Diretrizes brasileiras para o manejo da agitação psicomotora: cuidados gerais e avaliação

Autores

  • Leonardo Baldaçara Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ. 2 Universidade Federal do Tocantins (UFT), Palmas, TO. 3 Secretaria de Estado de Saúde do Tocantins, Palmas, TO. 4 Coordenadoria de Saúde Mental, São Caetano do Sul, SP; Universidade de São Caetano do Sul, São Caetano do Sul, SP; Secretaria de Saúde do Município de Palmas, Palmas, TO.
  • Flávia Ismael Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ; Coordenadoria de Saúde Mental, São Caetano do Sul, SP; Universidade de São Caetano do Sul, São Caetano do Sul, SP.
  • Verônica S. Leite Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ; Universidade Federal do Tocantins (UFT), Palmas, TO; Secretaria de Saúde do Município de Palmas, Palmas, TO.
  • Renata N.S. Figueiredo Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ; Associação Psiquiátrica de Brasília, Brasília, DF.
  • Lucas A. Pereira Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ; Universidade Salvador (UNIFACS), Salvador, BA; Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, BA.
  • Daniel Augusto Corrêa Vasques Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ; Faculdade de Medicina da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP.
  • Elie Leal de Barros Calfat Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ; 10 Faculdade de Medicina da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP; Centro de Atenção Integrada à Saúde Mental, Franco da Rocha, SP.
  • Alexandre Rizkalla Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ; Secretaria de Estado de Saúde do Tocantins, Palmas, TO; Universidade Federal do Oeste da Bahia (UFOB), Barreiras, BA.
  • Cintia A. M. Périco Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ; Faculdade de Medicina do ABC, Santo André, SP; Coordenadoria de Saúde Mental, São Bernardo do Campo, SP.
  • Deisy M. Porto Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ; 15 Associação Catarinense de Psiquiatria, Florianópolis, SC.
  • Carlos E. K. Zacharias Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ; Secretaria de Estado da Saúde de São Paulo, São Paulo, SP; Secretaria de Saúde do Município de Sorocaba, São Paulo, SP.
  • Roberto M. dos Santos Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ; Hospital Universitário Lauro Wanderley, Universidade Federal da Paraíba (UFPB), João Pessoa, PB; Pronto Atendimento em Saúde Mental, João Pessoa, PB.
  • Vicente de P. Gomes Júnior Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ; Associação Psiquiátrica do Piauí (APPI), Teresina, PI.
  • Quirino Cordeiro Secretaria de Cuidados e Prevenção às Drogas, Ministério da Cidadania, Brasília, DF.
  • Antônio Geraldo da Silva Diretoria Executiva da Associação Brasileira de Psiquiatria (ABP) https://orcid.org/0000-0003-3423-7076
  • Teng C. Tung Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ; Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP.
  • Alexandre Paim Díaz Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC.

DOI:

https://doi.org/10.25118/2763-9037.2021.v11.12

Palavras-chave:

Agitação psicomotora, agressividade, tranquilização farmacológica, emergência psiquiátricas, avaliação de risco, manejo não farmacológico

Resumo

Neste primeiro artigo, apresentamos os aspectos gerais dessa diretriz. Na sequência, apresentamos os cuidados gerais do ambiente e equipe e, posteriormente, a avaliação de pacientes agitados, principalmente focada no diagnóstico diferencial. Número de registro da revisão sistemática: CRD42017054440.

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Referências

Cordeiro DC, Baldacara L. Emergências psiquiátricas. São Paulo: Roca; 2007.

Barros RE, Marques JM, Carlotti IP, Zuardi AW, Del-Ben CM. Short admission in an emergency psychiatry unit can prevent prolonged lengths of stay in a psychiatric institution. Braz J Psychiatry. 2010;32:145-51. DOI: https://doi.org/10.1590/S1516-44462009005000014

Cruz CM, Leiva JL, Borgoño RV, Larach TK, Errázuriz LB, Chianale IC, et al. Epidemiología de la Urgencia Psiquiátrica en el Instituto Psiquiátrico“Dr. José Horwitz”: Un nuevo estudio comparativo. Rev Chil Neuro-psiquiatr. 2010;48:175-83. DOI: https://doi.org/10.4067/S0717-92272010000400002

Quevedo J, Carvalho AF. Emergências psiquiátricas.2ª ed. Porto Alegre: Artmed; 2014.

