Agitation psychomotor

Hallucinations (non-specific) Hypersomnia Insomnia Irritability, frustration Lacrimation, rhinorrhea Muscle/bone aches Nausea/vomiting Photophobia Psychomotor agitation Psychomotor retardation Pupiiiary diiatation Seizures Tremor Tremuiousness Yawning... 

When severe anxiety is present, it is important to obtain the history from a family member or friend. During the time the history is taken, the nurse observes the patient for behavioral symptoms indicating anxiety (eg, psychomotor agitation [extreme restlessness], facial grimaces, tense posture). Physiologic manifestations of anxiety include increased blood... 

Depression occurring as part of bipolar disorder may be severe and accompanied by ideas of guilt and hopelessness, an inability to function at work because of poor concentration and psychomotor retardation or agitation, poor judgement and suicidal ideation. The lifelong risk of suicide in people with this condition is as high as 15%. Factors associated with suicide risk include alcohol misuse, marital separation or divorce, living alone and unemployment, and these are all common secondary consequences of the illness. 

Agitation or slowing Psychomotor retardation (an actual physical slowing of speech, movement and thinking) or psychomotor agitation (observable pacing and physical restlessness) often are present in severe major depressive disorder. 

Psychomotor disturbances may include psychomotor retardation (slowed physical movements, thought processes, and speech) or psychomotor agitation. 

Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)... 

Depressed mood is the hallmark symptom of MDD, but it is neither required nor sufficient for the diagnosis of major depression. In addition to depressed mood, the key symptoms of a major depressive episode include anhedonia, changes in sleep or appetite, psychomotor retardation or agitation, poor concentration or indecisiveness, and recurrent thoughts of death or suicide. The DSM-IV definition of major depression requires that five or more of these symptoms be present for at least 2 weeks in the absence of an identifiable cause such as medication, medical illness, or the death of a loved one. Refer to Table 3.2 for the DSM-IV criteria for MDD. 

Apart from the antidepressant effect, acute effects occur that are evident also in healthy individuals. These vary in degree among individual substances and thus provide a rationale for differentiated clinical use (p. 233), based upon the divergent patterns of interference with amine transmitters/modula-tors. Amitriptyline exerts anxiolytic, sedative and psychomotor dampening effects. These are useful in depressive patients who are anxious and agitated. 

Ingestion of 6-10 g of camphor hy two men resulted in psychomotor agitation and hallucinations. The prohahle lethal dose for humans is in the 50-500mg/kg range. Camphor may be expected to be somewhat irritating on contact with the eye, but no serious eye injuries have been reported. ... 

Clonazepam is used in somnambulic epilepsy, various forms of muscular tonus, insomnia (especially in patients with structural brain lesions), and psychomotor agitation. Synonyms of this drag are clonopin and rivotril. 

Also indicated for management of anxiety, tension, and psychomotor agitation in conditions of emotional stress. 

Self-administration of psychostimulants by humans produces a syndrome of intoxication, the symptoms of which can include elevated pulse and blood pressure, pupillary dilation, euphoria, and psychomotor agitation. Ingestion of excessive amounts can result in compulsive behavior, psychotic symptoms that include auditory and visual hallucinations and paranoid delusions, chest pain, arrhythmias, dyskinesias, and seizures. 

The most common adverse events associated with buspirone use include dizziness, headache, nausea, ner-vounsness, lightheadedness, and agitation. These adverse effects decrease over time. Buspirone does not cause seizures or abnormal involuntary movements or impair psychomotor performance. 

Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation... 

A thorough discussion of this topic is beyond the scope of this chapter. However, a recent review of controlled studies of mood stabilizers (Keck et al, 2000) provides a reasonable summary. Pooling response data from five studies (from 1954 to 1994) and 124 acute manic patients revealed that 70% of the patients had at least partial improvement with lithium treatment. Response took 2-3 weeks, was superior to antipsychotics in ameliorating affective symptoms, produced an improvement in psychosis, but was less effective in treating psychomotor agitation. DSM-III and earlier criteria were used to diagnose the patients in these trials, so these samples may not be comparable to patients in more modern studies. Table 37.2 summarizes a compilation of clinical... 

To attempt to obtain a claim for a nonspecific symptom in a single disease model would, by definition, be pseudospecific, since such a claim would give the impression that the symptom is specific to that disease. For example, if there were agreement that psychomotor agitation could be considered a nonspecific psychiatric symptom, it would be important to study a drug treatment proposed for this symptom in several different disease models, such as schizophrenia, autism, and mental retardation. 

Antipsychotics are calming medications used to counteract marked inner unrest, psychomotor agitation and severe insomnia. These states can arise within the following contexts ... 

While the role of lithium in treating schizophrenia has not been well delineated, it may be useful in certain patients with aggression, agitation, or psychomotor excitement. Most, however, do not believe it has inherent antipsychotic properties. Clinical evidence from a small number of controlled trials finds lithium alone is not beneficial for process schizophrenia. For example, an earlier double-blind, controlled trial of lithium versus CPZ for chronic schizophrenics found lithium completely ineffective and possibly harmful in the more chronic patients, while the antipsychotic had its expected beneficial effect ( 372). 

Psychomotor agitation rather than psychomotor retardation... 

If patients have predominant symptoms of insomnia or psychomotor agitation, a more sedating drug (e.g., trazodone or mirtazapine) may benefit initially but could be problematic later in therapy (i.e., cause excessive sedation once sleep normalizes). 

Regardless of the specific agent, it is important to watch for improvement in target symptoms. Psychomotor agitation or retardation often improve first, followed by... 

The projection from the locus coeruleus to limbic cortex may regulate emotions, as well as energy, fatigue, and psychomotor agitation or psychomotor retardation (Fig. 5—26). A projection to the cerebellum may regulate motor movements, especially tremor (Fig. 5—27). Brainstem norepinephrine in cardiovascular centers controls blood pressure (Fig. 5—28). Norepinephrine from sympathetic neurons leaving the spinal cord to innervate peripheral tissues control heart rate (Fig. 5—29) and bladder emptying (Fig. 5—30). 

FIGURE 5-26. The noradrenergic projection from the locus coeruleus to limbic cortex may mediate emotions, as well as energy, fatigue, and psychomotor agitation or psychomotor retardation. 

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