity from mild anxiety to excruciating discomfort.

Like agitation, akathisia has several types:

• Acute – lasts about 4-6 months, appears after the start of taking antipsychotic drugs. Causes acute symptoms, while the patient experiences anxiety and is fully aware of what is happening.
• Chronic – persists for more than six months even after adjusting the dosage of medications. Provokes motor restlessness with stencil movements, mild dysphoria.
• Pseudoakathisia – occurs more often in men. Manifested by motor disorders, the patient is not aware of what is happening.
• Late – associated with changes in therapeutic regimens of antipsychotic drugs.

To diagnose akathisia, the Barnes scale is used, which allows one to evaluate objective and subjective criteria of the patient's behavior. Very often, the disorder is mistaken for agitation and other psychotic disorders. Treatment is aimed at eliminating the root cause of the painful condition.

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Treatment agitation

If you seek medical help in a timely manner, treatment of anxiety sensitivity is quite effective, since many causes of the disorder are easily corrected. If agitation is not caused by mental or infectious diseases, then the following medications are used for treatment:

• Tranquilizers.
• Sedatives and antidepressants.
• Anxiolytic and antipsychotics.
• Mood stabilizers.
• Neuroleptics and nootropics.
• Multivitamin complexes.

If agitation is caused by infectious diseases, then antibacterial, non-steroidal anti-inflammatory and other medications are used for therapy. Patients are also prescribed a course of psychocorrection, family psychotherapy, and spa treatment. Psychotherapy helps develop methods for combating the first symptoms of an emotional impulse and increases stress resistance.

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Treatment of agitation with drugs

One of the mandatory components of treating emotional agitation is the use of medications. Psychotherapy and non-verbal methods are effective in the early stages of the disorder. In the future, patients are prescribed pharmacotherapy:

• Antidepressants with a sedative effect - are used if the disorder is caused by depressive states. They have a calming effect, but provoke dry mouth, bowel disorders, drowsiness.

1. Prozac

A drug with an antidepressant effect. Contains the active component - fluoxetine, which inhibits the reuptake of serotonin and does not bind to other receptors. Increases the level of serotonin in the brain structures, increasing the duration of its stimulating effect. Reduces anxiety, fear and tension, improves mood, helps reduce dystrophy.

• Indications for use: depressive states of various etiologies, nervous bulimia, obsessive-compulsive disorder, premenstrual dystrophic disorder.
• Method of administration: orally 20 mg of the drug per day. The duration of therapy is determined by the attending physician, individually for each patient.
• Side effects: hot flashes, decreased blood pressure, dry mouth, nausea, vomiting, diarrhea, changes in taste. Increased fatigue and weakness, paresthesia, headache, feeling of weakness, drowsiness, skin allergic reactions, etc.
• Contraindications: intolerance to the components of the drug, pediatric practice. Not used simultaneously with drugs that inhibit monoamine oxidase. With special caution, it is prescribed for patients with suicidal thoughts. Use during pregnancy is possible only on medical prescription.
• Overdose: nausea, vomiting, tachycardia, convulsions, drowsiness, coma, fainting. There is no specific antidote. Symptomatic therapy is indicated for treatment.

Release form: capsules of 14 pieces in a blister, 1, 2 blisters in a package.

2. Paxil

Antidepressant, affects the pathogenetic link of depression, compensates for the deficiency of serotonin in the synapses of neurons of the brain. Contains the active component - paroxetine, which is similar to muscarinic cholinergic receptors and has weak anticholinergic properties. Quickly reduces anxiety, insomnia. May cause vomiting, diarrhea, decreased libido, weight gain.

