Psychomotor agitation: signs, first aid, drug treatment

Many neuropsychiatric pathologies may be accompanied by a condition characterized by hypermobility and abnormal behavior that does not correspond to the situation. It manifests itself in varying degrees - from fussy persistent agitation to uncontrolled aggression. The patient's actions 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 this state, especially if inaccessible to contact, may be dangerous to others and himself, moreover, he will not seek help himself, because he is unable to control his behavior. Psychomotor agitation suggests the development of acute psychosis, therefore requires the provision of emergency psychiatric care.

[1], [2], [3], [4], [5], [6]

Causes of the psychomotor agitation

In order to survive this state, it does not necessarily have to be a mentally ill person. It can arise as one of the types of reactive psychosis (psychogenic shock) that a person experiences as a result of very strong emotional upheavals. It can be an event that threatens the life of a person or people very close to him - an accident, a report of an incurable disease, any significant loss, and so on. At risk are people with psychopathic traits, paranoid tendencies, emotionally labile, prone to hysteria, accentuated individuals whose abnormalities are sufficiently compensated and do not reach the pathological level.

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

The development of psychomotor excitement 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 stroke often develops with hemorrhagic form of vascular catastrophe, with ischemia - is also not excluded, but less pronounced.

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

[7], [8], [9], [10], [11]

Risk factors

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

[12], [13], [14], [15], [16], [17]

Pathogenesis

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

[18], [19], [20]

Symptoms of the psychomotor agitation

This state of abnormal hyperactivity is characterized by age features. Psychomotor agitation in young children is expressed in monotonous repetitions of cries, one of any phrases or questions, movements - nodding, rocking from side to side, jumping. Children cry wistfully and monotonously, laugh hysterically, grimace, bark or howl, gnaw their nails.

Older children move unceasingly, they all crush and tear, sometimes manifestations of aggression are frankly sadistic. They can depict babies - sucking a finger for a long time, excitedly babbling like a child.

Psychomotor agitation in elderly people is also characterized by motor and speech monotony. Is manifested by fussiness, anxiety or irritability and grumbling.

And although the clinical picture of different species of this condition has symptomatic differences (described below), the first signs always manifest unexpectedly and sharply. The behavior of the patient attracts attention - inadequate movements, violent emotions, defensive reactions, aggressive actions, attempts to inflict injury.

In the mild stage of psychomotor agitation, the patient is unusually mobile, talkative, obviously hypertensive, but the abnormality of behavior is not yet very 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, unrestrained fun) and lack of critical attitude to one's behavior. Acute psychomotor agitation in the third stage is a very dangerous condition requiring emergency medical care. Affects are off scale: consciousness is darkened, speech and movements are chaotic, there may be delusions, hallucinations. In such a state the patient is inaccessible to contact and is very dangerous to others and himself.

Forms

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

Depressive syndromes are characterized by anxious arousal. Motor reactions in this case are endless monotonous repetitions of simple movements, accompanied by speech repetitions of the same phrase, words, sometimes just groans. Periodically observed raptus - sudden impulsive attacks, violent cries, self-damaging actions.

Psychogenic arousal occurs against a background of a strong mental shock or in circumstances that pose a threat to life. It is accompanied by the symptomatology of affective-shock disorder: mental and motoric overexcitation, vegetative disorders - increased pulse and respiration, dry mouth, hyperhidrosis, dizziness, tremor of extremities, fear of death. Various variants of symptoms are possible - from catatonic or anxious to senseless panic actions. There may be attempts at suicide, flight from the scene. With global cataclysms and catastrophes, psychogenic excitation is of a group nature.

Psychopathic excitation 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 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 traits. Aggression, anger, anger is directed at individuals who offended the patient, who did not appreciate his achievements. Most often expressed in threats, abuse, physical actions, suicide attempts, whose demonstrative nature is intended to provide a broad audience, which is especially characteristic of the hysterical subspecies of psychopathic excitement, when the game on the viewer is accompanied by violent emotions. Mimicry 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 situation and, in most cases, control the situation and can withhold violation of the law, as they realize that they will be responsible for their actions. Nevertheless, 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. It takes a defensive position more often, attempts to establish contact react with a 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 the performance of any purposeful action, while accelerated thinking is characterized by a lack of logic, attempts to prevent an individual in such a state can cause violent aggression. Patients often miss words in sentences, it seems that their actions do not keep up with the thought. The voice in patients acquires hoarseness and not one of their actions can not be brought to a logical conclusion.

