Agitation

The expressed anxiety arising in response to various irritating factors is agitation. Consider its main causes and symptoms, methods of treatment.

Many experts consider agitation as a prepathological state within the boundaries of the psychological norm. It manifests itself in the form of a strong motor excitation, accompanied by anxiety, fear, incomprehensible speech and other symptoms.

A painful condition occurs in the presence of severe stress and mental illness: Alzheimer's disease, depression, catatonic schizophrenia, and neurosis. Also, the disease manifests itself in drug and alcohol intoxication, some infectious pathologies, diseases of the brain.

The main types of psychomotor agitation and their signs:

• Catatonic - manifested by impulsiveness, lack of coordination, rhythm and monotony of movements, talkativeness.
• Gebefrenichesky - senseless actions, aggression. Occurs with 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 obscuration and is typical for people with alcoholism.
• Crazy state - the ideas of persecution, increased aggressiveness, threats, the use of force. Occurs with hallucinatory-delusional states, brain pathologies, symptomatic psychosis, schizophrenia.
• Manic arousal - high spirits, accelerated thought processes and inconsistent actions, fussiness.
• Anxious - anxiety, the desire to do something and move, pronounced motor reactions.
• Dystrophic - tension, distrust, gloominess, nastiness.
• Eretic - destructive meaningless actions with shouts. It occurs in people with oligophrenia.
• Epileptiform - sudden movements, fear, delirium, hallucinations. After the cessation of the state of affect, amnesia, disorientation in space and time is possible.
• Psychogenic - panic, fear, misunderstanding of what is happening. Manifested with mental injury.

For all types of agitation characteristic of the same type, conscious movement, excessive fussiness. In most cases, emotional instability is amenable to correction. To do this, use drugs, psychotherapy and other medical techniques.

[1]

Epidemiology

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

Also, the disease state develops against the background of mental illness, most often it is schizophrenia, Alzheimer's disease, depression, various metabolic disorders. In some cases, the disorder is manifested against the background of chronic alcohol and other intoxications of the body.

[2], [3], [4], [5]

Causes of the agitations

In most cases, emotional agility is associated with severe stress and psychological trauma. The reasons for the agitation include changes in the familiar environment, a strong fright. This condition is manifested in people whose professional activity is associated with a risk to life. It is also characteristic of such infectious and psychological diseases:

• Alzheimer's disease.
• Agitated or involutional depression.
• A violent recession.
• Endocrine pathology.
• Hyperteriosis.
• Bipolar mental disorder.
• Catatonic schizophrenia.
• Anxious neurosis.
• Acceptance of drugs.
• Alcohol or drug intoxication.
• Withdrawal syndrome.
• Avitaminosis.
• Caffeine excess.

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

[6], [7], [8], [9], [10], [11]

Alzheimer's Agitation

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

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

Very often, agitation arises from fatigue, fear, or a change in the environment that is familiar to the patient, things. The painful condition proceeds with unconscious motor and speech anxiety. A person becomes fussy, performs repetitive actions. Against this background, vegetative disturbances can form: sweating, catatonia, neurosis. To normalize the patient's condition, symptomatic therapy is carried out.

[12], [13],

Risk factors

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

• An acute reaction to stress - 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 pathogens.
• Epileptic disorder.
• Acute and chronic intoxication: alcoholic, narcotic, drug.
• Brain lesions: traumatic brain injury, postoperative complications, progressive paralysis. Hypoxia, intoxication, pre-comatose and comatose states.
• Mental diseases: schizophrenia, bipolar affective disorder, manic arousal, depressive psychosis.
• Hallucinatory clouding of consciousness with delusions and visual hallucinations.
• Hysterical state.

Elderly patients and people whose nervous systems are not able to effectively cope with stress loads and emotional experiences are at risk for developing affective state.

[14], [15], [16], [17], [18]

Pathogenesis

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

• Exchange violations.
• Intoxication processes.
• Autoimmune and immune responses.
• Psychological personality traits.
• Neuro-reflex mechanisms.
• Ischemia of the brain.

Regardless of the etiology, intense emotional impulse flows with pronounced motor anxiety, automated motor operations, fussiness, the need to move.