• Indications for use: depression of various origins, obsessive-compulsive disorder, obsessive-compulsive disorder, panic attacks, social phobias, anxiety disorders, nightmares.
• Method of administration: the drug is taken in the morning, before meals. The dosage and duration of treatment is determined by the attending physician, individually for each patient.
• Side effects: emotional lability, drowsiness, headaches, tremors of the extremities, dry mouth, nausea and vomiting, hepatotoxic effect, allergic reactions.
• Contraindications: hypersensitivity to the components of the drug, patients under 18 years of age, pregnancy and lactation. Not used in treatment with MAO inhibitors, Tryptophan, Thioridazine, Pimozide.
• Overdose: nausea, vomiting, asthenia, drowsiness, dizziness, convulsive state, urination and heart rhythm disorders, confusion, changes in blood pressure. In rare cases, liver failure and comatose state occur. Gastric lavage, artificial vomiting, and intake of adsorbents are indicated for treatment.

Release form: tablets for oral administration, 10, 30 and 100 pieces per package.

3. Cipramil

Psychoanaleptic-antidepressant, selective serotonin reuptake inhibitor. Its action is similar to histamine, dopamine and muscarinic receptors. Does not affect cardiovascular parameters, optimizes emotional state.

• Indications for use: panic attacks, phobias, obsessive-compulsive disorder, anxiety syndrome, depressive states of various etiologies.
• Method of administration: orally, initial dosage 20 mg once a day at any time. If necessary, the dosage is increased to 60 mg. The duration of treatment depends on the severity of the disease.
• Side effects are transient. In most cases, after 14 days of use, the undesirable symptoms disappear. The drug can cause gastrointestinal disorders, bowel disorders, tremors, sleep disorders, dizziness, loss of consciousness.
• Contraindications: hypersensitivity to the components of the drug, suspected serotonin syndrome, pregnancy and lactation.
• Overdose: abnormal heart rhythm, nausea, vomiting, convulsions, drowsiness, increased sweating. Detoxification therapy is indicated for treatment.

Release form: tablets for oral administration with enteric coating, 10 pieces per package.

4. Siozam

A medicinal product with antidepressant properties. Contains citalopram, a selective serotonin reuptake inhibitor.

• Indications for use: depressive states, panic disorders, agoraphobia. The medicine is taken orally, once a day. The duration of therapy and dosage are calculated by the doctor.
• Side effects: heart rhythm disturbances, bleeding, dizziness, sleep disturbances, skin allergic reactions, nervousness, headaches, convulsions, etc. Withdrawal syndrome may also develop.
• Contraindications: intolerance to the components of the drug, unstable epilepsy, pregnancy and lactation, recent therapy with MAO, tendency to bleeding, impaired functions of the urinary system and liver, elderly patients.
• Overdose: epileptic seizures, coma, drowsiness, nausea, convulsions. There is no specific antidote, treatment is symptomatic.

Release form: film-coated tablets, 10 pieces per blister, 2 blisters per package.

5. Oprah

Antidepressant, selective serotonin reuptake inhibitor. Contains citalopram, which inhibits serotonin reuptake, does not affect histamine and muscarinic receptors, adrenergic receptors. Has low toxicity, therapeutic doses do not affect blood pressure, body weight, kidney and liver function, hematological parameters.

• Indications for use: depressive illnesses, mild forms of panic disorders, fear of open spaces, obsessive-compulsive disorder, neuroses.
• Method of administration: orally, at any time of the day. The duration of therapy and the required dosage are determined by the attending physician. In case of agitation and similar conditions, take 10 mg per day for a week with a subsequent increase in dosage to 20 mg.
• Side effects: various disorders of the peripheral and central nervous system, serotonin syndrome. Nausea, vomiting, dry mouth, changes in blood pressure, decreased libido, allergic reactions, etc.
• Contraindications: hypersensitivity to the components of the drug, pediatric practice. With special caution, it is prescribed to patients with epilepsy, a tendency to seizures, with reduced kidney and liver function. For elderly patients, minimal doses are prescribed.
• Overdose: dysarthria, dizziness, nausea and vomiting, sinus tachycardia, drowsiness, increased sweating. In rare cases, cardiac conduction disturbances, convulsions, and comatose state occur. There is no specific antidote. Gastric lavage and enterosorbents are indicated for treatment.

Release form: tablets in blisters of 10 pieces, 1, 2, 10 blisters per package.

• Anxiolytics are psychotropic drugs that reduce and suppress anxiety, worry, fear, and emotional stress.