Catatonic excitation - impulsive rhythmic repetitions of monotonous indistinct murmuring, singing, scolding, grimacing, jumping, cries, pretentious unnatural movements and poses. Some patients inherent in the mannerisms - they greet everyone in succession and several times, try to conduct a small talk, asking the same questions.

In schizophrenics, there is often a hebephrenic agitation, the specific feature of which is foolish behavior; nevertheless, subject to a sudden impulse, it can go into aggression with elements of delusions, illusory visions, and psychic automatism.

Epileptiform psychomotor agitation, which is most susceptible to epileptics with a temporal lesion, is accompanied by confusion of consciousness, spatial and temporal disorientation, contact with the patient is impossible. Appears suddenly - is expressed by motor hyperactivity, aggressive actions. The patient defends himself from fictional enemies, strive to escape from them. There is an angry-intense affect, often such seizures are accompanied by the commission of violent actions. The excited state lasts about one to two minutes, then it also suddenly goes away. After that the patient does not remember his actions and for some time (at least 10 minutes) remains inaccessible to contact.

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

Delirious psychomotor agitation arises under the influence of psychoactive substances or in chronic alcoholics, drug addicts with experience - as a withdrawal syndrome, and also - with trauma, neuroinfections, tumors. Expressed chaotic senseless movements, tense concentration, incoherent speeches, changeable facial expressions, aggressive gestures. This kind of psychomotor agitation is almost always accompanied by delirium and hallucinations, under the influence of which patients are inclined to commit unmotivated attacks on imaginary enemies and / or self-damaging actions.

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

In patients with hallucinatory arousal, first of all, a very rich facial expression, they focus on their illusions, are hostile to others, their speech is usually incoherent.

Diametrically opposite state is psychomotor inhibition or stupor. This condition is characterized by hypo- and akinesia, decreased muscle tone, taciturnity or simply dull silence. Sometimes the patient is available to contact, sometimes not. The causes and types that caused psychomotor inhibition are similar to excitation, in addition, one state can be replaced by another, sometimes quickly and unexpectedly.

[21], [22], [23], [24], [25]

Complications and consequences

The most significant result of psychomotor agitation is the infliction of bodily injuries that are incompatible with life, self or others. Less significant - minor injuries and damage to property. Especially dangerous are patients who can not be contacted, with catatonic and hallucinatory-delusional kinds of stimulation, since their impulsive effects can not be predicted.

In addition, the emergence of such a condition may indicate the presence in the individual of serious diseases of the psyche or nervous system that require urgent action.

[26], [27], [28], [29]

Diagnostics of the psychomotor agitation

Prehospital diagnostics are performed 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 aimed directly at health workers.

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

However, some questions that will help to conduct differential diagnosis should be clarified, if not by the patient himself, then by his close people: whether the patient had such conditions before that preceded the onset of arousal, whether the patient has a psychiatric or neurologic diagnosis, whether he took psychoactive substances the day before whether he received injuries, whether alcoholism suffers, whether there have been attempts at suicide and others before.

On examination, the doctor should focus on identifying specific symptoms of the condition of the patient, whether they are increasing, whether there are delusions, or galucinations. Pay attention to the intensity of the affect, the presence of demonstrativeness, to try to determine the severity of psychomotor excitement - as the patient says (and the patient moves (especially loud, non-stop, meaningless speech and hyperkynetism combined with lack of response to requests, comments, orders of others) are the basis for hospitalization.

[30], [31],

Differential diagnosis

Differential diagnosis is carried out between psychomotor excitations without psychotic symptoms and with them. It is necessary to distinguish between psychogenic and psychopathic arousals from manic, epileptiform, schizophrenia, delirium.