Garriga M, Pacchiarotti I, Kasper S, Zeller SL, Allen MH, Vázquez G, et al. Assessment and management of agitation in psychiatry: expert consensus. World J Biol Psychiatry. 2016;17:86-128. DOI: https://doi.org/10.3109/15622975.2015.1132007

Pascual JC, Madre M, Puigdemont D, Oller S, Corripio I, Díaz A, et al. [A naturalistic study: 100 consecutive episodes of acute agitation in a psychiatric emergency department]. Actas Esp Psiquiatr. 2006;34:239-44.

Boudreaux ED, Allen MH, Claassen C, Currier GW, Bertman L, Glick R, et al. The psychiatric emergency research collaboration-01: methods and results. Gen Hosp Psychiatry. 2009;31:515-22. DOI: https://doi.org/10.1016/j.genhosppsych.2009.04.009

Pajonk FG, Schmitt P, Biedler A, Richter JC, Meyer W, Luiz T, et al. Psychiatric emergencies in prehospital emergency medical systems: a prospective comparison of two urban settings. Gen Hosp Psychiatry. 2008;30:360-6. DOI: https://doi.org/10.1016/j.genhosppsych.2008.03.005

San L, Marksteiner J, Zwanzger P, Figuero MA, Romero FT, Kyropoulos G, et al. State of acute agitation at psychiatric emergencies in Europe: the STAGE study. Clin Pract Epidemiol Ment Health. 2016;12:75-86. DOI: https://doi.org/10.2174/1745017901612010075

Brakoulias V, Mandali R, Seymour J, Sammut P, Starcevic V. Characteristics of admissions to a recently opened psychiatric emergency care centre. Australas Psychiatry. 2010;18:326-9. DOI: https://doi.org/10.3109/10398562.2010.498051

Chaput Y, Beaulieu L, Paradis M, Labonte E. Aggressive behaviors in the psychiatric emergency service. Open Access Emerg Med. 2011;3:13-20. DOI: https://doi.org/10.2147/OAEM.S14307

Grudnikoff E, Taneli T, Correll CU. Characteristics and disposition of youth referred from schools for emergency psychiatric evaluation. Eur Child Adolesc Psychiatry. 2015;24:731-43. DOI: https://doi.org/10.1007/s00787-014-0618-8

Santos ME, do Amor JA, Del-Ben CM, Zuardi AW. [Psychiatric emergency service in a university general hospital: a prospective study]. Rev Saude Publica. 2000;34:468-74. DOI: https://doi.org/10.1590/S0034-89102000000500006

Padilha VM, Schettini CS, Santos Junior A, Azevedo RC. Profile of patients attended as psychiatric emergencies at a university general hospital. Sao Paulo Med J. 2013;131:398-404. DOI: https://doi.org/10.1590/1516-3180.2013.1316598

Holloman GH Jr, Zeller SL. Overview of project BETA: best practices in evaluation and treatment of agitation. West J Emerg Med. 2012;13:1-2. DOI: https://doi.org/10.5811/westjem.2011.9.6865

Lukens TW, Wolf SJ, Edlow JA, Shahabuddin S, Allen MH, Currier GW, et al. Clinical policy: critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department. Ann Emerg Med. 2006;47:79-99. DOI: https://doi.org/10.1016/j.annemergmed.2005.10.002

National Institute for Health and Clinical Excellence (NICE). Violence: the short-term management of disturbed/violent behaviour in psychiatric in- patient settings and emergency departments [Internet]. 2005 Feb [cited 2020 Oct 28]. umh1946.edu.umh.es/wp-content/uploads/sites/172/2015/04/NICE-Violence-Theshort-term-management-of-disturbed-violentbehaviour-in-in-patient-psychiatric-settings-andemergency-departments.pdf