1. Helex

A drug with a potent active ingredient - alprazolam. It has a sedative-hypnotic effect, reduces the excitability of the cerebral subcortex, inhibiting spinal reflexes. Eliminates emotional stress, anxiety, worry and fear. It exhibits anticonvulsant, muscle relaxant and sedative activity. Reduces the number of night awakenings, increasing the duration and quality of sleep.

• Indications for use: panic and anxiety disorders, insomnia, agitation, irritability, tension. Anxiety disorders with mixed depressive and anxious states caused by somatic pathologies or alcohol intoxication.
• Method of administration: orally, 0.25-0.5 mg three times a day. The duration of therapy is determined by the attending physician.
• Side effects: headaches and dizziness, increased fatigue, drowsiness, absent-mindedness, slow psychomotor reactions, decreased appetite, thrombocytopenia, ataxia, development of dependence.
• Contraindications: allergic reactions to alprazolam and other substances in the drug, closed-angle glaucoma, respiratory failure, myasthenia, shock, epilepsy, renal and hepatic failure. Not prescribed for patients under 18 years of age, during pregnancy and lactation.
• Overdose: drowsiness, confusion, bradycardia, respiratory distress, hypotension, coma, decreased reflexes.

Release form: tablets for oral administration of 0.25, 0.5 and 1 mg in blisters of 15 pieces. There are two blisters in a package.

2. Relanium

A psycholeptic drug with the active component diazepam. It has anxiolytic, sedative, anticonvulsant properties. Increases the threshold of pain sensitivity.

• Indications for use: anxiety-phobic and anxiety-depressive states, alcoholic delirium, epileptic status, acute muscle spasms. It is used as premedication before general anesthesia. As sedation before endoscopy, dental treatment, cardiac catheterization.
• Method of administration and dosage: intravenously by drip or infusion. The dosage depends on the patient's body weight, so it is determined by the doctor for each patient individually.
• Contraindications: hypersensitivity to benzodiazepines and other components of the drug, severe respiratory failure, respiratory depression, severe renal/hepatic failure, hypercapnia, sleep apnea syndrome, phobias, chronic psychosis, comatose and shock states, alcohol or drug intoxication.
• Overdose: drowsiness, lethargy, bradycardia, decreased blood pressure. Allergic reactions at the injection site. Increased sweating, slow speech, muscle weakness, accommodation disorder, anxiety, visual impairment, metabolic disorders, etc.

Release form: ampoules of 2 ml solution, 5 ampoules per package.

3. Serax

Benzodiazepine derivative with the active substance diazepam. Reduces excitability of the subcortical areas of the brain responsible for communication with the cerebral cortex. Enhances inhibition processes in synapses, facilitates GABA transmission. Exhibits anxiolytic, antiarrhythmic, muscle relaxant and spasmolytic activity. Suppresses vestibular paroxysms and reduces gastric juice secretion.

• Indications for use: neurotic and anxiety disorders, withdrawal states, muscle hypertonia, dysphoria, arthritis, tetanus, insomnia, psychopathy, menopause, PMS, epilepsy, psychosis, schizophrenia, senestohypochondriac disorders. Premedication, general anesthesia.
• The method of administration and dosage depend on the form of the drug and are determined by the attending physician. Tablets are taken orally, injections are administered intravenously in the form of a solution.
• Side effects: ataxia, increased fatigue, decreased performance, disorientation, impaired coordination, headaches, confusion, myasthenia, catalepsy, tremor, skin allergic reactions. Withdrawal syndrome, muscle weakness, and respiratory distress may develop upon discontinuation of treatment.
• Contraindications: intolerance to the components of the drug, pregnancy and lactation, coma, Lennox-Gastaut syndrome, hypersensitivity to diazepam. Not used in acute alcohol and drug intoxication, severe COPD, closed-angle glaucoma, acute respiratory failure, for patients under 6 months.
• Overdose: drowsiness, paradoxical agitation, confusion, bradycardia, apnea, difficulty breathing, shortness of breath, tremor, collapse, depression of cardiac activity. Flumazenil is used for treatment with further symptomatic therapy.