Delirious disorders caused by taking psychoactive substances and requiring their neutralization from delirium caused by other causes - neuroinfections, epilepsy, tumors. Affective disorders - from each other, in particular, a large depressive disorder (clinical depression), characterized by long-term preservation of mood in one condition, are differentiated from intermittent manic and depressive episodes (bipolar disorder). Stress also needs differentiation from mental illnesses and the severity of the stress response indicates what measures to take.

[32], [33]

Treatment of the psychomotor agitation

In the overwhelming majority of cases, patients in a state of psychomotor agitation are dangerous, to a greater extent - for others, but sometimes they exhibit autoaggression. Prevent unwanted effects can be an emergency aid for psychomotor agitation. The patient is trying to isolate and not leave one, watching him, if possible, is not too noticeable, as a demonstrative observation can cause an attack of aggression on the part of the patient. Be sure to call an ambulance. Usually such a call is sent to a psychiatric team, before arriving in difficult cases it is possible to call the police, which is required by law to provide psychiatric help.

Algorithm of assistance at the prehospital stage - prevention of aggression on the part of the patient with the help of persuasion, distraction and physical strength (holding the patient). Of course, first of all, if the patient is available to the contact, they try to persuade him to take the medicine or allow him to inject and voluntarily go to the hospital.

In severe cases (the patient actively resists, menacingly behaves or has arms), law enforcement agencies are involved and assistance is rendered without the consent of the patient.

Empathetic patients are temporarily immobilized or immobilized with the help of improvised means or a straitjacket for the time necessary for transportation, while the medicines have not yet worked.

The main recommendations for tying a patient in psychomotor excitation are that soft and wide materials are chosen from improvised means - sheets, towels, cloth belts, which should not squeeze the vessels and nerve trunks of the body. It is necessary to reliably fix each hand of the patient separately, and also - the humeral girdle. Basically, this is enough. In especially violent and mobile patients immobilize and lower limbs. Thus it is necessary to be convinced of impossibility independently to get rid of fixing bandages. The condition of the immobilized patient must be constantly observed.

Coping of psychomotor agitation is medicated, except for cases of emergency surgery, when hyperactivity is a sign of progressive compression of the brain.

The most widely used drugs for psychomotor agitation are neuroleptics with a pronounced sedative effect. Parenteral administration is most often used - intramuscular or intravenous. If the patient gives in to persuasion, you can use parenteral forms of drugs. Patients who have never been treated with antipsychotics are given a minimally effective dose. Those who had previously been treated with psychotropic drugs - the dose is doubled. The patient is constantly monitored by the level of arterial pressure, respiratory function and the absence of signs of orthostatic phenomena. In more mild cases, as well as - weakened and elderly patients are assigned tranquilizers. Naturally, these drugs do not combine with alcohol.

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

In cases of anxious arousal in the mild and moderate stage, the drug Atarax is prescribed  . The active substance of the drug hydroxyzine dihydrochloride is a blocker of H1-histamine, as well as - choline receptors, has a moderate anxiolytic effect, besides it provides hypnotic and antiemetic effect. It is a tranquilizer of rather mild action. In case of anxious excitation, the process of falling asleep is accelerated, the quality of sleep and its duration improves. The relaxing effect of the drug on the musculature and sympathetic nervous system contributes to this effect.

In addition, Atarax generally has a beneficial effect on memory, concentration and memorization, but this is a remote effect. And during reception it is necessary to refuse driving of the car, works at height, with electroconducting, etc.

The active ingredient is absorbed with good speed in the gastrointestinal tract. The effect of taking pills comes 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 overcomes the placental barrier, cumulates in the tissues of the unborn child, penetrates into breast milk, so it is contraindicated for pregnant and lactating women.

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

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

Basically, it causes drowsiness, weakness, subfebrile condition, blurred vision, dyspepsia, hypotension.

With moderate psychomotor agitation, elderly and weakened patients, and also - for the purpose of arresting pre-dilerial arousal or symptoms of withdrawal of psychoactive substance, the drug Grandaxin can be used  . The active substance tofisopam belongs to the benzodiazepine group. This drug reduces mental stress, reduces anxiety, has a mild sedative effect. However, it is believed that it does not cause drowsiness, muscle relaxation and anticonvulsive effect, therefore, when expressed psychomotor agitation, its use is inexpedient. The drug can cause an increase in excitation, dyspepsia and allergic reactions. In the first three months of pregnancy is prohibited, then - only for life indications. Breastfeeding women can be taken if lactation is stopped. Side effects are more common in people with hepatic and renal dysfunction, mentally retarded and in advanced age.