[19], [20], [21], [22], [23]

Symptoms of the agitations

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

• Rapid pulse and breathing.
• Tremor of the limbs.
• Blanching of the skin.
• Increased sweating.
• Motor and speech anxiety.
• High blood pressure.
• Panic condition.
• Feeling of fear.
• Senseless action.

The above symptoms can be complemented by visual and auditory hallucinations, sudden mood swings, aggression. Possible temporary memory impairment, problems with speech and cognitive functions. Violation of coordination of movements. The patient can not establish a causal relationship of what is happening, goes from side to side, performs stereotypical actions.

Agitation may be supplemented by symptoms of the underlying disease. Such a state is dangerous both for the patient himself and for those around him. The patient needs medical care. Often the therapy is carried out in a specialized medical institution.

In the initial stages, the agitation is manifested by blanching of the skin, trembling of the hands, rapid breathing, pulse and heartbeat. Against this background, there is increased sweating, jumps in blood pressure.

During an attack, the ability to correct reasoning and cause-effect relationships is lost. A person experiences strong anxiety and fear, cannot calm down on his own. The paranoid confidence that something bad is about to take hold. Speech changes, the patient monotonously repeats the same phrases. Restlessness and the need for constant movement is accompanied by delusional thoughts, aggression.

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

[24], [25], [26]

Morning agitation

One of the reasons why there is morning agitation is a violation of night sleep. Anxiety can be one of the symptoms of neurological or mental illness. Do not exclude the influence of physiological and hereditary factors. For example, the stress transferred on the eve, deep experiences in personal life or at work, can also provoke emotional nervous excitement.

Symptoms of the disorder:

• After waking up, anxiety appears and quickly grows.
• General weakness and fatigue.
• Trembling limbs.
• Mood swings.
• Dizziness and headaches.
• Soreness in the region of the heart.
• Shortness of breath and lack of air.

Anxiety can cause shallow, intermittent sleep with frequent awakenings, nightmares. Often, affective disorders are accompanied by an incomplete awakening, which is why a person does not adequately perceive what is happening. After such an awakening, repeated sleep does not come for a long time.

The average duration of an aggression attack is about 20 minutes. Treatment is aimed at addressing the root causes of the disease state. If the pathology is associated with neurosis, depression, or psychological abnormalities, then the patient is prescribed antidepressants, antipsychotics, antipsychotics, and other drugs.

[27], [28], [29]

Agitation sedation scale

Emotional excitement requires a structured and consistent assessment. For this, the sedation scale of agitation RASS is applied. It is one of the most informative methods for assessing anxiety. Consists of several subscales, which are separated by a neutral border. This allows you to comprehensively assess the condition of the patient.

Richmond excitation-sedation scale:

Evaluation	Definition	Description
+4	Aggression	The patient shows aggression. It represents a threat to both itself and medical personnel.
+3	Pronounced agitation	Aggressive behavior towards others. Pulls or removes tubes and catheters.
+2	Excitation	Frequent non-directional movements and / or desynchronization with the ventilator.
+1	Anxiety	Excited, the movements are not energetic. There is no aggression.
0		In adequate condition, calm.
-one	Drowsiness	Loss of care, with verbal contact does not close the eyes for more than 10 seconds.
-2	Easy sedation	With verbal contact closes eyes in less than 10 seconds.
-3	Moderate sedation	Any movement (but not eye contact) in response to a voice.
-four	Deep sedation	No reaction to the voice. Shows activity on physical stimulation.
-five	Lack of awakening	There is no response to voice and physical stimulation.

 

In order to diagnose a mental disorder, the following signs are necessary: a dramatic change or unstable mental state, impaired attention, disorganized thinking, the patient is not aware of what is happening at the moment. 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.

[30], [31], [32], [33]

Complications and consequences

The main danger of agitation is that during an attack, the patient may cause harm to himself or others. According to medical statistics, it is the affective state that is one of the causes of injuries and injuries in 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 are a complication of the underlying pathology. With timely treatment for medical care, anxious sensitivity is easily corrected and does not cause complications.