Release form: ampoules of 0.5% solution, 10 pieces per package. Tablets are available in 10 and 20 pieces per pack.

4. Grandaxin

A medicinal product with tranquilizing activity. Does not cause drowsiness, does not have anticonvulsant or muscle relaxant effects.

• Indications for use: neuroses and neurosis-like conditions, tension and vegetative disorders, moderate fear, apathy, decreased activity. Alcohol withdrawal syndrome.
• Method of administration: orally 50-100 mg 1-3 times a day. The duration of treatment depends on the severity of the disease.
• Side effects: increased excitability, dyspeptic disorders, allergic reactions.
• Contraindications: intolerance to the components of the drug, first trimester of pregnancy. Prescribed with caution in psychopathic disorders with increased excitability, irritability, withdrawal syndrome.

Release form: tablets of 10 mg, 50 pieces per package. Granules for the preparation of suspension for oral administration, 20 g per jar.

5. Relium

Anxiolytic, sedative and anticonvulsant with the active component diazepam. Depresses several structures in the central nervous system. Reduces the severity of seizures, exhibits sedative and hypnotic activity.

• Indications for use: anxiety disorders, insomnia, premedication for minor surgical interventions. Muscle spasms associated with spasms of cerebral genesis, complex therapy of epilepsy.
• Method of administration: orally, 5-30 mg depending on the severity of the disease. The duration of treatment depends on the results in the first days of therapy. The maximum duration is 12 weeks, with longer therapy there is a risk of withdrawal syndrome.
• Side effects: drowsiness, muscle weakness, circulatory failure, bradycardia, arterial hypotension, heart failure. Headaches, tremors, speech disorders and dizziness, aggression, allergic reactions, etc.
• Contraindications: hypersensitivity to the components of the drug, pregnancy and lactation, sleep apnea syndrome, severe respiratory failure, severe forms of renal and hepatic failure, obsessive and phobic conditions. It is prescribed with caution in chronic respiratory failure, porphyria, glaucoma.
• Overdose: ataxia, nystagmus, dysarthria, ataxia, arterial hypotension, depression of cardiac and vascular function. To normalize the patient's condition, administration of Flumazenil and further symptomatic therapy are indicated.

Release form: tablets in cell packs of 20 capsules per blister, 1 blister per pack.

• Antipsychotics (neuroleptics) – used for clouded consciousness, delusional states, paranoia.

1. Haloperidol

A neuroleptic with pronounced antipsychotic properties. It is used for schizophrenia, manic, delusional and hallucinatory states. It is prescribed for psychoses, in the complex therapy of pain syndrome, angina, vomiting and nausea.

The medicine is taken orally at 15-30 mg or intramuscularly/intravenously at 0.4-1 ml of 0.5% solution. Side effects include extrapyramidal disorders and insomnia.

The drug is contraindicated in diseases of the central nervous system, cardiac conduction disorders, and renal dysfunction. Haloperidol is available in packages of 50 tablets and in the form of ampoules of 1 ml of 0.5% solution in a package of 5 pieces, as well as in vials of 10 ml of 0.2% solution.

2. Risperidone

Selective monoamine antagonist. Suppresses symptoms of schizophrenia without suppressing the patient's motor activity. Eliminates delusional syndrome and hallucinations, reduces manifestations of phobias and aggression.

• Indications for use: acute and chronic schizophrenia, psychoses with productive symptoms, affective disorders of various etiologies. Complex therapy of bipolar disorder and manic syndrome. Acquired dementia, aggression, delusional syndrome, mental retardation.
• Method of administration: orally 1-2 times a day, the dosage is selected by the attending physician for each patient individually.
• Side effects: sleep disturbances, increased fatigue, agitation, convulsive activity, genitourinary disorders, decreased libido, arthritis, arthrosis, skin allergic reactions.
• Contraindications: identified sensitivity to the components of the drug. Use during pregnancy is possible only under strict medical indications.
• Overdose: drowsiness, sedation, tachycardia, arrhythmia, vascular dystonia. Treatment includes gastric lavage, sorbents, laxatives and symptomatic medications.