In case of epilepsy, this drug can cause convulsions, in conditions of depressive anxiety, the risk of attempts to settle scores with life increases, special care should be taken with patients with organic brain disorders, as well as suffering from personality disorders.

Another benzodiazepine anxiolytic  Relanium  (the active ingredient is diazepam) is often used in emergency cases of acute psychomotor anxiety. It is applied either orally, or parenterally - intramuscularly and intravenously. The drug, in contrast to the previous one, has a pronounced hypnotic, anticonvulsant and muscular relaxing muscles.

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

Soothing and hypnotic action is realized, mainly, by influencing the neurons of the reticular formation of the brain stem.

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

Relanium weakens the delirious excitement of alcoholic etiology, however, the productive manifestations of psychotic disorders (delirium, hallucinations) have virtually no effect.

Contraindicated with severe respiratory failure, a tendency to stop breathing in sleep and the patient's muscle weakness. Also not used for comatose conditions, for the treatment of patients with phobic disorders and chronic psychoses. Contraindicated in patients with glaucoma, especially with a closed-angle, with severe dysfunction of the liver and kidneys. Chronic alcoholics and drug addicts are prescribed exclusively for arresting the excitement caused by withdrawal syndrome.

In bipolar and other types of mixed disorders with predominance of the anxiety component, the preparation Amitriptyline may be used to stop the attack of psychomotor agitation  . Belongs to the class of tricyclic antidepressants, it is available both in tablet form and in injectable form. Increases the concentration of catecholamines and serotonin in the synaptic cleft, inhibiting the process of their re-uptake. It blocks choline and histamine receptors. Improving mood when taking the drug is simultaneously reinforced 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 should be at least two weeks.

Paradoxical side effects are possible, as well as increased drowsiness, headache, coordination disorder, dyspepsia. The drug is not recommended to appoint in the manic phase of bipolar disorder, epileptics and patients with suicidal tendencies. Contraindicated in children up to the age of twelve, with special care is assigned to men suffering from prostate adenoma, people of both sexes with dysfunction of the thyroid gland, heart and blood vessels, glaucoma, patients with myocardial infarction, pregnant and lactating women.

Sleeping drug with antipsychotic action  Tiapride  blocks adrenoreceptors of the brain stem. In parallel, it exerts an antiemetic effect by blocking the receptors of the neurotransmitter dopamine in the chemoreceptory trigger zone of the brain, and also 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 genesis, including alcohol, drug and senile aggression. Orally, the drug is taken with minimal doses, leading to effective doses.

Non-contact patients receive injections every four or six hours. The dose is prescribed by a doctor, but per day you can get no more than 0.3 g of the drug to a child and 1.8 g to an adult. 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 expressed cardiovascular and renal pathologies.

Epileptics and patients of advanced age are appointed with caution.

Undesirable effects of taking the drug may be expressed in the intensification of hypnotic effects or paradoxical effects, hyperprolactinaemia, allergic reactions.

The most universal and widely used at the present time when the state of psychomotor agitation is relieved in different stages are neuroleptics, the most popular of them is  Aminazine. This neuroblocker has proved to be an effective means of fighting hyperexcitation and is used in many countries of the world under different names: Chlorpromazine (English version), Megafen (Germany), Largaktil (France).

This drug has a diverse and complex dose-dependent effect on the central and peripheral nervous system. An increase in the dose causes an increase in sedation, the musculature of the patient's body relaxes and motor activity decreases - the patient's condition approaches the normal physiological state of sleep, which differs from the narcotic in that it is devoid of side effects of anesthesia-dyspnea, characterized by ease of awakening. Therefore, this medicine is a drug of choice for arresting the states of motor and speech excitation, anger, rage, unmotivated aggression in combination with hallucinations and delirium.

In addition, the medicine, acting at the center of thermoregulation, can 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 capacity, soothes hiccups, which is also important in the above cases. Potentsiruet action of anticonvulsants, analgesics, narcotic, sedatives. It is 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.