[34], [35], [36]

Diagnostics of the agitations

Confirmation of the diagnosis of agitation presents a number of difficulties. If you suspect emotional nervous excitement requires prolonged monitoring of the patient to assess his condition. In addition to external examination, the patient is prescribed a complex of such studies:

• Clinical analysis of urine and blood.
• Thyroid hormone analysis.
• Blood test for alcohol content.
• CT scan.
• Magnetic resonance imaging of the brain.
• Measurement of blood pressure and pulse.
• Screening of drugs used.

During diagnosis, the psychiatrist determines the current symptoms, collects personal and family history, carefully examines the patient's medical history. Particular attention is paid to the differentiation of agitation with symptomatic diseases.

[37], [38], [39], [40], [41]

Differential diagnosis

This type of research is aimed at isolating psychomotor agitation among other pathologies and psychotic symptoms. When differentiation delimit the agitation from such disorders:

• Manic arousal.
• Schizophrenia.
• Delirium.
• Delirium.
• Epileptiform arousal.
• Complications after brain injuries and CNS lesions.
• Neuroinfection.
• Tumor formations.
• Depressive disorders.
• Bipolar disorder.
• Stress response.
• Akathisia.
• Various intoxications of the body.

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

[42], [43], [44], [45], [46], [47]

Akathisia and agitation

Impaired motor functionality with a constant sense of inner anxiety and the need to make movements of the same type is akathisia. Agitation can occur on the background of this disorder.

There are two main factors for the development of akatizia:

1. Pathophysiological - a violation of blood supply or oxygen starvation of the brain, various injuries and postoperative complications.
2. Drug - overdose or long-term use of drugs from such pharmacological groups: antipsychotics, antidepressants, antiemetic, antipsychotic drugs that affect the regulation of dopamine levels.

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

Like agitation, Akatizia has several types:

• Acute - lasts about 4-6 months, appears after starting antipsychotic medications. It causes acute symptoms, while the patient is anxious and fully aware of what is happening.
• Chronic - persists for more than six months, even after adjusting the dosage of drugs. It provokes motor fussiness with stencilled movements, mild dysphoria.
• Psevdoakatiziya - most often occurs in men. Manifested by motor disorders, the patient is not aware of what is happening.
• Late - is associated with a change in therapeutic regimens of antipsychotic drugs.

To diagnose akathisia, the Barnes scale is used, which allows to evaluate the objective and subjective criteria of the patient's behavior. Very often, the disorder is taken for agitation and other psychotic disorders. Treatment is aimed at addressing the root causes of the disease state.

[48], [49], [50], [51], [52], [53]

Treatment of the agitations

With timely treatment for medical care, treatment of anxiety sensitivity is quite effective, since many of the causes of the disorder respond well to correction. If the agitation is not provoked by mental or infectious diseases, then the following medications are used for the treatment:

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

If the agitation is caused by infectious diseases, then anti-bacterial, nonsteroidal anti-inflammatory and other drugs are used for therapy. Also, patients are shown a course of psychocorrection, family psychotherapy, spa treatment. Psychotherapy helps develop methods of dealing with the first symptoms of an emotional impulse, increases stress resistance.

[54], [55], [56],

Treatment of agitation with drugs

One of the indispensable components of the treatment of emotional agility is the use of drugs. Psychotherapy and non-verbal methods are effective in the early stages of the disorder. In the future, patients are shown 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, stool disorders, drowsiness.

1. Prozac

Drug with antidepressant effect. Contains the active ingredient fluoxetine, which inhibits serotonin reuptake and does not bind to other receptors. Increases the level of serotonin in the structures of the brain, increasing the duration of its stimulating effect. It reduces anxiety, fear and tension, improves mood, helps reduce dystrophy.

• Indications for use: depressive states of various etiologies, bulimia nervosa, obsessive-compulsive disorder, premenstrual dystrophic disorder.
• Method of application: oral dose of 20 mg per day. The duration of therapy is determined by the attending physician, individually for each patient.
• Side effects: hot flashes, lowering blood pressure, dryness of the oral mucosa, nausea, vomiting, diarrhea, changes in taste. Increased fatigue and weakness, paresthesias, headache, feeling of weakness, drowsiness, skin allergic reactions and more.
• Contraindications: intolerance to the components of the drug, pediatric practice. Not used simultaneously with drugs that inhibit monoamine oxidase. It is prescribed with special care for patients with suicidal thoughts. Use during pregnancy is possible only for medical purposes.
• Overdose: nausea, vomiting, tachycardia, convulsions, drowsiness, coma, fainting. There is no specific antidote. Symptomatic therapy is indicated for treatment.

