Management of psychomotor agitation in patients with COVID -19
DOI:
https://doi.org/10.25118/2236-918X-11-1-5Keywords:
Psychiatric emergencies, psychomotor agitation, coronavirus diseaseAbstract
Psychomotor agitation is a frequent situation that requires training and an individualized approach. However, little information is available to standardize Manejo da agitação psicomotora em pacientes com COVID -19 Management of psychomotor agitation in patients with COVID -19 the management of this situation in patients infected by COVID-19. The objective of this study is to propose a psychomotor agitation protocol for patients with COVID-19. A narrative review of the literature was conducted by the Brazilian Psychiatric Association (Rio de Janeiro, Brazil) and Universidade Federal do Tocantins (Tocantins, Brasil). The review was conducted on PubMed by a group of experts (eight psychiatrists, one allergist-immunologist, and one infection disease specialist). Of the 144 articles retrieved, 62 manuscripts were selected. The protocols currently available present the necessary information for the management of agitated patients (management of the setting and team), including communication, rapid tranquilization, and physical restraint. However, in cases with suspected infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), additional measures should be adopted to prevent contamination. Moreover, the pharmacological approach needs to be tailored to each case, taking side effects and drug interactions into consideration. It is possible to conclude that infection by SARS-CoV-2 in patients presenting with psychomotor agitation due to mental illness require specific care and adjustments to treatment protocols.
Downloads
Metrics
References
International Society of Substance use Professionals (ISSUP). Saúde mental e considerações psicossociais durante o surto de COVID-19 [Internet]. 2020 Apr 3 [cited 2020 Dec 8]. www.issup.net/pt-br/knowledgeshare/publications/2020-04/saude-mentalconsideracoes psicossociais-durante-surto-covid
Kozloff N, Mulsant BH, Stergiopoulos V, Voineskos AN. The COVID-19 global pandemic: implications for people with schizophrenia and related disorders. Schizophr Bull. 2020;46:752-7.
Morgan VA, Waterreus A, Carr V, Castle D, Cohen M, Harvey C, et al. Responding to challenges for people with psychotic illness: updated evidence from the survey of high impact psychosis. Aust N Z J Psychiatry 2017;51:124-40.
Saxena S, Major M. Physical health of people with severe mental disorders: leave no one behind. World Psychiatry. 2017;16:1-2.
Saraceno B, Levav I, Kohn R. The public mental health significance of research on socio-economic factors in schizophrenia and major depression. World Psychiatry. 2005;4:181-5.
Green MF, Horan WP, Lee J, McCleery A, Reddy LF, Wynn JK. Social disconnection in schizophrenia and the general community. Schizophr Bull. 2018;44:242-9.
Thornicroft G, Brohan E, Rose D, Norman Sartorius, Morven Leese, INDIGO Study Group. Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional surveyl. Lancet. 2009;373:408-15.
Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P, Fusar-Poli P, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020;7:611-27.
Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun. 2020;87:18-22.
British Geriatrics Society. Coronavirus: Managing delirium in confirmed and suspected cases [Internet]. 2020 Mar 19 [cited 2020 Dec 7]. www. bgs.org.uk/resources/coronavirus-managingdelirium-in-confirmed-and-suspected-cases
Cui LB, Wang XH, Wang HN. Challenges of facing coronavirus disease 2019: Psychiatric services for patients with mental disorders. Psychiatry Clin Neurosci. 2020;74:371-2.
Baldacara L, Ismael F, Leite V, Pereira LA, Dos Santos RM, Gomes Júnior VP, et al. Brazilian guidelines for the management of psychomotor agitation. Part 1. Non-pharmacological approach. Braz J Psychiatry. 2019;41:153-67.
Organização Pan-Americana da Saúde (OPAS). Prevenção e controle de infecções durante os cuidados de saúde quando suspeita-se de infecção por novo coronavírus (nCoV) [Internet]. 2020 Mar 3 [cited 2020 Dec 8]. iris.paho.org/handle/10665.2/51910
Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020;77:683-90.
Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, et al. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med. 2020;382:2268-70.
O’Hanlon S, Inouye SK. Delirium: a missing piece in the COVID-19 pandemic puzzle. Age Ageing. 2020;49:497-8.
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.
World Health Organization. Mental health and psychosocial considerations during the COVID-19 outbreak. Geneva: WHO; 2020.
Richmond JS, Berlin JS, Fishkind AB, Holloman GH Jr, Zeller SL, Wilson MP, et al. Verbal De-escalationof 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.
Baldacara L, Diaz AP, Leite V, Pereira LA, Dos Santos RM, Gomes Júnior VP, et al. Brazilian guidelines for the management of psychomotor agitation. Part 2. Pharmacological approach. Braz J Psychiatry. 2019;41:324-35.
Shulman M, Njoku IJ, Manu P. Thrombotic complications of treatment with antipsychotic drugs. Minerva Med. 2013;104:175-84.
Poissy J, Goutay J, Caplan M, Parmentier E, Duburcq T, Lassalle F, et al. Pulmonary embolism in patients with COVID-19: awareness of an increased prevalence. Circulation. 2020;142:184-6.
Middeldorp S, Coppens M, van Haaps TF, Foppen M, Vlaar AP, Müller MC, et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost. 2020;18:1995-2002.
Klok FA, Kruip MJ, van der Meer NJ, Arbous MS, Gommers D, Kant KM, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: an updated analysis. Thromb Res. 2020;191:148-50.
Giudicessi JR, Noseworthy PA, Friedman PA, Ackerman MJ. Urgent guidance for navigating and circumventing the QTc-prolonging and torsadogenic potential of possible pharmacotherapies for coronavirus disease 19 (COVID-19). Mayo Clin Proc. 2020;95:1213-21.
Asadollahi S, Heidari K, Hatamabadi H, Vafaee R, Yunesian S, Azadbakht A, et al. Efficacy and safety of valproic acid versus haloperidol in patients with acute agitation: results of a randomized, doubleblind, parallel-group trial. Int Clin Psychopharmacol. 2015;30:142-50.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Debates em Psiquiatria allows the author (s) to keep their copyrights unrestricted. Allows the author (s) to retain their publication rights without restriction. Authors should ensure that the article is an original work without fabrication, fraud or plagiarism; does not infringe any copyright or right of ownership of any third party. Authors should also ensure that each one complies with the authorship requirements as recommended by the ICMJE and understand that if the article or part of it is flawed or fraudulent, each author shares responsibility.
Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) - Debates em Psiquiatria is governed by the licencse CC-By-NC
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material
The licensor cannot revoke these freedoms as long as you follow the license terms. Under the following terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- NonCommercial — You may not use the material for commercial purposes.
No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