Release form: tablets for oral administration, 10 pieces per package.

3. Zyprexa

An antipsychotic drug with anti-anxiety and potentiating effects. Binds to receptors in the central nervous system, reduces excitability in neurons of the mesolimbic region, affecting the striatal nerve tracts.

• Indications for use: injections are prescribed for agitation of psychomotor etiology, bipolar affective disorder, schizophrenia, dementia. Tablets are prescribed for the prevention of exacerbations of schizophrenia, affective disorders, depressive-delusional syndrome, psychosis. The method of administration and dosage are individual for each patient.
• Side effects: convulsions, drowsiness, asthenia, hyperprolactinemia, akathasia, leukopenia, diabetic coma, bowel disorder, allergic reactions.
• Contraindications: hypersensitivity to oxazapines. Prescribed with caution in case of tendency to convulsions, leukopenia, neutropenia, intestinal obstruction of paralytic nature, suppression of bone marrow hematopoiesis, closed-angle glaucoma. Use during pregnancy is possible only according to strict medical indications.
• Overdose: convulsions, aspiration, extrapyramidal disorders, tachycardia, impaired consciousness, dyspnea, aggression, hypertension, hypotension. There is no specific antidote, treatment is symptomatic.

Release form: lyophilisate in the form of tablets and dispersible capsules, 28 pieces per package.

4. Leponex

An antipsychotic drug for the treatment of schizophrenic disorders. The dosage regimen is determined individually for each patient. Treatment begins with a minimum dosage of 12.5 mg once a day. Side effects include gastrointestinal disorders, skin allergic reactions, and other painful symptoms.

Leponex is contraindicated in case of hypersensitivity to its components, bone marrow dysfunction, psychosis due to alcohol or toxic substance abuse. It is not used to treat pregnant women and during breastfeeding.

Overdose causes drowsiness, impaired consciousness, comatose state, increased emotional arousal, convulsive states, hypersecretion of the salivary glands, pathologies of the visual system, low blood pressure and other painful symptoms. Gastric lavage and intake of absorbents are indicated for treatment. The medicine is available in tablet form, 10 pieces per package.

5. Chlorprothixene

Neuroleptic and tranquilizing drug. Has an inhibitory effect on the central nervous system. Enhances the activity of sleeping pills and painkillers.

• Indications for use: psychosis with fear and anxiety, neurotic states, anxiety, aggression, sleep disorders. Somatic diseases with neurosis-like disorders, skin itching.
• Method of administration: orally 50 and 25 mg, maximum daily dosage 600 mg with its gradual reduction.
• Side effects: drowsiness, increased heart rate, hypotension, impaired coordination of movements, dry mouth.
• Contraindications: alcohol intoxication and barbiturate poisoning, tendency to collapse, epilepsy, blood diseases, parkinsonism.

Release form: tablets of 15 and 50 mg per package, ampoules of 1 ml of 2.5% solution.

In addition to the above-mentioned drugs, vitamin therapy is recommended for agitation. It is aimed at increasing the protective forces of the immune system and preventing a deficiency of nutrients in the body. All medications are prescribed by the attending physician.

Prevention

Prevention of emotional nervous excitement is aimed at maintaining mental health. Prevention of agitation consists of:

• Minimizing stressful situations.
• Refusal to use alcohol and drugs.
• Taking medications only as prescribed by a doctor, following all recommendations regarding the duration of therapy and dosage of the medication.
• Treatment of mental illnesses.
• Vitamin therapy.
• Healthy, full sleep.
• Favorable emotional background.

In some cases, agitation is a normal variant, for example, in an acute stress situation. In this case, preventive methods allow to minimize its manifestations.

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Forecast

With timely medical attention and correct diagnosis, the prognosis for agitation is favorable. Treatment is carried out in a hospital setting for 15-20 days. A comprehensive treatment approach allows you to minimize the risk of relapse. If you refuse to go to the hospital and try to cope with the pathology on your own, the outcome of the disease is unpredictable.

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