Product form: 14 capsules in a blister, 1, 2 blisters per package.

2. Paxil

The antidepressant, acts on the pathogenetic link of depression, compensates for the deficiency of serotonin in the synapses of brain neurons. Contains the active ingredient - 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 origin, obsessive-compulsive disorder, obsessive-compulsive disorder, panic attacks, social phobias, anxiety disorders, nightmares.
• Method of application: 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, tremor 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 for treatment with MAO inhibitors, Tryptophan, Thioridazine, Pimozide.
• Overdose: nausea, vomiting, asthenia, drowsiness, dizziness, convulsive state, urination and heart rhythm disturbances, confusion, changes in blood pressure. In rare cases, there is liver failure, coma. For the treatment indicated gastric lavage, artificial vomiting, taking adsorbents.

Form release: tablets for oral administration of 10, 30 and 100 pieces per pack.

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 states, anxiety syndrome, depressive states of various etiologies.
• Dosage: oral, initial dosage of 20 mg once a day at any time. If necessary, increase the dosage to 60 mg. The duration of treatment depends on the severity of the disease state.
• Side effects are transient. In most cases, after 14 days of intake, unwanted symptoms disappear. The drug can cause disorders of the gastrointestinal tract, disorders of the chair, tremor, sleep disorders, dizziness, loss of consciousness.
• Contraindications: excessive sensitivity to the components of the drug, suspected serotonin syndrome, pregnancy and lactation.
• Overdose: heart rhythm disturbance, nausea, vomiting, convulsions, drowsiness, increased sweating. Detoxification therapy is indicated for treatment.

Form release: tablets for oral administration with an enteric shell of 10 pieces per pack.

4. Zionism

Drug with antidepressant properties. Contains citalopram - selective serotonin reuptake inhibitor.

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

Form release: tablets in a shell of 10 pieces in a blister, 2 blisters per pack.

5. Oprah

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

• Indications for use: depressive diseases, mild forms of panic disorders, fear of open space, obsessive-compulsive disorder, neuroses.
• Method of administration: orally, at any time of the day. The duration of therapy and the required dosage is determined by the attending physician. With agitation and similar conditions, take 10 mg per day for a week with a further increase in dosage to 20 mg.
• Side effects: various disorders of the peripheral and central nervous system, serotonin syndrome. Nausea, vomiting, dryness of the oral mucosa, changes in blood pressure, decreased libido, allergic reactions and more.
• Contraindications: hypersensitivity to the components of the drug, pediatric practice. It is prescribed with special care for patients with epilepsy, a tendency to convulsive seizures, with reduced functions of the kidneys and liver. For elderly patients prescribed minimal doses.
• Overdose: dysarthria, dizziness, nausea and vomiting, sinus tachycardia, drowsiness, increased sweating. In rare cases, there is a violation of cardiac conduction, convulsions, coma. There is no specific antidote. For the treatment shown gastric lavage, taking enterosorbents.

Product form: tablets in blisters of 10 pieces, 1, 2, 10 blisters per pack.

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

1. Heleks

Drug with a potent active ingredient - alprazolam. It has a sedative-hypnotic effect, reduces the excitability of the cortex of the brain, inhibiting spinal reflexes. Eliminates emotional stress, anxiety, anxiety and fear. Shows anticonvulsant, muscle relaxant and sedative activity. Reduces the number of nighttime 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 anxiety states caused by somatic pathologies or alcohol intoxication.
• Dosage: 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, fatigue, drowsiness, confusion, delayed psychomotor reactions, loss of appetite, thrombocytopenia, ataxia, dependence development.
• Contraindications: allergic reactions to alprazolam and other substances in the composition of the drug, angle-closure glaucoma, respiratory failure, myasthenia gravis, shock, epilepsy, insufficiency of the kidneys and liver. Not prescribed for patients under 18 years of age, during pregnancy and lactation.
• Overdose: drowsiness, confusion, bradycardia, respiratory failure, hypotension, coma, decreased reflexes.