Mantovani C, Migon MN, Alheira FV, Del-Ben CM. [Management of the violent or agitated patient]. Braz J Psychiatry. 2010;32 Suppl 2:S96-103. DOI: https://doi.org/10.1590/S1516-44462010000600006

Schleifer JJ. Management of acute agitation in psychosis: an evidence-based approach in the USA. Adv Psychiatr Treat. 2011;17:91-100. DOI: https://doi.org/10.1192/apt.bp.109.007310

Kawakami D, Prates JG, Tung TC. Propostas para o futuro: estrutura física e equipe ideal nas emergências psiquiátricas. Debates Psiquiatr. 2016;6:28-34. DOI: https://doi.org/10.25118/2236-918X-6-4-3

Mental Health Division, WA Department of Health. Guidelines: the management of disturbed/violent behaviour in inpatient psychiatric settings. Perth: Department of Health; 2006.

Richmond JS, Berlin JS, Fishkind AB, Holloman GH Jr, Zeller SL, Wilson MP, et al. Verbal de-escalation of the agitated patient: consensus statement of the american association for emergency psychiatry project BETA de-escalation workgroup. West J Emerg Med. 2012;13:17-25. DOI: https://doi.org/10.5811/westjem.2011.9.6864

Marder SR. A review of agitation in mental illness: treatment guidelines and current therapies. J Clin Psychiatry. 2006;67 Suppl 10:13-21. DOI: https://doi.org/10.4088/JCP.0706e03

Caldieraro MA, Spode A, Fleck MPA. Avaliação do paciente na emergência. In: Quevedo J, Schimitt R, Kapczinski F. Emergências psiquiátricas. Porto Alegre: Artmed; 2008. p. 7-48.

O’Brien L, Cole R. Close-observation areas in acute psychiatric units: a literature review. Int J Ment Health Nurs. 2003;12:165-76. DOI: https://doi.org/10.1046/j.1440-0979.2003.t01-1-00286.x

Baldaçara L, Cordeiro DC, Calfat ELB, Cordeiro DC, Chung TC. Emergências psiquiátricas. Rio de Janeiro: Elsevier; 2019.

Baldacara L, Ismael F, Leite V, Pereira LA, Dos Santos RM, Gomes VP Jr, et al. Brazilian guidelines for the management of psychomotor agitation. Part 1. Non-pharmacological approach. Braz J Psychiatry. 2019;41:153-67. DOI: https://doi.org/10.1590/1516-4446-2018-0163

Stowell KR, Florence P, Harman HJ, Glick RL. Psychiatric evaluation of the agitated patient: consensus statement of the american association for emergency psychiatry project Beta psychiatric evaluation workgroup. West J Emerg Med. 2012;13:11-6. DOI: https://doi.org/10.5811/westjem.2011.9.6868

Nordstrom K, Zun LS, Wilson MP, Stiebel V, Ng AT, Bregman B, et al. Medical evaluation and triage of the agitated patient: consensus statement of the american association for emergency psychiatry project Beta medical evaluation workgroup. West J Emerg Med. 2012;13:3-10. DOI: https://doi.org/10.5811/westjem.2011.9.6863

Passamar M, Tellier O, Vilamotc B. [Psychomotor agitation, pharmaceutical sedation and psychiatric emergency in psychotic patients]. Encephale. 2011;37:448-56. DOI: https://doi.org/10.1016/j.encep.2011.10.001

Strout TD. Psychometric testing of the Agitation Severity Scale for acute presentation behavioral management patients in the emergency department. Adv Emerg Nurs J. 2014;36:250-70. DOI: https://doi.org/10.1097/TME.0000000000000014

Swift RH, Harrigan EP, Cappelleri JC, Kramer D, Chandler LP. Validation of the behavioural activity rating scale (BARS): a novel measure of activity in agitated patients. J Psychiatr Res. 2002;36:87-95. DOI: https://doi.org/10.1016/S0022-3956(01)00052-8

Almvik R, Woods P. Predicting inpatient violence using the Broset Violence Checklist (BVC). Int J Psychiatr Nurs Res. 1999;4:498-505.