Mechanisms of its action have not been fully studied yet, but its effectiveness is beyond doubt. Data from studies in different countries indicate that the active substance (the phenothiazine derivative) has a direct effect on the occurrence and conduct of nerve impulses that transmit excitation in different parts of both the central and autonomic nervous system. Under the influence of the drug, metabolic processes in the brain tissues slow down, especially in the neurons of its cortex. Therefore, the neuroplegic effects of the drug are associated with cortical activities. In addition, Aminazine acts on the subcortex, the reticular formation and peripheral nerve receptors, extinguishes virtually all types of psychomotor agitation, removes hallucinatronic and delusional symptoms, however, it is not a hypnotic. The patient, who is 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 to the use of the medicine are severe system pathologies of the brain and spinal cord, dysfunction of the liver and kidneys, hematopoietic organs, myxedema, propensity to thromboembolism, decompensated heart disease.

Applied 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 painful sensations, the contents of the ampoule are diluted with novocaine or lidocaine, saline solution, glucose solution (intravenous administration).

After applying the drug, especially the injection, it is possible to drop blood pressure, so the patient is recommended to lie down for several hours and take a vertical position without sudden movements.

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

The drug  Fenotropil  - a new word in improving the work of the central and peripheral nervous system. Nootrop, who came to a wide consumer from space medicine. Pharmacological action of the drug is close to natural - its manufacturers claim that the drug is able to activate more rational use of its own resource, rather than lead to its depletion.

The drug has a beneficial effect on the metabolic processes in neurons of the brain and stimulates blood circulation in the cerebral vessels. It activates the course of oxidation-reduction processes, increases the efficiency of glucogenesis, thus increasing the energy potential of the organism. The active substance of the drug phenylpyricetam promotes an increase in the content of mediators of vivacity, pleasure and good mood - norepinephrine, dopamine and serotonin. It is not necessary to enumerate all of its remarkable qualities, but we note that it has a direct bearing on the relief of psychomotor agitation. The drug has a psycho-stimulating effect - speeds up the transmission of nerve impulses, improves performance, cognitive qualities, has moderate anti-anxiety activity. True, in the specifics of the application, it is noted that it is necessary to use caution when using people prone to panic attacks and attacks of psychotic excitement. The drug is more suitable for the prevention of psychomotor agitation and increase the stress-resistance of the body. There are no direct indications for the reduction of 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.

To treat psychomotor agitation, various agents with sedative properties are used: barbiturates - veronal, medinal, luminal, chloral hydrate and others. They have a pronounced hypnotic effect. They are sometimes prescribed rectally (in enema). The effectiveness of such agents increases with simultaneous intravenous administration of sulfurous magnesia.

In severe cases resort to high-speed, often narcotic drugs (Thiopental-sodium, Hexenal) and intravenous administration. Complications of such therapy can be apnea and acute disruption of the heart muscle.

The effect of  reserpine  in cases of psychomotor agitation resembles the action of Aminazine. It is not a hypnotic, but it potentiates a natural sleep and relieves excitement, providing a central action. Patients feel calm, muscle relaxed, fall asleep with a calm and deep sleep. This process is accompanied by a decrease in blood pressure. Hypotension remains after Reserpine's withdrawal. Normalization of pressure after drug cancellation occurs also gradually, as well as its decrease under the action of the drug. This drug is indicated for hypertensive patients with acute psychomotor agitation. Contraindicated to epileptics and other patients prone to the appearance of seizures.

After placing a patient with psychomotor agitation in the inpatient department and providing first aid (arresting an arousal), the patient is monitored in a special ward because the stability of his condition is in question and there is a possibility of resuming the attack.

Prevention

To prevent an accident or a catastrophe, other serious stress factors are almost impossible. However, to try to increase their stress-resistance is necessary.

First, it concerns the general state of health. Proper nutrition, lack of 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 should not run them and take courses of necessary treatment.

People who are stressed and acutely reactive should be psycho-corrected - 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 phyto-therapeutist, homeopath, a neurologist.

[34], [35], [36], [37], [38], [39]

Forecast

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

[40], [41], [42]