Form release: tablets for oral administration of 0.25, 0.5 and 1 mg in blisters of 15 pieces. In the package two blisters.

2. Relanium

Psycholeptic drug with the active ingredient - diazepam. It has anxiolytic, sedative, anticonvulsant properties. Increases the threshold of pain sensitivity.

• Indications for use: anxiety-phobic and anxiety-depressive states, delirium tremens, status epilepticus, acute muscle spasms. It is used as premedication before general anesthesia. As sedation before endoscopy, dental treatment, cardiac catheterization.
• Dosage and administration: intravenous drip or as an infusion. The dosage depends on the patient's body weight, therefore, 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, phobias, chronic psychosis, comatose and shock, alcohol or drug intoxication.
• Overdose: drowsiness, lethargy, bradycardia, lowering blood pressure. Allergic reactions at the injection site. Sweating, slow speech, muscle weakness, disturbance of accommodation, anxiety, blurred vision, metabolic disturbances and more.

Form release: ampoules of 2 ml solution, 5 ampoules per pack.

3. Serax

Benzodiazepine derivative with the active ingredient - diazepam. Reduces the excitability of subcortical areas of the brain, which are responsible for communication with the cerebral cortex. Strengthens the processes of inhibition in synapses, facilitates the GABA transmission. It shows anxiolytic, antiarrhythmic, muscle relaxant and antispasmodic activity. Suppresses vestibular paroxysms and reduces the secretion of gastric juice.

• Indications for use: neurotic and anxiety disorders, withdrawal conditions, muscular hypertonia, dysphoria, arthritis, tetanus, insomnia, psychopathy, menopause, PMS, epilepsy, psychosis, schizophrenia, senestoichiopondritic disorders. Premedication, general anesthesia.
• The method of administration and dosage depends on the form of release of the drug and are determined by the attending physician. The tablets are taken orally, injections are administered intravenously in the form of a solution.
• Side effects: ataxia, fatigue, decreased performance, disorientation, incoordination, headaches, confusion, myasthenia gravis, catalepsy, tremor, skin allergic reactions. With the cessation of treatment may develop withdrawal, muscle weakness, respiratory disorders.
• 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, angle-closure glaucoma, acute respiratory failure, for patients younger than 6 months.
• Overdose: drowsiness, paradoxical excitement, confusion, bradycardia, apnea, shortness of breath, shortness of breath, tremor, collapse, cardiac depression. Flumazenil is used for treatment with further symptomatic therapy.

Form release: vials of 0.5% solution of 10 pieces per pack. Tablets produce 10 and 20 pieces per pack.

4. Grandaxine

Drug with tranquilizing activity. Does not cause drowsiness, does not have an anticonvulsant and muscle relaxant effect.

• Indications for use: neurosis and neurosis-like condition, tension and autonomic disorders, moderately pronounced fear, apathy, decreased activity. Alcohol withdrawal syndrome.
• Dosing: inside 50-100 mg 1-3 times a day. The duration of treatment depends on the severity of the disease state.
• Side effects: anxiety, dyspeptic disorders, allergic reactions.
• Contraindications: intolerance to the components of the drug, the first trimester of pregnancy. It is prescribed with caution in case of psychopathic disorders with increased excitability, irritability, withdrawal syndrome.

Form release: tablets of 10 mg, 50 pieces per pack. Granules for suspension for oral administration of 20 g in the bank.

5. Relij

Anxiolytic, sedative and anticonvulsant drug with the active ingredient - diazepam. Inhibits several structures in the central nervous system. Reduces severity of seizures, shows sedative and hypnotic activity.

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

Product form: tablets in cellular packs of 20 capsules in a blister, 1 blister in a pack.

• Antipsychotics (neuroleptics) - are used for the clouding of consciousness, delusional state, paranoia.

1. Haloperidol

Neuroleptic with pronounced antipsychotic properties. It is used in schizophrenia, manic, delusional and hallucinatory conditions. It is prescribed for psychosis, in the complex treatment of pain, angina, vomiting and nausea.