Abderhalden C, Needham I, Dassen T, Halfens R, Haug HJ, Fischer J. Predicting inpatient violence using an extended version of the Broset-Violence-Checklist: instrument development and clinical application. BMC Psychiatry. 2006;6:17. DOI: https://doi.org/10.1186/1471-244X-6-17

Marques I, Bessa A, Santos L, Carvalho S. Tradução e adaptação da BrØset Violence Checklist [dissertação]. Coimbra; 2004.

Huber CG, Lambert M, Naber D, Schacht A, Hundemer HP, Wagner TT, et al. Validation of a Clinical Global Impression Scale for Aggression (CGI-A) in a sample of 558 psychiatric patients. Schizophr Res. 2008;100:342-8. DOI: https://doi.org/10.1016/j.schres.2007.12.480

Douglas KS, Ogloff JR, Nicholls TL, Grant I. Assessing risk for violence among psychiatric patients: the HCR-20 violence risk assessment scheme and the Psychopathy Checklist: Screening Version. J Consult Clin Psychol. 1999;67:917-30. DOI: https://doi.org/10.1037/0022-006X.67.6.917

Telles LE, Day VP, Folino JO, Taborda JG. Reliability of the Brazilian version of HCR-20 assessing risk for violence. Braz J Psychiatry. 2009;31:253-6. DOI: https://doi.org/10.1590/S1516-44462009005000001

Yudofsky SC, Silver JM, Jackson W, Endicott J, Williams D. The Overt Aggression Scale for the objective rating of verbal and physical aggression. Am J Psychiatry. 1986;143:35-9. DOI: https://doi.org/10.1176/ajp.143.1.35

Yudofsky SC, Kopecky HJ, Kunik M, Silver JM, Endicott J. The Overt Agitation Severity Scale for the objective rating of agitation. J Neuropsychiatry Clin Neurosci. 1997;9:541-8. DOI: https://doi.org/10.1176/jnp.9.4.541

Montoya A, Valladares A, Lizan L, San L, Escobar R, Paz S. Validation of the Excited Component of the Positive and Negative Syndrome Scale (PANSSEC) in a naturalistic sample of 278 patients with acutpsychosis and agitation in a psychiatric emergency room. Health Qual Life Outcomes. 2011;9:18. DOI: https://doi.org/10.1186/1477-7525-9-18

Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PO, Keane KA, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166:1338-44. DOI: https://doi.org/10.1164/rccm.2107138

Nassar Junior AP, Pires Neto RC, de Figueiredo WB, Marcelo P. Validity, reliability and applicability of Portuguese versions of sedation-agitation scales among critically ill patients. Sao Paulo Med J. 2008;126:215-9. DOI: https://doi.org/10.1590/S1516-31802008000400003

Ryder-Lewis MC, Nelson KM. Reliability of the Sedation-Agitation Scale between nurses and doctors. Intensive Crit Care Nurs. 2008;24:211-7. DOI: https://doi.org/10.1016/j.iccn.2007.11.004

Calver LA, Stokes B, Isbister GK. Sedation assessment tool to score acute behavioural disturbance in the emergency department. Emerg Med Australas. 2011;23:732-40. DOI: https://doi.org/10.1111/j.1742-6723.2011.01484.x

Hvidhjelm J, Sestoft D, Bjorner JB. The Aggression Observation Short Form identified episodes not reported on the Staff Observation Aggression Scale--Revised. Issues Ment Health Nurs. 2014;35:464-9. DOI: https://doi.org/10.3109/01612840.2013.879359

Nijman HL, Muris P, Merckelbach HL, Palmstierna T, Wistedt B, Vos AM, et al. The Staff Observation Aggression Scale–Revised (SOAS-R). Aggr Behav. 1999;25:197-209. DOI: https://doi.org/10.1002/(SICI)1098-2337(1999)25:3<197::AID-AB4>3.0.CO;2-C

McNiel DE, Gregory AL, Lam JN, Binder RL, Sullivan GR. Utility of decision support tools for assessing acute risk of violence. J Consult Clin Psychol. 2003;71:945-53. DOI: https://doi.org/10.1037/0022-006X.71.5.945

Citrome L, Volavka J. The psychopharmacology of violence: making sensible decisions. CNS Spectr. 2014;19:411-8. DOI: https://doi.org/10.1017/S1092852914000054

Duxbury J, Whittington R. Causes and management of patient aggression and violence: staff and patient perspectives. J Adv Nurs. 2005;50:469-78. DOI: https://doi.org/10.1111/j.1365-2648.2005.03426.x

Buchanan A, Leese M. Detention of people with dangerous severe personality disorders: a systematic review. Lancet. 2001;358:1955-9. DOI: https://doi.org/10.1016/S0140-6736(01)06962-8

Dack C, Ross J, Papadopoulos C, Stewart D, Bowers L. A review and meta-analysis of the patient factors associated with psychiatric in-patient aggression. Acta Psychiatr Scand. 2013;127:255-68. DOI: https://doi.org/10.1111/acps.12053

Cornaggia CM, Beghi M, Pavone F, Barale F. Aggression in psychiatry wards: a systematic review. Psychiatry Res. 2011;189:10-20. DOI: https://doi.org/10.1016/j.psychres.2010.12.024

Hankin CS, Bronstone A, Koran LM. Agitation in the inpatient psychiatric setting: a review of clinical presentation, burden, and treatment. J Psychiatr Pract. 2011;17:170-85. DOI: https://doi.org/10.1097/01.pra.0000398410.21374.7d

Langstrom N, Grann M, Ruchkin V, Sjostedt G, Fazel S. Risk factors for violent offending in autism spectrum disorder: a national study of hospitalized individuals. J Interpers Violence. 2009;24:1358-70. DOI: https://doi.org/10.1177/0886260508322195

Xavier RM, Dora JM, Souza CFM, Barros E. Laboratório na prática clínica consulta rápida. 2ª ed. Porto Alegre: Artmed; 2011.

Mental Health and Drug and Alcohol Office. Mental health for emergency departments – a reference guide. Sydney: New South Wales Ministry of Health; 2009.

Sanches M, Marques AP, Ortegosa S, Freirias A, Uchida R, Tamai S. O exame do estado mental. É possível sistematizá-lo? Arq Med Hosp Fac Cienc Med Santa Casa São Paulo. 2005;50:18-23.

Mantovani C, Labate CM, Sponholz A Jr, Marques JM, Guapo VG, dos Santos ME, et al. Are low doses of antipsychotics effective in the management of psychomotor agitation? A randomized, ratedblind trial of 4 intramuscular interventions. J Clin Psychopharmacol. 2013;33:306-12. DOI: https://doi.org/10.1097/JCP.0b013e3182900fd6

Baldacara L, Diaz AP, Leite V, Pereira LA, Dos Santos RM, Gomes Júnior VdP, et al. Brazilian guidelines for the management of psychomotor agitation. Part 2. Pharmacological approach. Braz J Psychiatry. 2019;41:324-35. DOI: https://doi.org/10.1590/1516-4446-2018-0177

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Publicado

2021-03-31

Como Citar

1.
Baldaçara L, Ismael F, Leite VS, Figueiredo RN, Pereira LA, Vasques DAC, Calfat EL de B, Rizkalla A, Périco CAM, Porto DM, Zacharias CEK, Santos RM dos, Gomes Júnior V de P, Cordeiro Q, Silva AG da, Tung TC, Díaz AP. Diretrizes brasileiras para o manejo da agitação psicomotora: cuidados gerais e avaliação. Debates em Psiquiatria [Internet]. 31º de março de 2021 [citado 21º de dezembro de 2024];11(1):8-20. Disponível em: https://revistardp.org.br/revista/article/view/12

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v. 11 n. 1 (2021): Agitação Psicomotora - edição especial

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Artigos de Revisão

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