The medicine is taken orally in 15-30 mg or intramuscularly / intravenously in a dose of 0.4-1 ml of a 0.5% solution. Side effects are manifested extrapyramidal disorders, insomnia.

The drug is contraindicated in diseases of the central nervous system, impaired cardiac conduction, impaired renal function. Haloperidol is available in packs 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 bottles of 10 ml of 0.2% solution.

2. Risperidone

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

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

Form release: tablets for oral administration of 10 pieces per pack.

3. Ziprexa

Antipsychotic drug with anti-anxiety and potentiating action. It binds to receptors in the central nervous system, reduces the excitability in the neurons of the mesolimbic region, affecting the striatal nerve tracts.

• Indications for use: injections are prescribed for the initiation of psychomotor etiology, bipolar affective disorder, schizophrenia, dementia. Tablets prescribed for the prevention of exacerbations of schizophrenia, affective disorders, depressive-delusional syndrome, psychosis. Dosage and administration are individual for each patient.
• Side effects: convulsions, drowsiness, asthenia, hyperprolactinemia, akatasia, leukopenia, diabetic coma, impaired stool, allergic reactions.
• Contraindications: hypersensitivity to oxazapine. It is prescribed with caution when it is prone to convulsive seizures, leukopenia, neutropenia, intestinal obstruction of a paralytic nature, inhibition of bone marrow hematopoiesis, angle-closure glaucoma. Use during pregnancy is possible only under strict medical indications.
• Overdose: convulsive reactions, aspiration, extrapyramidal disorders, tachycardia, impaired consciousness, dyspnea, aggression, arterial hypertension, hypotension. There is no specific antidote, symptomatic treatment.

Form release: the lyophilisate in the form of tablets and dispersible capsules of 28 pieces per pack.

4. Leponeks

Antipsychotic medication for the treatment of schizophrenic disorders. Dosage regimen is determined individually for each patient. Treatment begins with a minimum dosage of 12.5 mg once a day. Side effects are manifested by disorders of the gastrointestinal tract, skin allergic reactions and other painful symptoms.

Leponex is contraindicated for hypersensitivity to its components, bone marrow dysfunction, psychosis due to alcohol or toxic substance abuse. Not used for the treatment of pregnant women and breastfeeding.

Overdose causes drowsiness, impaired consciousness, coma, increased emotional arousal, convulsive states, hypersecretion of the salivary glands, pathology of the visual system, low blood pressure and other painful symptoms. For treatment, gastric lavage and absorption of absorbents are indicated. The medicine has a tablet form of release of 10 pieces per pack.

5. Chlorprotixen

Neuroleptic and tranquilizing drug. It has an inhibitory effect on the central nervous system. Strengthens 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, pruritus.
• Method of application: oral 50 mg and 25 mg, the maximum daily dosage of 600 mg with its gradual decrease.
• Side effects: drowsiness, heart palpitations, hypotension, impaired motor coordination, dryness in the mouth.
• Contraindications: alcohol intoxication and poisoning with barbiturates, a tendency to collapse, epilepsy, blood diseases, parkinsonism.

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

In addition to the above preparations, vitamin therapy is recommended for agitation. It is aimed at increasing the defenses of the immune system and preventing the deficiency of beneficial substances in the body. All medicines are prescribed by the attending physician.

Prevention

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

• Minimization of stressful situations.
• Abstinence from the use of alcohol and drugs.
• Taking medication only for medical purposes in compliance with all recommendations on the duration of therapy and dosage of the drug.
• Treatment of mental illness.
• Vitamin therapy.
• Healthy, full sleep.
• Favorable emotional background.

In some cases, agitation is a variant of the norm, for example, in acute stressful situations. In this case, preventive methods can minimize its manifestations.

[57], [58], [59], [60], [61],

Forecast

With timely treatment for medical care and proper diagnosis, the prediction of agitation is favorable. The treatment is carried out in a hospital for 15-20 days. An integrated treatment approach minimizes the risk of recurrence of the disease. If you refuse to go to the hospital and try to cope with the pathology yourself, the outcome of the disease is unpredictable.

[62]